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Article ; Online: Examining the role of social support in treatment for co-occurring substance use disorder and posttraumatic stress disorder.

Jarnecke, Amber M / Saraiya, Tanya C / Brown, Delisa G / Richardson, James / Killeen, Therese / Back, Sudie E

2022 Volume 15, Page(s) 100427

Abstract: Objective: Social support may be a critical mechanism in the treatment of co-occurring substance use disorder (SUD) and posttraumatic stress disorder (PTSD). However, no studies have examined how social support changes as a function of treatment or ... ...

Abstract	Objective: Social support may be a critical mechanism in the treatment of co-occurring substance use disorder (SUD) and posttraumatic stress disorder (PTSD). However, no studies have examined how social support changes as a function of treatment or predicts treatment outcome in a Veteran population with co-occurring SUD and PTSD. Method: The current study is a secondary analysis that examined social support over the course of treatment for co-occurring SUD and PTSD (N = 81). Analyses were conducted to examine if a) social support predicts change in substance use and PTSD symptoms, respectively, over the course of treatment and during follow-up, and b) substance use and PTSD symptoms, respectively, predicts change in social support over treatment and during follow-up. Results: The findings revealed that between-person social support moderated decreases in substance use ( Conclusions: The findings highlight the critical role of social support during treatment in enhancing outcomes for individuals with co-occurring SUD and PTSD.
Language	English
Publishing date	2022-04-11
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2831558-3
ISSN	2352-8532 ; 2352-8532
ISSN (online)	2352-8532
ISSN	2352-8532
DOI	10.1016/j.abrep.2022.100427
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Article ; Online: The role of posttraumatic guilt and anger in integrated treatment for PTSD and co-occurring substance use disorders among primarily male veterans.

Saraiya, Tanya C / Badour, Christal L / Jones, Alyssa C / Jarnecke, Amber M / Brown, Delisa G / Flanagan, Julianne C / Killeen, Therese K / Back, Sudie E

Psychological trauma : theory, research, practice and policy

2022 Volume 15, Issue 8, Page(s) 1293–1298

Abstract: Objective: PTSD and substance use disorders (SUD) frequently co-occur among veterans. Integrated exposure-based treatments, such as Concurrent Treatment of PTSD and SUD Using Prolonged Exposure (COPE), are efficacious in reducing PTSD and SUD symptoms ... ...

Abstract	Objective: PTSD and substance use disorders (SUD) frequently co-occur among veterans. Integrated exposure-based treatments, such as Concurrent Treatment of PTSD and SUD Using Prolonged Exposure (COPE), are efficacious in reducing PTSD and SUD symptoms and posttraumatic emotions. This study examines whether guilt and anger (a) decreased in a randomized clinical trial comparing COPE with Relapse Prevention (RP) therapy for SUD and (b) mediated PTSD and SUD symptom reductions or vice versa. Method: Veterans (90.1% men) diagnosed with PTSD and SUD were randomized to 12 sessions of COPE ( Results: Guilt ( Conclusions: Among veterans, integrated, trauma-focused treatments may be associated with greater guilt (directly) and anger (indirectly) reductions due to processing trauma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
MeSH term(s)	Humans ; Male ; Female ; Veterans/psychology ; Stress Disorders, Post-Traumatic/psychology ; Implosive Therapy ; Comorbidity ; Anger ; Guilt ; Substance-Related Disorders/complications
Language	English
Publishing date	2022-01-13
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	2497028-1
ISSN	1942-969X ; 1942-9681
ISSN (online)	1942-969X
ISSN	1942-9681
DOI	10.1037/tra0001204
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Article ; Online: Patient- and therapist-rated alliance predict improvements in posttraumatic stress disorder symptoms and substance use in integrated treatment.

Saraiya, Tanya C / Jarnecke, Amber M / Bauer, Alexandria G / Brown, Delisa G / Killeen, Therese / Back, Sudie E

Clinical psychology & psychotherapy

2022 Volume 30, Issue 2, Page(s) 410–421

Abstract: Objective: Concurrent Treatment of Posttraumatic Stress Disorder (PTSD) and Substance Use Disorders Using Prolonged Exposure (i.e., COPE) is an efficacious, integrated, psychotherapy that attends to PTSD and substance use disorders simultaneously. No ... ...

