Cannabis use and trauma-focused treatment for co-occurring posttraumatic stress disorder and substance use disorders: A meta-analysis of individual patient data

• Published in: Journal of anxiety disorders 2024-03, Vol.102, p.102827-102827, Article 102827
• Main Authors: Hill, Melanie L., Kline, Alexander C., Saraiya, Tanya C., Gette, Jordan, Ruglass, Lesia M., Norman, Sonya B., Back, Sudie E., Saavedra, Lissette M., Hien, Denise A., Morgan-López, Antonio A.
• Format: Article
• Language: English
• Subjects: Attendance; Cannabis; Ethanol; Female; Humans; Male; Marijuana; Posttraumatic stress disorder; Stress Disorders, Post-Traumatic - complications; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - therapy; Substance use; Substance-Related Disorders - therapy; Treatment Outcome
• ISSN: 0887-6185; 1873-7897; 1873-7897
• DOI: 10.1016/j.janxdis.2024.102827

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. •Treatment outcomes for PTSD+SUD are similar for those with and without cannabis use.•Trauma-focused outperforms non-trauma-focused treatment for PTSD severity reduction.•PTSD, alcohol and drug use decrease during trauma- and non-trauma-focused treatment.•Trauma-focused treatment is efficacious for individuals with recent cannabis use.•Reducing access barriers to evidence-based treatments is a priority.