Clinical challenges in the treatment of patients with posttraumatic stress disorder and substance abuse.
ABSTRACT The aim of this article is to review the current literature on co-occuring posttraumatic stress disorder and substance-use disorder, with an emphasis on clinical aspects and emerging treatments.
In clinical populations (focusing on either disorder), about 25-50% have a lifetime dual diagnosis of posttraumatic stress disorder and substance-use disorder. Patients with both disorders have a more severe clinical profile than those with either disorder alone, lower functioning, poorer well being, and worse outcomes across a variety of measures. In recent years, several promising treatment programs have been developed specifically for co-occuring posttraumatic stress disorder and substance-use disorder, with one model having been established as effective thus far.
Comorbid posttraumatic stress disorder/substance-use disorder is a frequent diagnosis in clinical populations that severely affects course and outcome. Treatment approaches appropriate for this vulnerable population need to be evaluated further and implemented in routine practice.
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ABSTRACT: Research on substance use suggests that distress tolerance mediates the relationship between posttraumatic stress disorder (PTSD) symptoms and alcohol use; however, given that distress tolerance may represent vulnerabilities for both PTSD symptoms and alcohol use, it may in fact facilitate PTSD and subsequent alcohol use. The present study investigated the relationship between distress tolerance, and alcohol consumption and alcohol-related consequences, with PTSD hyperarousal, re-experiencing, avoidance, and numbing symptoms as mediating variables. A community based North-American sample (n = 146, 81 % = women) completed measures online as part of a larger ongoing study. Results demonstrated that distress tolerance had an indirect effect on alcohol consumption through hyperarousal symptoms but no other PTSD symptoms. No significant relationships were demonstrated with alcohol-related consequences. Findings suggest interventions promoting distress tolerance following trauma exposure may help decrease hyperarousal symptoms and subsequent risk of alcohol-use disorders. Comprehensive results, implications, and future research are discussed.Cognitive Therapy and Research 06/2014; 38(3). DOI:10.1007/s10608-013-9591-7 · 1.70 Impact Factor
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ABSTRACT: Abstract We investigated the role of comorbid posttraumatic stress disorder (CO-PTSD) in substance use disorder (DSM-IV/ICD-10 substance abuse or dependence, SUD) treatment. We conducted a systematic review of treatment outcome studies in SUD patients with and without CO-PTSD from 2000 to 2011. The N = 22 studies found differed clearly with regard to methodology and the sufficiency of provided study information, limiting their comparability. Remarkably, no consistent indication of a negative effect of CO-PTSD on the reported SUD treatment outcome was found. In addition to CO-PTSD, we point out possible further effect modifiers which need to be better understood. Finally, we emphasize the requirements for future research such as methodological standardization and a focus on long-term studies.Psychotherapy Research 06/2014; DOI:10.1080/10503307.2014.923125 · 1.75 Impact Factor
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ABSTRACT: ABSTRACT Background: A high prevalence of comorbid Posttraumatic Stress Disorder (PTSD) is found in patients with substance use disorders (SUD). In the few existing studies, mixed results regarding the psychometric properties of common screening instruments for PTSD have been reported for patients with SUD. No results are available for the Posttraumatic Diagnostic Scale (PDS), an established self-report measure for PTSD. Methods:We assessed 105 patients with alcohol dependence according to DSM-IV (70% male) two weeks after their admission to an inpatient detoxification unit. Participants were administered the PDS, the PTSD module of the Structured Clinical Interview for DSM-IV (SCID) as well as measures of depression and anxiety. Patients with other substance use disorders were excluded as were patients reporting no traumatic event. Results: Internal consistencies were good to very good for the total scale (0.93) and the subscales of the PDS (0.82-0.91). In our sample, the PDS had a high specificity (0.89) but only moderate sensitivity (0.57). Diagnostic agreement with the SCID was 83% (0.46). The results of a ROC-analysis suggested that a PDS-score of 8 was the optimal cut-off to screen for PTSD. The highest diagnostic agreement between PDS and SCID (89%; 0.60) was achieved using a cut-off score of 24. Conclusions: Our findings confirm previous results suggesting that the psychometric properties of self-report measures of PTSD in patients with SUD might differ from those in the general population. When the PDS is used in recently detoxified patients with alcohol dependence, it seems advisable to modify the cut-off score of this instrument to improve its sensitivity and diagnostic accuracy.Substance Abuse 03/2014; 35(3). DOI:10.1080/08897077.2014.891555 · 1.62 Impact Factor