Abstract	Objective: Concurrent Treatment of Posttraumatic Stress Disorder (PTSD) and Substance Use Disorders Using Prolonged Exposure (i.e., COPE) is an efficacious, integrated, psychotherapy that attends to PTSD and substance use disorders simultaneously. No study has examined how therapeutic alliance functions during the provision of COPE and how this compares to non-integrated treatments, such as relapse prevention (RP) for substance use disorders. Understanding the role of alliance in COPE versus RP could inform treatment refinement and ways to enhance treatment outcomes. Methods: Participants (N = 55 veterans) were randomized to 12, individual, weekly sessions of COPE or RP in a randomized clinical trial. Piecewise linear mixed effect models examined how mid-treatment (1) patient-rated alliance, (2) therapist-rated alliance, and (3) the convergence between patient- and therapist-rated alliance as measured by a difference score predicted reductions in PTSD symptoms and substance use across treatment and follow-up periods. Results: Both patient- and therapist-rated alliance predicted reductions in PTSD symptoms in COPE. Higher patient-rated alliance predicted lower percent days using substances in RP. Difference score models showed higher patient-rated alliance relative to therapist-rated alliance scores predicted symptom reductions in COPE whereas higher therapist-rated alliance scores relative to patient-rated alliance scores predicted symptom reductions in RP. Discussion: Preliminary findings show a unique relationship between the rater of the alliance and treatment modalities. Patient-rated alliance may be important in trauma-focused, integrated treatments whereas therapist-rated alliance may be more important in skills-focused, substance use interventions.
MeSH term(s)	Humans ; Stress Disorders, Post-Traumatic/therapy ; Substance-Related Disorders/therapy ; Treatment Outcome ; Therapeutic Alliance ; Implosive Therapy
Language	English
Publishing date	2022-12-16
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	1169313-7
ISSN	1099-0879 ; 1063-3995
ISSN (online)	1099-0879
ISSN	1063-3995
DOI	10.1002/cpp.2810
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Article ; Online: The Drug Abuse Research Training (DART) Program for Psychiatry Residents and Summer Fellows: 15-Year Outcomes.

Jones, Jennifer L / Barth, Kelly S / Brown, Delisa G / Halliday, Colleen A / Brady, Kathleen T / Book, Sarah W / Bristol, Emily J / Back, Sudie E

Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry

2022 Volume 46, Issue 3, Page(s) 317–324

Abstract: Objective: To increase the number of physician-scientists in research, the Drug Abuse Research Training (DART) program at the Medical University of South Carolina offers a 2-year research track for psychiatry residents and a 10-week summer fellowship ... ...

Abstract	Objective: To increase the number of physician-scientists in research, the Drug Abuse Research Training (DART) program at the Medical University of South Carolina offers a 2-year research track for psychiatry residents and a 10-week summer fellowship for students. The goal of this study was to examine program outcomes and alumni diversity levels over DART's 15-year history. Methods: To date, 215 trainees (44 residents, 171 summer fellows) have completed the program. An anonymous online survey was sent to the 143 program alumni with valid contact information. Survey data included demographic characteristics, post-program research involvement, and self-reported barriers to continued research engagement. Results: Overall survey completion response was 83.5% (N = 122). The alumni included 59.0% women, and 36.1% of respondents identified as a member of a minority racial/ethnic group. Following program completion, 77.0% of the alumni reported continued research involvement. More than half of the alumni reported scientific publications (57.4%) and conference presentations (63.1%) since completing DART. Among respondents who did not subsequently engage in research, the most common modifiable barriers included difficulty finding a mentor, self-perceived deficits in statistical skills and research methodology, and overall lack of confidence in research ability. Conclusions: Over the past 15 years, the DART program has established a diverse research training program that now spans the educational spectrum from undergraduate to residency training. Future program goals include additional training to address self-reported modifiable research barriers. This program provides a model for other training programs designed to cultivate research interests and promote the diversity of clinical researchers.
MeSH term(s)	Fellowships and Scholarships ; Female ; Humans ; Internship and Residency ; Male ; Psychiatry/education ; Substance-Related Disorders/therapy ; Surveys and Questionnaires
Language	English
Publishing date	2022-02-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	1045331-3
ISSN	1545-7230 ; 1042-9670
ISSN (online)	1545-7230
ISSN	1042-9670
DOI	10.1007/s40596-022-01593-5
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Article ; Online: Ethnoracial differences in treatment-seeking veterans with substance use disorders and co-occurring PTSD: Presenting characteristics and response to integrated exposure-based treatment.

Brown, Delisa G / Flanagan, Julianne C / Jarnecke, Amber / Killeen, Therese K / Back, Sudie E

Journal of ethnicity in substance abuse

2020 Volume 21, Issue 3, Page(s) 1141–1164

Abstract: Objective: Substance use disorders (SUD) and posttraumatic stress disorder (PTSD) frequently co-occur. While previous research has examined ethnoracial differences among individuals with either SUD or PTSD, little research to date has focused on ... ...

