Exposure therapy in the treatment of PTSD among cocaine-dependent individuals: preliminary findings

Individuals (n = 39) participated in an outpatient, 16-session individual, manual-guided psychotherapy designed to treat concurrent PTSD and cocaine d ependence. Therapy consisted of a combination of imaginal and in-vivo expos ure therapy techniques to treat PTSD symptoms and cognitive-behavioral tech niques to treat cocaine dependence. Although the dropout rate was high, tre atment completers; (i.e., patients who attended at least 10 sessions; n = 1 5) demonstrated significant reductions in all PTSD symptom clusters and coc aine use from baseline to end of treatment. Significant reductions in depre ssive symptomatology, as measured by the Beck Depression Inventory, and psy chiatric and cocaine use severity, as measured by the Addiction Severity In dex, were also observed. These improvements in PTSD symptoms and cocaine us e were maintained over a 6-month follow-up period among completers. The ave rage pre- to posttreatment effect size was 1.80 for PTSD symptoms and 1.26 for drug and alcohol use severity. Baseline comparisons between treatment c ompleters and noncompleters revealed significantly higher avoidance symptom s, as measured by the Impact of Events Scale, and fewer years of education among treatment noncompleters as compared to completers. This study provide s preliminary evidence to suggest that exposure therapy can be used safely and may be effective in the treatment of PTSD in some individuals with coca ine dependence. However, the study is limited by the uncontrolled nature of the study design, small number of subjects, and high dropout rate. (C) 200 1 Elsevier Science Inc. All rights reserved.