Observational studyAddiction (Abingdon, England)2025
How changes in post-traumatic stress disorder (PTSD) severity mediate substance use disorder (SUD) severity during and after treatment for co-occurring PTSD and SUD: Results from Project Harmony.
Observational study in Addiction (Abingdon, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
5 citing papers in PubMed.
- Temporal sequencing of symptom change in youth receiving treatment for posttraumatic stress disorder and substance use: secondary findings from a randomised controlled trial.European journal of psychotraumatology · 2026Trial
- Indirect effects of Seeking Safety plus sertraline on alcohol use: The mediating role of reductions in posttraumatic stress disorder symptom severity.Journal of traumatic stress · 2026Trial
- Project Harmony 2.0: protocol for an updated and expanded individual patient data meta-analysis and virtual clinical trial of treatments for comorbid PTSD and substance use disorders.European journal of psychotraumatology · 2026Article
- Silent regulators of trauma: the microRNA blueprint underlying post-traumatic stress disorder biology.Environmental epigenetics · 2026Review
- How changes in post-traumatic stress disorder (PTSD) severity mediate substance use disorder (SUD) severity during and after treatment for co-occurring PTSD and SUD: Results from Project Harmony.Addiction (Abingdon, England) · 2025Observational
Corrections and comments
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Authors and funding
16 authors.
Funding
Abstract
BACKGROUND AND
aimsPost-traumatic stress disorder (PTSD) commonly co-occurs with substance use disorders (SUD). Comorbid PTSD and SUD (PTSD+SUD) is associated with greater severity and impairment and poorer treatment outcomes. Several interventions exist to treat PTSD, SUD and PTSD+SUD; however, research has yet to elucidate the indirect pathways underlying treatment for PTSD+SUD. The present study examined how changes in PTSD severity relate to changes in SUD severity across treatment types during and post-treatment.
methodsObservational study using data collected as part of Project Harmony, a virtual clinical trial employing integrative data analysis to compare treatment effectiveness of PTSD+SUD interventions from 36 randomized controlled trials for PTSD+SUD (n = 4046). Multilevel mediated linear growth modeling was used to examine potential outcomes mediation. Each of the eight active treatments was compared to treatment as usual (TAU) for both alcohol and drug use outcomes.
resultsAlcohol use severity outcomes were fully or partially mediated by changes in PTSD severity for trauma-focused psychotherapy + AUD medication [ab = -0.16 (95% confidence interval = -0.30 to -0.04)]; other treatments with mediation effects included trauma-focused integrated psychotherapy, AUD medications and PTSD medications. Drug use severity outcomes were fully or partially mediated by changes in PTSD severity for trauma-focused psychotherapy + AUD medication [ab = -0.08 (-0.18 to -0.001)]; other treatments with mediation effects on drug use severity included trauma-focused integrated psychotherapy, AUD medications, PTSD medications and placebo medications.
conclusionsAmong people with co-occurring post-traumatic stress disorder (PTSD) and substance use disorders (SUD), reductions in alcohol and drug use severity appear to be mediated by reductions in PTSD during treatment. For those with drug use disorders, PTSD reductions appear to mediate further SUD reductions after treatment.
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