MUSC-led study could change treatment for teens with trauma and substance abuse issues

February 13, 2020
Researchers say a new approach appears to improve outcomes. iStock

Research out of the Medical University of South Carolina could change the way clinicians around the world treat teenagers suffering from a combination of post-traumatic stress disorder symptoms and substance use problems. That’s the hope of Carla Kmett Danielson, Ph.D., a professor in the National Crime Victims Research and Treatment Center in the Department of Psychiatry and Behavioral Sciences at MUSC, who led the clinical trial.

“I know that sounds incredibly ambitious,” she said. “But there’s been a tremendous disconnect in treating PTSD and substance use disorders together.”

Her team’s results, showing treating those conditions together is safe and leads to a significant reduction in substance use compared to trauma treatment alone, appear online in JAMA Psychiatry.

The research was funded by the National Institute on Drug Abuse. The team includes members from MUSC, the Indiana University School of Medicine, the Oregon Social Learning Center and the Dee Norton Child Advocacy Center in Charleston, South Carolina.

Dr. Carla Danielson 
Dr. Danielson

Traditionally, patients go to an addiction specialist for the substance use problem and a separate mental health specialist for PTSD. Danielson said clinicians know the issues are related, but haven’t had data to show it’s safe to treat the problems together.

“The fear has been that people are using substances to cope with their trauma symptoms, and if you trigger an urge to use by talking about the trauma, you’re going to make the substance abuse problem worse. It was coming from a good place, but there was no empirical support behind that notion. So that was behind our line of research.”

Improving treatments for teenagers with PTSD and substance abuse problems is important, Danielson said. “We have a youth population of about 74 million in the U.S. Epidemiological, clinical, and community studies suggest that over 9 million of them will have PTSD symptoms and/or co-occurring substance use problems by 18 years.

“Many kids are resilient, but if you have a kid who’s starting to use substances under the age of 21, that’s a huge risk factor for later problems. There are so many reasons to take this really seriously when we see it in adolescents.”

PTSD symptoms in teenagers can come from a lot of things, such as sexual abuse, physical abuse and witnessing violence. Being exposed to those things raises their risk for abusing drugs and/or alcohol.

The MUSC study enrolled 124 people from 13 to 18 years old through child advocacy centers. All had recently abused a substance such as drugs or alcohol, had suffered at least one interpersonal traumatic event and had at least five symptoms of PTSD.

They were put into two groups. One got what the researchers called “treatment as usual,” which typically meant cognitive behavioral therapy focused on trauma. Those kids and their parents or caregivers had weekly sessions, separately and together, with therapists.

The teenagers in that first group were gradually exposed to things that reminded them of their trauma to help desensitize them. It’s one of the most common and effective treatments for PTSD. The therapists did not directly target substance abuse issues but had the option of referring the teenagers to other agencies if they needed that type of help.

The second group in the clinical trial got risk reduction through family therapy, or RRFT. RRFT also uses weekly cognitive behavioral therapy, but in addition to PTSD, it targets substance abuse and sexual health issues.

The teenagers in the second group were coached in how to regulate their behavior and were carefully encouraged to write or talk about traumatic events in their lives to make the memories less stressful over time. They also had random urine tests to screen for drugs and alcohol.

Danielson said the teenagers in both groups reduced their PTSD symptoms and substance use, but the kids in the second group who got the RRFT had bigger improvements and showed no negative effects from the inclusion of substance abuse treatment.

“My hope is that it sets a standard of care where we have none right now. The one we have now is to treat these things separately, and there’s no research, no clinical base for that,” Danielson said.

“That empirical basis is so critically important. This is what makes MUSC a premier place to be, because we’re an academic medical center. We have led in many ways across all areas of research. That research directly affects how we treat patients here, and we hope it informs practice elsewhere.”

This was the third and largest clinical trial testing the integrated treatment.

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