Behaviour Research and Therapy 45 (2007) 2417–2431 Psychological trauma and PTSD symptoms as predictors of substance dependence treatment outcomes Julian D. Ford à , Josephine Hawke, Sheila Alessi, David Ledgerwood, Nancy Petry University of Connecticut School of Medicine Psychiatry, MC1410 263 Farmington Avenue, Farmington, CT 06030, USA Received 6 December 2006; received in revised form 27 March 2007; accepted 10 April 2007 Abstract Psychological trauma and post-traumatic stress disorder (PTSD) may complicate and reduce the effectiveness of treatment for substance use disorders (SUDs). This study assessed trauma history and symptoms of simple and complex PTSD at baseline in a randomized trial of contingency management (CM) compared to standard treatment (ST) with 142 cocaine- or heroin-dependent outpatients. History of exposure to each of eight types of psychological trauma was unrelated to treatment outcome, except for witnessed assaults and emotional abuse. Complex PTSD symptoms were inversely associated with short-term treatment outcomes, and PTSD symptoms were positively related to long-term outcome, independent of the effects of demographics, psychological distress, baseline substance use status, and treatment modality. Complex PTSD symptoms warrant further study as a potential negative prognostic factor in SUD interventions. r 2007 Elsevier Ltd. All rights reserved. Keywords: Post-traumatic stress disorder; Contingency management; Cocaine abuse; Heroin abuse; Treatment outcome Introduction Post-traumatic stress disorder (PTSD) is prevalent among persons with substance use disorders (SUDs) (Dansky, Saladin, Brady, Kilpatrick, & Resnick, 1995; Fullilove et al., 1993; Najavits et al., 1998) and SUDs are prevalent among adults with PTSD (Chilcoat & Menard, 2003; Jacobsen, Southwick, & Kosten, 2001). As many as 90% of adult SUD patients report a history of psychological trauma, and as many as 33–50% of those meet criteria for post-traumatic stress disorder (PTSD) (Chilcoat & Menard, 2003; Hien, Cohen, & Campbell, 2005; Miller, Downs, & Testa, 1993). Adults with SUDs (particularly due to opiates or cocaine) are 11 times more likely to have PTSD than SUD-free adults; and, adults with PTSD are four to five times more likely to have a SUD than adults with no PTSD (Chilcoat & Menard, 2003). Higher levels of substance use are also correlated with worse intrusive and avoidance PTSD symptoms (Read, Brown, & Kahler, 2004) and dissociation (Seedat, Stein, & Carey, 2005). PTSD also may negatively influence the course and outcome of treatment for SUDs. Co-occurring PTSD and SUDs are associated with poorer SUD treatment recruitment and retention (Brown, Read, & Kahler, 2003) and outcomes (Ouimette, Moos, & Finney, 2003; Palacios, Urmann, Newel, & Hamilton, 1999). ARTICLE IN PRESS www.elsevier.com/locate/brat 0005-7967/$ - see front matter r 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.brat.2007.04.001 à Corresponding author. E-mail address: ford@psychiatry.uchc.edu (J.D. Ford).