Implementing Prolonged Exposure Therapy in a Community Substance Use Treatment Program: A Qualitative Study
TL;DR
It is suggested that staff generally viewed M‐PE favourably but emphasised the importance of ensuring client readiness and organisational support, and the feasibility and acceptability of integrating M‐PE into a community‐based SUD program.
Abstract
ABSTRACT Introduction Post‐traumatic stress disorder (PTSD) commonly co‐occurs with substance use disorders (SUD), yet few community‐based SUD programs incorporate evidence‐based trauma‐focused. Prolonged exposure (PE), including its massed format (M‐PE) with session frequency of 3–4 times per week, is a gold standard intervention for PTSD; however, concerns about client readiness, logistical demands and relapse risk have limited its adoption within SUD settings. This study examined staff perspectives on the feasibility and acceptability of integrating M‐PE into a community‐based SUD program. Methods Prior to launching a Hybrid Type 1 effectiveness–implementation trial (Project COMET), we conducted semi‐structured virtual interviews with 15 community clinic staff: providers (n = 8), administrators (n = 2) and peer specialists (n = 5). Interviews were recorded, transcribed and analysed using a rapid qualitative analysis framework with matrix techniques to compare themes across roles. Results Four overarching themes captured staff perspectives on integrating M‐PE: (Theme 1) Prior Knowledge and Experiences: Most staff were familiar with EMDR, while direct knowledge of PE/M‐PE was limited. (Theme 2) Perceptions of M‐PE: M‐PE was widely viewed as a promising, structured intervention that fits the pacing and duration of SUD care. (Theme 3) Symptom Reduction and Client Impact: Staff anticipated improvements in PTSD and SUD symptoms through trauma‐focused treatment. (Theme 4) Barriers and Constraints: Participants identified several potential implementation challenges, including logistical barriers and client readiness. Discussion and Conclusions Findings suggest that staff generally viewed M‐PE favourably but emphasised the importance of ensuring client readiness and organisational support. Enhancing feasibility and long‐term sustainability may require expanded psychoeducation, targeted provider training and flexible delivery models. Trial Registration: ClinicalTrials.gov identifier: NCT06968832.