Toward an Improved Model of Treating Co-Occurring PTSD and Substance Use Disorders

American Journal of Psychiatry (Impact Factor: 12.3). 01/2010; 167(1):11-3. DOI: 10.1176/appi.ajp.2009.09111602
Source: PubMed
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Available from: Sudie E Back, Sep 29, 2015
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    • "Although individuals with PTSD and comorbid AUD had more severe self-reported PTSD symptom severity prior to beginning treatment, treatment generally appeared effective in reducing symptoms of PTSD and depression for those with or without current or past AUD diagnoses. Traditionally, trauma-focused treatments like CPT or prolonged exposure were thought to be inappropriate for patients with comorbid substance use disorders unless they had been in remission for 6-to 9-months because of concerns that the intensity of trauma-focused treatment would lead to a substance relapse or interfere with emotional processing and prevent PTSD from improving (Back, 2010; Becker, Table 2 ANCOVA results for the effects of time, AUD diagnosis, and time × AUD. "
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    ABSTRACT: Posttraumatic stress disorder (PTSD) and alcohol-use disorders (AUD) frequently present comorbidly in veteran populations. Traditionally those with alcohol dependence have been excluded from PTSD treatment outcome studies, thus we do not know how those with alcohol dependence may tolerate or respond to PTSD-specific interventions; no studies to date have examined the extent to which cognitive PTSD interventions are tolerated or effective for those with comorbid PTSD/AUD. The present study examines the extent to which CPT is tolerated by and effective in treating PTSD symptoms for veterans with PTSD and AUD, as compared to veterans with PTSD only in an outpatient treatment setting. Data were obtained through chart review of 536 veterans diagnosed with PTSD who had received at least 1 session of CPT at a Midwestern US Veterans Affairs hospital. Nearly half (n=264, 49.3%) of the veterans in the study exhibited a current or past AUD diagnosis. Participants were grouped into the following diagnostic groups: current AUD (past 12months), past AUD (prior to 12months), and no AUD. Participants completed an average of 9 sessions of CPT with no significant difference between AUD diagnostic groups on the number of CPT sessions completed. Individuals with past AUD had higher initial symptoms of self-reported PTSD symptoms than those with no AUD. All groups reported significant reductions in PTSD symptoms and depression over time. Overall, the results suggest that CPT appears well tolerated among veterans with comorbid AUD and is associated with significant reductions in symptoms of PTSD and depression in an outpatient treatment setting.
    Addictive behaviors 08/2013; 39(2). DOI:10.1016/j.addbeh.2013.08.016 · 2.76 Impact Factor
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    • "Conducting screening and promoting mental service outreach to high-risk populations, and providing personalized treatment may help decrease barriers to treatment for individuals with PSTD-AD. For example, a common strategy in the management of PTSD and AD is to treatment sequentially, often usually requiring abstinence from substance use before initiating PTSD treatment (Back, 2010 "
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    ABSTRACT: Background: Despite the high rates of comorbidity of post-traumatic stress disorder (PTSD) and alcohol dependence (AD) in clinical and epidemiological samples, little is known about the prevalence, clinical presentation, course, risk factors and patterns of treatment-seeking of co-occurring PTSD-AD among the general population. Methods: The sample included respondents of the Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Weighted means, frequencies and odds ratios (ORs) of sociodemographic correlates, prevalence of psychiatric disorders and rates of treatment-seeking were computed. Results: In the general population, the lifetime prevalence of PTSD only, AD only and PTSD-AD was 4.83%, 13.66% and 1.59%, respectively. Individuals with comorbid PTSD-AD were more likely than those with PTSD or AD only to have suffered childhood adversities and had higher rates of Axis I and II disorders and suicide attempts. They also met more PTSD diagnostic criteria, had earlier onset of PTSD and were more likely to use drugs and alcohol to relieve their PTSD symptoms than those with PTSD only; they also met more AD diagnostic criteria than those with AD only and had greater disability. Individuals with PTSD-AD had higher rates of treatment seeking for AD than those with AD only, but similar rates than those with PTSD only. Conclusion: PTSD-AD is associated with high levels of severity across a broad range of domains even compared with individuals with PTSD or AD only, yet treatment-seeking rates are very low. There is a need to improve treatment access and outcomes for individuals with PTSD-AD.
    Drug and alcohol dependence 05/2013; 132(3). DOI:10.1016/j.drugalcdep.2013.04.016 · 3.42 Impact Factor
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    • "Erste Befunde weisen darauf hin, dass Suchtpatienten mit Traumata in der Vorgeschichte bzw. mit einer komorbiden PTBS von integrativen und insbesondere von traumafokussierten Behandlungsansätzen profitieren kçnnen (Back, 2010; Henslee & Coffey, 2010). Zudem sollten sich derartige Therapieformen nicht nur an Patienten mit einer voll ausgebildeten PTBS richten. "
    Sucht 08/2012; 58(4):227-235. DOI:10.1024/0939-5911.a000191
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