Pamela J Brown’s research while affiliated with Syracuse VA Medical Center and other places

Patients with substance use (SUD) and posttraumatic stress disorders (PTSD) are at high risk for relapse. This study examined the reasons patients identify for their first substance use following discharge from SUD treatment. A total of 65 patients with and without PTSD completed clinical interviews, including an adapted version of the Relapse Interview [RI; Miller, W.R., & Marlatt, G.A. (1996). Appendix A: Relapse Interview. Addiction, 91(Suppl), 231-240.] at a 6-month follow-up. Qualitative data from the RI was consensus coded using Marlatt's taxonomy of relapse situations. Results indicated that patients with PTSD were less likely to report first substance use triggered by cue-based urges and more likely to report use in response to negative emotions of an interpersonal nature than those patients without PTSD. Other characteristics of first use associated with PTSD included greater subjective urges right before using, greater efforts to obtain substances and more likelihood to use to intoxication. Patients with unremitted PTSD reported poorer outcome and self-efficacy expectations than those without PTSD or with remitted PTSD. Implications for self-medication theory and clinical practice are discussed.

While studies link posttraumatic stress disorder (PTSD) to substance use disorders (SUDs), little is known about the health and functional status of patients with such comorbidity. This study examined the health and well being of SUD patients with and without PTSD. Participants were assessed using structured clinical interviews and self-administered questionnaires assessing chronic physical symptoms, and functional status and well being. PTSD was significantly associated with more cardiovascular, neurological, and total chronic physical symptoms. In addition, PTSD was significantly related to poorer functional status and well being, particularly in the mental health realm of functioning. The association between PTSD and mental health component of functional health and well-being remained significant after controlling for chronic physical symptoms and other comorbid psychopathology.

We review 15 studies that examined rates of post-traumatic stress disorder (PTSD) in substance use disorder (SUD) patients to determine whether the typical female-greater-than- male gender difference in PTSD rates is attenuated in SUD samples. Since the majority of studies reviewed did not find a gender difference in PTSD rates, we critically examined methodological factors that might account for this attenuation, but none appeared to completely account for the variability in detection of gender differences across studies. Several factors may contribute to making rates of PTSD among SUD males equivalent to the high rates observed in SUD females: 1) the risky lifestyle associated with men's substance abuse may increase their exposure to traumatic events, 2) a history of more severe trauma characteristics may be apparent among men with SUDs, or 3) attenuated gender differences in rates of other comorbidities that increase PTSD risk (e.g., depression) may exist. Clinical implications are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Posttraumatic stress disorder (PTSD) is prevalent among substance use disorder (SUD) patients. Although Criterion A trauma is critical to the formulation of a PTSD diagnosis, little research has examined the reliability of retrospective reports of such stressors and factors that affect reporting among these patients. This study examined these issues among SUD patients. Participants (N = 120) were assessed by interviews and questionnaires after entering inpatient SUD treatment and at a 6-month follow-up. About 40% of participants met criteria for a current PTSD diagnosis. Results revealed moderate stability of Criterion A trauma reports, which improved when Criterion A requirements were relaxed (i.e., participants were required to report the stressor but not the Criteria A1 and A2). Intrusive symptoms were associated with increased stressor reporting over time, whereas numbing symptoms and SUD abstinence were associated with decreased stressor reporting over time. Dissociative symptoms were associated with changes in reporting in either direction.

This study examined concurrent and prospective associations between substance use disorder (SUD) and posttraumatic stress disorder (PTSD) diagnosis and symptoms and mechanisms underlying these associations. Participants (n = 133) were assessed at intake and 6 months following inpatient SUD treatment. Patients differed by baseline PTSD status on psychiatric comorbidity and substance use history but not on current substance use symptoms. Participants with alcohol use disorders reported a greater number of reexperiencing symptoms. Baseline PTSD status did not predict substance use outcome. However, change in PTSD status over follow-up predicted substance use outcomes; those with unremitted PTSD demonstrated poorer SUD outcome than those with remitted PTSD. General psychiatric distress at follow-up was associated with poorer outcomes, and such distress mediated the association between PTSD change status and substance use outcome. Findings suggest that clinicians should assess for PTSD among those with SUD and, during treatment, should monitor PTSD and other psychological symptoms, which may be risk factors for relapse to substance abuse.

In this chapter the authors review empirical research on the treatment course of substance use disorder-posttraumatic stress disorder (SUD-PTSD) comorbidity. They highlight treatment implications in an attempt to profile the state of the art in treating this particular comorbidity. The findings show that comorbid PTSD is associated with poorer treatment outcomes following treatment for SUDs. On the basis of the empirical evidence reviewed in this chapter, the authors make recommendations for empirically based practice. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

In this chapter the authors describe a study that examines the prospective relationship between posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) among inpatients (aged 18-55 yrs) recently treated for substance abuse or dependence. To provide a context for this study, the authors survey the relevant prospective literature on SUD-PTSD comorbidity and review factors suggested by this literature on affect symptom presentation, treatment, and remission of these two disorders. Specifically, the authors discuss the role of gender and coping skills in the relationship between SUDs and PTSD. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

The major purpose of this chapter is to examine gender as a potentially important individual-difference variable with respect to the co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs). We begin with a review of studies that have examined comorbidity rates in both general and patient populations to demonstrate that PTSD-SUD comorbidity is an important issue in both nonclinical and clinical samples of both genders. We then examine similarities and differences in the predictors of comorbidity in male and female samples. We review the research examining potential functional relations between these two forms of behavioral pathology to determine whether there may be gender differences in the ways that PTSD and SUDs are interrelated. For example, we look at evidence suggesting that women may be more susceptible than men to a form of comorbidity in which the PTSD precedes the development of the SUD. We present new data from treatment-seeking men and women with SUDs to demonstrate that gender moderates PTSD status effects on aspects of service utilization and treatment course. We conclude with a section on the implications of observed gender differences for the treatment of women versus men with comorbid PTSD-SUDs. (PsycINFO Database Record (c) 2012 APA, all rights reserved)