Combined Treatment of PTSD and Emotional Dysregulation among Inpatients with Substance Use Disorder: A Feasibility Study

Abstract There are high rates of co-occurring post-traumatic stress disorder (PTSD) among patients undergoing treatment for substance use disorder (SUD). Simultaneous treatment is often lacking, despite its importance for reducing psychological burden, emotion dysregulation, dropout rates, and relapse risks. This study aimed to evaluate the feasibility of integrating Narrative Exposure Therapy (NET) and Dialectical Behavior Therapy for SUD skills training (DBT-SUD Skills) into standard inpatient SUD treatment. The feasibility was assessed by measuring if the treatment combination was relevant for the patient population, accepted by the participants and staff, and safe to implement. We also assessed the potential benefits of the intervention on PTSD symptom severity and difficulties in emotion regulation. In total, 77 consecutive patients from a long-term SUD facility in Norway were recruited, with 71 participating in NET, DBT, or both. Prevalence of traumatic experiences was high (96%), with 72% meeting PTSD criteria. Participation in the intervention (NET, 97%; DBT-SUD, 94%) and completion rates were high. Dropout rates (23.2%) are low compared to historical data (42%), and rates of self-harm and suicide attempts did not increase during treatment. There was a statistically and clinically significant improvement in both PTSD symptom severity and difficulties in emotion regulation. All progress criteria for the feasibility for further multicenter RCT study were reached. Thus, integrating NET and DBT-SUD skills seems to be relevant, accepted, and safe, and has a promising potential for improving care in this population. REC number: #203 428/2020, Clinicaltrials.gov: #203,428.