Treatment of PTSD & Addiction (TOPA)


Problematic substance use and Post-Traumatic Stress Disorder (PTSD) are common in clinical practice. Within addiction care, 20%-30% of patients meet criteria for a PTSD diagnosis. According to the current standard, substance use disorder is first addressed in this patient group, followed by treatment for PTSD.  However, there is evidence of a functional relationship between PTSD and substance use disorder (SUD). For example, relapse in substance use often appears to be related to PTSD symptoms.

There are various treatments for PTSD. Prolonged exposure, EMDR and Imaginary rescripting are among the most effective treatments and are widely used in the Netherlands. All three treatments have been proven effective in patients with PTSD. However, it is not yet clear whether these treatments are as effective in patients with a comorbid SUD or behavioral addiction. Moreover, it is not known whether there are differences in the effectiveness of these treatments and when it is the best time to start treatment for PTSD.

Research aims

The first aim of the TOPA (Treatment Of PTSD and Addiction) study is to find out whether three different treatments reduce PTSD symptoms in patients with PTSD and a substance use disorder (SUD). The treatments under investigation are: Prolonged Exposure (PE), Eye Movement Desensitization and Reprocessing (EMDR) and Imagery Rescripting (ImRs). A second research aim is to investigate whether simultaneous SUD and PTSD treatment or consecutive treatment of SUD, followed by PTSD treatment results in better clinical outcomes. One third of the subjects will receive PE, a third will receive EMDR and a third will receive ImRs.

75% of the subjects receive the PTSD treatment simultaneously with SUD treatment and 25% receives the PTSD treatment after 3 months of SUD treatment. All therapists participating in this research project have been trained in all these specific forms of PTSD treatment by certified trainers.

This study is closed for participation of new clients, since the intended number of clients has been reached.

For an open-access published protocol of the study, see:

Study-protocol (Lortye & Will, 2021)