Merging paths to healing - efficacy of integrated vs. non-integrated treatment programs for comorbid substance use disorder and posttraumatic stress disorder: A systematic review
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Date
2024
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Publisher
London's Global University
Abstract
Introduction: The heightened prevalence of comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) constitutes an increasing cause for concern as both disorders become more severe and challenging to treat. Integrated treatment (IT) programs address the substantial interaction between symptoms of PTSD and SUD and thus aim to address both disorders simultaneously. Despite rapid development in IT programs in the last decade, there is a scarcity of studies that comprehensively investigate treatment outcomes and patient acceptability. Therefore, the current study aims to examine the evidence for integrated compared to non-integrated programs in the treatment of comorbid PTSD and SUD. Methods: Studies that used randomised controlled trials to examine the efficacy of ITs compared to non- ITs for adults with SUD and PTSD between 2012 and 2023 were searched through Medline, PsycINFO, Embase, CINAHL Plus, Cochrane Central Register of Controlled Trials, Electronic Theses Online Service, OpenGrey, and ProQuest. PROSPERO CRD42023442012. Results: The search identified 871 studies, and after de-duplication, 676 studies were screened for title/ abstract. Of those, 55 studies were assessed for eligibility based on full texts, of which 9 met eligibility criteria. A narrative synthesis revealed that ITs effectively alleviated symptoms of both PTSD and SUD, demonstrating sustained improvement from the initial treatment phase to the longest follow-up. Nevertheless, the studies presented varied outcomes concerning the comparative advantage of IT over non-IT. While some indicated superior effectiveness of IT on either SUD or PTSD symptoms, others found comparable improvement effects. Both treatment approaches exhibited similar levels of acceptability, as evidenced by equivalent retention, engagement, and completion rates. Conclusions. This review showed that IT programs effectively improved symptoms of both PTSD and SUD. However, there was limited evidence supporting the superiority of IT programs over non-IT comparators in reducing PTSD and SUD symptoms, and patient acceptability. Nonetheless, given these similar treatment outcomes, the consideration of treatment choice may shift toward a patient-centred approach, where individuals are educated about treatment choices and can thus make informed decisions about their treatment.
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Keywords
Substance Abuse, Post-traumatic stress disorder, Integrated treatment, Systematic review, Comorbidity, Randomised control trial