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Implementing CPT in an AOD Service

Updated: Jun 17

At Lives Lived Well (LLW) we recognise that many of the clients accessing our AOD and mental health services have significant histories of experiencing trauma. Around 70% of clients report having experienced trauma in their lifetime, with over 50% reporting clinically significant symptoms of trauma on the Primary Care PTSD Screen for DSM-5. Trauma is a major driver of harmful alcohol and other drug (AOD) use, mental health concerns, and impacts markedly on quality of life (Mills, 2015; Vadon-Bounes et al., 2019). For many people we support, substance use has provided a way to cope in the wake of overwhelming experiences. While trauma-informed care has long been a cornerstone of our approach, we recognise that accessing trauma-focused therapy faces too many barriers, particularly for people who use alcohol and other drugs. To overcome these barriers, we have committed to making trauma-focused therapy more accessible. Implementing Cognitive Processing Therapy (CPT) has helped us bridge the gap.


After observing a promising initial pilot in 2021 through our partnership with the University of Queensland (see Walter et al., 2025), Lives Lived Well commenced an internal implementation project in 2022. Working in partnership with Professor Reg Nixon and Dr Marja Elizabeth, we trained an initial cohort of 17 clinicians across a three-day workshop in August 2023, complemented by weekly group supervision (two weekly groups capped at 10). The success of this initial cohort supported training a second cohort of 10 clinicians who commenced supervised practice in January 2025. Already we are making plans to train a third cohort of clinicians in early 2026 to ensure the sustainability and growth of the program.


Training includes completing CPT Web 2.0 online course, core readings (Cognitive Processing Therapy for PTSD, Resick et al., 2024), and an intensive two-day workshop facilitated by expert trainers. In this respect we have been privileged to be supported by Professor Reg Nixon and Dr Marja Elizabeth, with Marja having facilitated our ongoing weekly group supervision.Their expertise and mentorship have been integral to ensuring quality and fidelity across LLW.


Implementation efforts have been designed to minimise disruption while maximising client benefit. Most of our clinicians deliver CPT within their existing caseloads, drawing on the strength of pre-existing therapeutic relationships. To ensure effective care and support the program evaluation, clients complete comprehensive outcome measures including the LEC-5, PCL-5, PTCI, and PHQ-9, with the PCL-5 and PHQ-9 completed every session (see below at 1). Combined with supervision, this ensures robust outcome tracking.


The ultimate measure of success for the program is the outcomes achieved by clients. In this respect the results are promising:

  • 141 clients have been offered CPT, with over 95% initiating therapy and 50% of those completing a full course of CPT

  • PCL-5 scores average 49.44 at assessment

  • PCL-5 demonstrate an average reduction of 38.75 points by completion

  • Clients report meaningful gains in both symptom reduction and quality of life

  • Many clinicians report that CPT is ‘the best thing they’ve ever done’


Our clinicians have valued the enrichment of the training and supervision and have felt confident in the structure CPT provides. Collectively they’ve noted it has enhanced their ability to go beyond support clients impacted by PTSD to helping them effectively challenge and restructure trauma-related stuck points. Clients have described CPT as a transformative experience, helping them not only manage distress but deeply understand their trauma through a new lens, and to set their recovery journey well on track.


The implementation of CPT has not been without challenges. Workforce turnover, competing service demands, and the realities of complex service delivery mean that sustained change requires more than enthusiasm. Our CPT program includes structured onboarding, supervision, fidelity monitoring, and dedicated internal champions to support new clinicians with mentoring and guidance. Additionally, clinicians who complete their supervised practice can apply to become accredited CPT Providers with CPT Australia, representing a deeply enriching and rewarding professional development opportunity.


Looking ahead, LLW is committed to growing our CPT capability. We are aiming to train an additional cohort of 10 clinicians annually, creating a specialist trauma stream within our broader AOD services. With strong foundations in place, our aim is to become a leader in trauma-informed and trauma-responsive AOD care nationally.


One of our core values at LLW is ‘Why not, and what’s next?’. The implementation of CPT at LLW is an example of living this value by taking on a bold challenge with enthusiasm to better serve our clients.

 

1 Scales

Post-traumatic Cognitions Inventory (PTCI):  https://www.goodmedicine.org.uk/files/ptsd,%20assessment,%20pcti.pdf

 

References

Mills, K.L. (2015), The importance of providing trauma-informed care in alcohol and other drug services. Drug and Alcohol Review, 34: 231-233. https://doi.org/10.1111/dar.12273

Vardon-Bounes, F., Gracia, R., Abaziou, T., Crognier, L., Seguin, T., Labaste, F., Geeraerts, T., Georges, B., Conil, J-M., & Minville, V. (2021). A study of patients’ quality of life more than 5 years after trauma: a prospective follow-up. Health and Quality of Life Outcomes, 19, 1-10. doi: https://doi.org/10.1186/s12955-020-01652-1

Walter, Z., Carlyle, M., Mefodeva, V., Glasgow, S., Newland, G., Nixon, R.D.V., Cobham, V., & Hides, L. (2025). Feasibility and outcomes of a trauma-informed model of care in residential treatment facility for substance use. Substance Use and Addiction Treatment, 169: 209571. https://doi.org/10.1016/j.josat.2024.209571

 
 
 

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