Abstract	Objective: Substance use disorders (SUD) and posttraumatic stress disorder (PTSD) frequently co-occur. While previous research has examined ethnoracial differences among individuals with either SUD or PTSD, little research to date has focused on individuals with co-occurring SUD/PTSD. The current study addresses this gap in the literature. Method: Participants were 79 military veterans (91% male; 38% African American [AA] and 62% White) with current SUD/PTSD who were randomized to receive Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE) or Relapse Prevention (RP). Primary outcomes included substance use and self-reported and clinician-rated PTSD symptoms. Results: At baseline, AA participants were significantly older, reported greater substance and alcohol use, and tended to report higher PTSD severity than White participants. AA participants evidenced greater decreases in substance and alcohol use during treatment, but greater increases in substance and alcohol use during follow-up as compared to White participants. All participants decreased alcohol consumption during treatment; however, AA participants in the COPE condition and White participants in the RP condition evidenced the steepest decreases in average number of drinks per drinking day (DDD) during treatment. Additionally, White participants receiving RP reported greater increases in DDD during follow-up compared to AA participants. Conclusion: Overall, integrated treatment for co-occurring SUD/PTSD was effective for both AA and White participants; however, some important differences emerged by ethnoracial group. Findings suggest that greater attention to race and ethnicity is warranted to better understand the needs of diverse patients with SUD/PTSD and to optimize treatment outcomes.
MeSH term(s)	Alcohol Drinking ; Comorbidity ; Female ; Humans ; Male ; Stress Disorders, Post-Traumatic/therapy ; Substance-Related Disorders/epidemiology ; Substance-Related Disorders/therapy ; Treatment Outcome ; Veterans
Language	English
Publishing date	2020-10-28
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	2052900-4
ISSN	1533-2659 ; 1533-2640
ISSN (online)	1533-2659
ISSN	1533-2640
DOI	10.1080/15332640.2020.1836699
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Article ; Online: Clinician perspectives on technology-enhanced in vivo exposures during prolonged exposure therapy for PTSD.

Brown, Delisa G / Jarnecke, Amber M / Saraiya, Tanya C / Santa-Ana, Elizabeth / Acierno, Ron / Reese, Mclain / Adams, Robert / Harley, William / Back, Sudie E

Journal of clinical psychology

2023 Volume 79, Issue 12, Page(s) 2947–2958

Abstract: Objective: To investigate clinicians' perceptions regarding the use of mobile technology tools during prolonged exposure (PE) therapy to allow for monitoring and enhancing in-vivo exposures (IVEs).: Methods: Clinicians with training in PE therapy (N = ...

Abstract	Objective: To investigate clinicians' perceptions regarding the use of mobile technology tools during prolonged exposure (PE) therapy to allow for monitoring and enhancing in-vivo exposures (IVEs). Methods: Clinicians with training in PE therapy (N = 32; average of 9 years of practice) completed surveys asking about their perspectives on the utility of virtually attending IVEs with patients while simultaneously having access to real-time subjective and physiological data (i.e., heart rate, galvanic skin conductance) to guide exposure exercises and assure optimal stimulus engagement. Results: Findings showed clinicians to have a favorable view of applying technology devices and systems to enhance IVEs of PE therapy. Most clinicians (93.8%) believed that real-time monitoring of IVEs-particularly monitoring patients' subjective distress and completion of and duration of time in the IVE-would be useful and significantly enhance PE therapy. Conclusion: The positive perceptions toward integrating technology into IVEs in this study have important implications for the development and implementation of technology-enhanced PE therapy. A mobile technology system that incorporates real-time indicators of engagement (i.e., both subjective and physiological) during IVEs and allows clinicians to review recordings of, or virtually accompany, patients during IVEs has the potential to innovate and transform PE and other exposure-based treatments. Clinicians also believed that technology-enhanced IVEs may help reduce early termination from PE.
MeSH term(s)	Humans ; Implosive Therapy ; Stress Disorders, Post-Traumatic/therapy ; Treatment Outcome ; Surveys and Questionnaires
Language	English
Publishing date	2023-09-13
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	219160-x
ISSN	1097-4679 ; 0021-9762
ISSN (online)	1097-4679
ISSN	0021-9762
DOI	10.1002/jclp.23591
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Article ; Online: Laboratory-induced stress and craving predict opioid use during follow-up among individuals with prescription opioid use disorder.

