COMPASS - A Study on the Treatment of Veterans with Co-Occurring Posttraumatic Stress Disorder and Substance Use

May 1, 2020

Minneapolis VA Health Care System’s Center for Veterans Research and Education Approved for $5,000,000 in Research Funding for Study on Treatment of Veterans with Co-Occurring Posttraumatic Stress Disorder and Substance Use.

Funds awarded by the Patient-Centered Outcomes Research Institute

A research team at the Minneapolis VA Health Care System (MVAHCS) has been approved for a $5 million funding award by the Patient-Centered Outcomes Research Institute (PCORI) to study the comparative effectiveness of two psychotherapies for veterans with co-occurring posttraumatic stress disorder (PTSD) and substance use disorders. The team is led by Dr. Shannon Kehle-Forbes, a research investigator at MVAHCS and the Women’s Health Sciences Division of VA’s National Center for PTSD, and Dr. Hildi Hagedorn, a MVAHCS research investigator.

Patients with co-occurring PTSD and substance use disorders prefer that their PTSD be treated alongside the substance use disorder, but little is known about how to best treat PTSD among those with impairing alcohol or drug use. This newly approved study will test two psychotherapy approaches for treating PTSD that have been shown to be effective for those without co-occurring substance use but have not been widely studied among those with both conditions: trauma-focused therapy and non-trauma-focused therapy.

Trauma-focused therapy addresses thoughts or memories related to one’s trauma, while non-trauma-focused therapy involves learning about how PTSD relates to one’s current difficulties and problem solving of current life problems. The project will test which approach is better for reducing symptoms of PTSD and which is more likely to be completed by 420 patients at 14 VA Health Care Facilities nationwide. It will also test whether veterans with varying substance use patterns and preferences for treatment respond differentially to the two approaches.

The project, titled Comparative Effectiveness of Trauma-Focused and Non-Trauma-Focused Treatment Strategies for PTSD among those with Co-occurring SUD (COMPASS), will be the largest study to date examining psychotherapy treatment options for patients with both PTSD and substance use. The findings will guide patients and providers in making individualized treatment decisions about how to best treat symptoms of PTSD for those with co-occurring substance use, such that more veterans will experience meaningful improvement in their PTSD symptoms and their overall quality of life.

A patient panel comprised of veterans with personal experience with co-occurring PTSD and substance use will be engaged in all phases of the project to ensure study findings are relevant, accessible, and actionable to patients.

“Although as many as 50% of patients with PTSD also have a substance use disorder, those struggling with both conditions have typically been excluded from studies evaluating treatments for PTSD. This has left these patients and their clinicians to make treatment decisions with limited information about whether our evidence-based therapies for PTSD will work as well for them. We are excited to be able to answer this important clinical question to ensure that the care offered to veterans who are struggling with multiple treatment needs meets their preferences and gives them the best possible chance at improvement,” said Dr. Kehle-Forbes, the project’s principal investigator.

“We were excited to hear that PCORI plans to fund Dr. Kehle-Forbes’ 4-year, $5 million clinical trial comparing the effectiveness of 2 different treatment approaches for Veterans with PTSD and substance use disorder, an important but under-studied population,” stated Hanna E. Bloomfield, MD, MPH Associate Chief of Staff for Research.  “Results of this study will likely change clinical practice and ultimately improve outcomes for Veteran and non-veteran patients suffering from these co-morbid conditions”

“This project was selected for PCORI funding not only for its scientific merit and commitment to engaging patients and other stakeholders, but also for its potential to fill an important gap in our health knowledge and give people information to help them weigh the effectiveness of their care options,” said PCORI Interim Executive Director Josephine P. Briggs, MD. “We look forward to following the study’s progress and working with the Minneapolis VA to share the results.”

The Minneapolis VA Health Care system study was selected for PCORI funding through a highly competitive review process in which patients, clinicians and other stakeholders joined clinical scientists to evaluate the proposals. Applications were assessed for scientific merit, how well they will engage patients and other stakeholders and their methodological rigor among other criteria.

PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed healthcare decisions. For more information about PCORI’s funding, visit