Cannabis use and trauma-focused treatment for co-occurring posttraumatic stress disorder and substance use disorders: A meta-analysis of individual patient data.
Hill et al.·Journal of anxiety disordersImpact 3.3
Clear benefitGRADEHigh10 citations
Samplek = 4 Studien n = 410 Pat.
Durationunclear
ControlNon-trauma-focused treatment
EndpointPTSD symptom severity
Blindingunklar
DesignMeta-Analyse
”Key finding
Trauma-focused treatments showed greater PTSD symptom reductions than non-trauma-focused treatments, independent of cannabis use at baseline.
Summary
IPD meta-analysis across k=4 RCTs from Project Harmony (subset n=410, 33.2% cannabis users) on trauma-focused (TF) vs. non-TF therapies in comorbid PTSD+SUD. TF treatment showed greater PTSD symptom reduction than non-TF — independent of cannabis use — but lower attendance rates. Alcohol and drug outcomes similar across all conditions.
P
PopulationAdults with comorbid PTSD and substance use disorder (SUD), of whom 33,2 % with cannabis use at baseline, n=410, 70 % male
I
InterventionTrauma-focused (TF) treatment
C
ControlNon-trauma-focused (non-TF) treatment
O
OutcomeTF treatment showed significantly greater PTSD symptom reductions than non-TF (independent of cannabis use); however lower participation rates under TF; comparable reductions in alcohol and drug use across all groups
Confidence in the evidence
Very lowLowModerateHigh
High
The highest of four GRADE levels, the effect estimate is very reliable.
Quality profile
Sample size★★★★★
Blinding—
Effect sizeClear benefit
Citations / year★★★★★
Authors
Hill ML, Kline AC, Saraiya TC, Gette J, Ruglass LM, Norman SB, Back SE, Saavedra LM, Hien DA, Morgan-Lopez AA
High rates of cannabis use among people with posttraumatic stress disorder (PTSD) have raised questions about the efficacy of evidence-based PTSD treatments for individuals reporting cannabis use, particularly those with co-occurring alcohol or other substance use disorders (SUDs). Using a subset of four randomized clinical trials (RCTs) included in Project Harmony, an individual patient meta-analysis of 36 RCTs (total N = 4046) of treatments for co-occurring PTSD+SUD, we examined differences in trauma-focused (TF) and non-trauma-focused (non-TF) treatment outcomes for individuals who did and did not endorse baseline cannabis use (N = 410; 70% male; 33.2% endorsed cannabis use). Propensity score-weighted mixed effects modeling evaluated main and interactive effects of treatment assignment (TF versus non-TF) and baseline cannabis use (yes/no) on attendance rates and within-treatment changes in PTSD, alcohol, and non-cannabis drug use severity. Results revealed significant improvements across outcomes among participants in all conditions, with larger PTSD symptom reductions but lower attendance among individuals receiving TF versus non-TF treatment in both cannabis groups. Participants achieved similar reductions in alcohol and drug use across all conditions. TF outperformed non-TF treatments regardless of recent cannabis use, underscoring the importance of reducing barriers to accessing TF treatments for individuals reporting cannabis use.