Saraiya, Tanya C / Jarnecke, Amber M / Jones, Jennifer / Brown, Delisa G / Brady, Kathleen T / Back, Sudie E

Drug and alcohol dependence

2021 Volume 225, Page(s) 108755

Abstract: Background: Opioid use disorder (OUD) remains a public health crisis in the USA. Although stress and craving are common precipitants of substance use, no research to date has investigated the impact of laboratory-induced stress and craving on subsequent ...

Abstract	Background: Opioid use disorder (OUD) remains a public health crisis in the USA. Although stress and craving are common precipitants of substance use, no research to date has investigated the impact of laboratory-induced stress and craving on subsequent opioid use. Method: Participants (N = 31) were individuals with prescription OUD who completed a human laboratory study followed by a one-month follow-up visit. Participants were randomly assigned to either a stress task (i.e., Trier Social Tress Task; TSST) or a no-stress condition, and then all participants completed an opioid cue paradigm. Measures of subjective (e.g., stress, craving), and neuroendocrine (e.g., cortisol, dehydroepiandrosterone) reactivity were assessed before and after each task. Survival and regression models tested the association between reactivity to the laboratory tasks and a) time to first opioid use and b) amount of opioid use during follow-up. Results: On average, participants first used opioids 3.65 (SD = 2.08) days following the study. Craving after the opioid cue paradigm (B = 0.44, Exp(B) = 1.55, 95 % CI [1.06, 2.28], p = .02) and after the TSST/no-stress condition plus opioid cue paradigm (B = 1.06, Exp(B) = 2.88, 95 % CI [1.70, 4.85], p < .001) predicted time to first use. Additionally, there was a significant interaction between randomization to the TSST, stress reactivity, and amount of opioids used. Conclusions: Findings demonstrate that elevated cue-induced craving, either in the context of a stressor or not, is associated with shortened time to opioid use, whereas stress reactivity impacts the amount of opioids consumed. Preliminary findings add to the literature on stress, craving and opioid use and implicate treatment.
MeSH term(s)	Analgesics, Opioid/therapeutic use ; Craving ; Cues ; Follow-Up Studies ; Humans ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/epidemiology ; Prescriptions
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2021-05-21
Publishing country	Ireland
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	519918-9
ISSN	1879-0046 ; 0376-8716
ISSN (online)	1879-0046
ISSN	0376-8716
DOI	10.1016/j.drugalcdep.2021.108755
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Article: Substance use disorders in military veterans: prevalence and treatment challenges.

Teeters, Jenni B / Lancaster, Cynthia L / Brown, Delisa G / Back, Sudie E

Substance abuse and rehabilitation

2017 Volume 8, Page(s) 69–77

Abstract: Substance use disorders (SUDs) are a significant problem among our nation's military veterans. In the following overview, we provide information on the prevalence of SUDs among military veterans, clinical characteristics of SUDs, options for screening ... ...

Abstract	Substance use disorders (SUDs) are a significant problem among our nation's military veterans. In the following overview, we provide information on the prevalence of SUDs among military veterans, clinical characteristics of SUDs, options for screening and evidence-based treatment, as well as relevant treatment challenges. Among psychotherapeutic approaches, behavioral interventions for the management of SUDs typically involve short-term, cognitive-behavioral therapy interventions. These interventions focus on the identification and modification of maladaptive thoughts and behaviors associated with increased craving, use, or relapse to substances. Additionally, client-centered motivational interviewing approaches focus on increasing motivation to engage in treatment and reduce substance use. A variety of pharmacotherapies have received some support in the management of SUDs, primarily to help with the reduction of craving or withdrawal symptoms. Currently approved medications as well as treatment challenges are discussed.
Language	English
Publishing date	2017-08-30
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	2616895-9
ISSN	1179-8467
ISSN	1179-8467
DOI	10.2147/SAR.S116720
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Article ; Online: COPE and oxytocin for the treatment of co-occurring PTSD and alcohol use disorder: Design and methodology of a randomized controlled trial in U.S. military veterans.

Back, Sudie E / Flanagan, Julianne C / Killeen, Therese / Saraiya, Tanya C / Brown, Delisa G / Jarnecke, Amber M / Rothbaum, Alex O / Joseph, Jane / Ana, Elizabeth Santa / de Arellano, Abigail / Shoemaker, Hannah L / Dixon, Reagan Ashley / Nietert, Paul J / Brady, Kathleen T

Contemporary clinical trials

2023 Volume 126, Page(s) 107084

Abstract: Background: A significant proportion of individuals with alcohol use disorder (AUD) also meet criteria for posttraumatic stress disorder (PTSD). Military veterans are at increased risk for developing co-occurring AUD/PTSD, with prevalence rates 2-4 ... ...

