PTSD & SUD: New Therapy Combines Past & Present for Better Outcomes

A new study offers encouraging evidence for a group-based therapy approach, combining elements of Internal Family Systems (IFS) therapy with telehealth, as a potential treatment for individuals grappling with both post-traumatic stress disorder (PTSD) and substance apply disorder (SUD). The research, conducted by researchers at the Center for Mindfulness & Compassion at the Cambridge Health Alliance, a Harvard Medical School affiliate, suggests that this integrated approach—dubbed PARTS-SUD—may offer a more accessible and engaging pathway to healing for a population often underserved by traditional mental health services.

PTSD and SUD frequently co-occur, affecting an estimated 30 to 60 percent of individuals with PTSD. Trauma can significantly increase the risk of substance use as individuals attempt to cope with distressing symptoms, while substance use can exacerbate PTSD symptoms and hinder recovery. Current treatments often fall short, with past-focused therapies proving more effective at reducing PTSD symptoms but not necessarily addressing substance use, and present-centered approaches lacking the depth needed for lasting change. Widely recommended trauma-focused therapies like Cognitive Behavioral Therapy integrated with prolonged exposure (COPE) often struggle with high dropout rates and inconsistent outcomes.

Addressing Access and Engagement in PTSD-SUD Treatment

The challenges of accessing effective PTSD and SUD treatment are particularly acute for marginalized communities and those facing financial constraints. Traditional individual therapy can be expensive and time-consuming, while community mental health centers often grapple with underfunding and staffing shortages, leading to long wait times. Recognizing these barriers, the researchers sought to develop a treatment model that was brief, holistic, accessible via a telehealth platform, and designed to engage diverse populations.

The resulting intervention, PARTS-SUD, is a 12-week program grounded in Internal Family Systems (IFS) therapy. IFS views the psyche not as a monolithic entity, but as an ecosystem of “parts”—each with its own unique experiences, feelings, and motivations. Problematic behaviors, including substance use, are often understood as arising from internal conflicts between these parts. For example, a “protector” part might rigidly criticize the individual, leading another part to seek relief through addictive behaviors. The goal of IFS is not to eliminate these parts, but to understand their underlying intentions and help them work together more harmoniously.

As Martha Sweezy, Ph.D., Assistant Professor at Harvard Medical School and a key researcher involved in the study, explains in her work, IFS is a “non-pathologizing, de-stigmatizing therapy model” that integrates both past and present-focused techniques. This approach allows individuals to explore the origins of their trauma while simultaneously developing coping skills for managing present-day challenges. The study builds on the foundation of the Internal Family Systems Skills Training Manual, offering a practical framework for clinicians.

How PARTS-SUD Works: A Combined Approach

The PARTS-SUD study combined group therapy sessions with individual sessions, providing participants with both peer support and personalized attention. The intervention incorporated elements of both past- and present-focused therapies. Present-moment awareness and self-compassion, similar to techniques used in mindfulness-based relapse prevention (MBRP) and acceptance and commitment therapy (ACT), were cultivated to help participants observe their thoughts, emotions, and physical sensations without judgment. Past-centered components included imaginal exposure to traumatic material, allowing participants to gradually process and reduce their emotional reactivity to traumatic memories.

Preliminary findings from the study suggest that participants experienced reductions in both PTSD symptoms and substance-related cravings. Researchers hypothesize that these improvements may be linked to increased emotion regulation, self-compassion, and the ability to step back from internal experiences—a process known as “de-centering.”

Study Limitations and Future Directions

While the initial results are promising, the researchers acknowledge several limitations. The study involved a small sample size of only 10 participants, which limits the generalizability of the findings. The lack of a control group makes it demanding to determine whether the observed improvements were directly attributable to the intervention or to other factors. The study similarly noted a skewed representation, with no Black participants enrolled after initial screening, highlighting the need for greater diversity in future research. Finally, the reliance on a virtual platform may exclude individuals without access to the necessary technology.

To address these limitations, larger and more rigorous studies are needed, including randomized controlled trials with diverse participant samples. Future research should also incorporate objective measures of substance use, such as toxicology testing, to provide a more comprehensive assessment of treatment outcomes. The researchers emphasize the importance of continued investigation to refine and optimize the PARTS-SUD intervention and to ensure its accessibility to those who need it most.

Implications for Community Mental Health

Despite its limitations, the PARTS-SUD study offers a valuable contribution to the field of PTSD and SUD treatment. The intervention’s emphasis on accessibility, cost-effectiveness, and a whole-person approach aligns with the needs of community mental health clinics and other settings serving underserved populations. By addressing both trauma and substance use within a framework of self-compassion and internal understanding, PARTS-SUD holds the potential to empower individuals to heal and build more fulfilling lives.

Further research is underway to evaluate the long-term effectiveness of PARTS-SUD and to explore its potential for adaptation to different cultural contexts. The researchers are also working to develop training materials for clinicians interested in implementing the intervention in their own practice. The ultimate goal is to create a more equitable and effective system of care for individuals struggling with the complex challenges of PTSD and substance use.