Cognitive Therapy for PTSD in Addiction Treatment

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DESCRIPTION (provided by applicant): This is a revised K23 Mentored Patient-Oriented Research Career Development proposal for training and research in the field of drug abuse. The training plan capitalizes on previous experience, the present position at Dartmouth, and on the expertise and commitment of a solid mentoring team. This plan details the acquisition of knowledge and skill to modify a cognitive behavioral therapy (CBT) for posttraumatic stress disorder (PTSD) in routine addiction treatment settings. Based upon the NIDA stage model for behavioral treatment development, the specific goal is to gain expertise in the methodological requirements to conduct Stage I behavioral therapy research, with the end product a NIH proposal for a Stage II efficacy study of CBT for PTSD. The candidate's career goal is to become fully capable of high quality and independent research, with a particular focus on translating and transferring efficacious behavioral treatments for co-occurring disorders into the community. The research plan proposes to test CBT for PTSD among persons in addiction treatment. Background and preliminary studies find PTSD to be a common type of co-occurring disorder, with correlated negative outcomes, and with promising behavioral treatments that are available for testing and potential implementation. PTSD is of documented major concern to addiction treatment providers, who have a readiness for adopting useful practices. Characteristics of these treatments have been examined on patient outcome and addiction program fit criteria, and one is proposed for testing here. CBT for PTSD will be examined using the stage model of behavioral therapy research development: 1) Stage Ia Phase I (therapy development and feasibility testing); 2) Stage Ia Phase II (specification of therapy procedure and training manual); and, 3) Stage Ib Phase III (Pilot Trial: comparing CBT for PTSD plus treatment-as-usual to an attention control plus treatment-as-usual). The primary outcome criteria are: treatment retention, substance use and PTSD symptoms. If warranted by Stage I findings, a final aim is a Stage II Efficacy proposal, using a more rigorous and controlled experimental design, testing a more highly specified therapeutic procedure, and studying a more homogenous sample of persons with co-occurring substance use and posttraumatic stress disorders.