# Evaluating the Impact of Supplementing Residential Substance Use Treatment with Written Exposure Therapy for Veterans with Co-Occurring PTSD and Substance Use Disorders

> **NIH VA I21** · SALEM VA MEDICAL CENTER · 2024 · —

## Abstract

Posttraumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) are highly comorbid, and
comorbidity increases risk for poor functional outcomes. SUDs are associated with poor functional outcomes
such as quality of life, community engagement, and suicide (Teeters, Lancaster, Brown & Back, 2017). Risks
for poor quality of life and suicide increase further for those with co-occurring PTSD and SUD diagnoses as
compared to either condition alone, with suicide attempt rates three times higher for Veterans with alcohol use
disorder and PTSD (Norman, Haller, Hamblen, Southwick & Pietrzak, 2018). For patients with PTSD-SUD,
there is evidence of greater PTSD symptom severity and poorer SUD treatment outcomes (e.g., Back et al.,
2000), as well as higher rates of homelessness and disability (Bowe & Rosenheck, 2015). PTSD-SUD
treatments have shown promising reductions in PTSD and SUD symptoms (Flanagan, Korte, Killeen & Back,
2016). Yet, there are still major challenges in widely implementing concurrent or single-target gold-standard
treatments for this population, especially with rural veterans where care access may be limited (e.g., Flanagan
et al., 2016). Written Exposure Therapy (WET) is a front-line, brief and effective treatment for PTSD that
addresses some of the challenges posed by other gold-standard treatments. This project is designed to
examine the feasibility and acceptability of Written Exposure Therapy (WET) delivered to Veterans with
comorbid PTSD-SUD while they are completing a 28 day-residential SUD program (DOM SUD). The
preliminary effects of the treatment during the program, and at one month and 3 month follow-up periods will
also be examined, with particular attention to rates of substance use, homelessness, treatment attendance,
treatment completion, quality of life, suicidality, and PTSD and depression symptoms. Veterans enrolled in the
DOM SUD with PTSD Checklist-5 (PCL-5) scores over 33 will be recruited for further screening into the study.
Those that meet criteria for PTSD through confirmation using the Clinician Administered PTSD Scale for DSM-
5 (CAPS-5) will be randomized into one of two treatment arms: Treatment as Usual (DOM SUD) and Written
Exposure Therapy in a residential SUD program (resWET). Randomization will be stratified by gender and
oversampling for women and minority participants will be used. Those in the TAU control group will participate
in the DOM SUD treatment program, while those in the resWET group will also have five individual treatment
sessions of WET. Participants will complete weekly measures of symptoms, in addition to rating cravings for
substance use. Treatment completion rates will also be compiled for both DOM SUD and resWET. Participants
will complete pre-treatment, post-treatment, 1 month, and 3 month follow-up measures in person, over video,
or by phone, and these measures, along with data available from the treatment record, will be examined using
descriptive analyses to look for importan...

## Key facts

- **NIH application ID:** 10745328
- **Project number:** 5I21RX004083-02
- **Recipient organization:** SALEM VA MEDICAL CENTER
- **Principal Investigator:** Dana Holohan
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-12-01 → 2025-11-01

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10745328

## Citation

> US National Institutes of Health, RePORTER application 10745328, Evaluating the Impact of Supplementing Residential Substance Use Treatment with Written Exposure Therapy for Veterans with Co-Occurring PTSD and Substance Use Disorders (5I21RX004083-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10745328. Licensed CC0.

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