Abstract	Background: A significant proportion of individuals with alcohol use disorder (AUD) also meet criteria for posttraumatic stress disorder (PTSD). Military veterans are at increased risk for developing co-occurring AUD/PTSD, with prevalence rates 2-4 times higher than the general population. Research is needed to develop more effective treatments for this common comorbidity. The current investigation addresses this need by examining the synergistic effects of a novel pharmacotherapy combined with psychotherapy for co-occurring AUD/PTSD among veterans. Accumulating evidence suggests that the neuropeptide oxytocin (OT) is a promising pharmacotherapy to augment psychotherapy for AUD/PTSD. OT targets neurobiological and behavioral dysregulation common to both AUD and PTSD, in particular, corticolimbic connectivity. Human and animal studies show OT reduces alcohol self-administration, tolerance, and withdrawal; enhances fear extinction; and promotes prosocial behaviors. The current study builds on previous work by examining OT among veterans with AUD/PTSD receiving Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE), an evidence-based integrated treatment. Methods: This paper describes the rationale, design, and methodology of a Stage II, 12-week, double-blind, randomized clinical trial of intranasal OT (40 IU) versus placebo combined with COPE among veterans (N = 180) with current AUD/PTSD. In addition, the effects of treatment on corticolimbic connectivity will be examined using functional magnetic resonance imaging (fMRI) at pre- and post-treatment. Conclusions: The proposed study will provide new knowledge and mechanistic insights to accelerate research in this understudied area and may lead to improved treatment outcomes for co-occurring AUD/PTSD. Clinicaltrials: gov: NCT04523922.
MeSH term(s)	Humans ; Stress Disorders, Post-Traumatic/complications ; Stress Disorders, Post-Traumatic/drug therapy ; Veterans ; Alcoholism/drug therapy ; Alcoholism/epidemiology ; Oxytocin/therapeutic use ; Extinction, Psychological ; Fear
Chemical Substances	Oxytocin (50-56-6)
Language	English
Publishing date	2023-01-13
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2182176-8
ISSN	1559-2030 ; 1551-7144
ISSN (online)	1559-2030
ISSN	1551-7144
DOI	10.1016/j.cct.2023.107084
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Article ; Online: Enhancing Prolonged Exposure therapy for PTSD using physiological biomarker-driven technology.

Back, Sudie E / Acierno, Ron / Saraiya, Tanya C / Harley, Bill / Wangelin, Bethany / Jarnecke, Amber M / McTeague, Lisa M / Brown, Delisa G / Ana, Elizabeth Santa / Rothbaum, Alex O / Adams, Robert J

Contemporary clinical trials communications

2022 Volume 28, Page(s) 100940

Abstract: Prolonged Exposure (PE) therapy is one of the most efficacious, evidence-based treatments for posttraumatic stress disorder (PTSD). A key component of PE involves in vivo exposures (IVEs) during which patients approach situations or activities in "real ... ...

Abstract	Prolonged Exposure (PE) therapy is one of the most efficacious, evidence-based treatments for posttraumatic stress disorder (PTSD). A key component of PE involves in vivo exposures (IVEs) during which patients approach situations or activities in "real life" that are safe but avoided because they elicit a fear response. Despite their critical role in treatment, little research has focused on IVEs. This gap in knowledge is primarily due to the fact that IVEs are typically conducted by patients in between therapy sessions, leaving clinicians reliant upon patient self-report. This approach has numerous shortcomings, which the current study addresses by leveraging technology to develop an innovative device that allows for physiological, biomarker-driven, therapist-guided IVEs. The new system enables clinicians to virtually accompany patients during IVEs and provides real-time physiological (heart rate, skin conductance) and self-report (subjective units of distress) data that clinicians can use to modify the exposure and optimize therapeutic value. This Small Business Innovation Research (SBIR) Phase I project aims to: (1) integrate physiological sensors and live audio/visual streaming into a system for clinicians to guide patients during IVEs; (2) determine feasibility and acceptability of the system; and (3) conduct a pilot randomized clinical trial among veterans with PTSD (
Language	English
Publishing date	2022-05-27
Publishing country	Netherlands
Document type	Journal Article
ISSN	2451-8654
ISSN (online)	2451-8654
DOI	10.1016/j.conctc.2022.100940
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