Background: Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) have high comorbidity. Although prior research indicated that PTSD can effectively be treated with Prolonged Exposure (PE) in these patients, reported effects are small and treatment dropout rates high. Eye Movement Desensitization and Reprocessing (EMDR) and Imagery Rescripting (ImRs) are other promising treatment options for PTSD, that have not yet been examined in this patient group. Furthermore, it is unclear whether PTSD treatment is most effective when offered simultaneous to or after SUD treatment. Methods: In this article, the Treatment Of PTSD and Addiction (TOPA) study is described: a Dutch randomized controlled trial (RCT) that studies the effectiveness of PTSD treatment as an add-on to regular SUD treatment in patients with SUD and co-occurring PTSD. Effects of PE, EMDR, ImRs, and a 3-month SUD treatment only condition will be compared, as well as simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment. The primary outcome measure is PTSD symptoms. Secondary outcomes are: treatment completion, psychological distress, substance use, interpersonal problems, emotion dysregulation, and trauma-related emotions guilt, shame, and anger. Discussion: This study is the first to compare effects of PE, EMDR, and ImRs in one study and to compare simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment as well. This RCT will provide more knowledge about the effectiveness of different treatment strategies for PTSD in patients with co-occurring SUD and will ultimately improve treatment outcomes for patients with this common co-morbidity worldwide. Trial registration: Netherlands Trial Register (NTR), Identifier: NL7885. Registered 22 July 2019.

Background: Childhood maltreatment (CM) can be divided into: emotional abuse (EA), physical abuse (PA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN). CM is associated with (Complex)Posttraumatic stress disorder (PTSD/CPTSD) and substance use disorder (SUD).

(1) Background: Ethnic minorities exhibit a higher prevalence of post-traumatic stress disorder (PTSD), while results for problematic substance use among ethnic groups remain mixed. PTSD and problematic substance use often co-occur; however, the impact of ethnicity on this association has not yet been investigated. (2) Methods: Self-report data on problematic alcohol/cannabis use (AUDIT/CUDIT) and presence of severe PTSD symptoms (PSS-SR) of N = 22,841 participants of Dutch (n = 4610), South-Asian Surinamese (n = 3306), African Surinamese (n = 4349), Ghanaian (n = 2389), Turkish (n = 3947), and Moroccan (n = 4240) origin were available from the HELIUS study. (3) Results: We found a positive association between the presence of severe PTSD symptoms and problematic alcohol and cannabis use. Ethnicity did not moderate the association between the presence of severe PTSD symptoms and problematic alcohol/cannabis use. (4) Conclusions: We demonstrated the relationship between the presence of severe PTSD symptoms and problematic alcohol/cannabis use in a multi-ethnic sample. The relationship between the presence of severe PTSD symptoms and problematic alcohol/cannabis use was similar between ethnic groups. We recommend screening for PTSD symptoms in those exhibiting problematic substance use and vice versa, regardless of ethnic background.

Patients with co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) often experience additional psychosocial difficulties, including emotion dysregulation, interpersonal problems, and trauma-related guilt and shame. Evidence on optimal timing and type of trauma-focused treatment remains limited, particularly for psychosocial outcomes beyond PTSD and SUD-severity. This study examined secondary outcomes from a randomized controlled trial (RCT) comparing Prolonged Exposure (PE), Eye Movement Desensitization and Reprocessing (EMDR), and Imagery Rescripting (ImRs), delivered simultaneously with or sequentially to SUD-treatment. Aims were to evaluate (1) added effects of trauma-focused treatment at 3-month follow-up, and over 9 months (2) simultaneous versus sequential delivery, and (3) differences between PE, EMDR, and ImRs. 209 patients were randomly allocated to PE, EMDR, or ImRs; 75% received simultaneous and 25% sequential treatment. Assessments were conducted at baseline, 3-, 6-, and 9-month follow-up. Outcomes included psychological distress, emotion dysregulation, interpersonal problems, trauma-related guilt and shame, and anger control. Multiple linear regression and linear mixed models were used; missing data were handled using multiple imputation. Adding EMDR or ImRs to SUD-treatment resulted in improvements in several psychosocial outcomes at 3-month follow-up, whereas PE did not. Simultaneous treatment yielded greater improvements than sequential treatment, largely due to differences before PTSD-treatment initiation in the sequential condition. No significant differences emerged between treatment types. Trauma-focused treatments, particularly EMDR and ImRs, are effective add-ons to SUD-treatment for improving psychosocial outcomes. Simultaneous delivery may be preferable due to faster benefits. This study supports shared-decision making regarding timing and type of PTSD-treatment.