Reynolds Martina, Mezey Gillian, Chapman Murray, Wheeler Mike, Drummond Colin, Baldacchino Alex
School of Social Sciences and Law, Brunel University, Uxbridge, Middlesex, UB8 3PH, UK.
Drug Alcohol Depend. 2005 Mar 7;77(3):251-8. doi: 10.1016/j.drugalcdep.2004.08.017.
BACKGROUND: USA studies have reported high rates of co-morbid post-traumatic stress disorder (PTSD) and substance (drugs and alcohol) dependence/misuse. Avoidance of trauma reminders and associated distress may be achieved by the use of drugs and alcohol, alternatively a substance abusing lifestyle might predispose such individuals to experience traumatic events. This may have implications for treatment and management of patients with co-morbid substance misuse and PTSD. There have been no British studies looking at the extent of traumatic life events and post-traumatic stress disorder amongst substance misusers, although high rates of reported sexual and physical abuse have been reported in two recent UK studies with drug- and alcohol-dependent patients in clinical settings. AIMS: (i) To investigate the prevalence of co-morbid PTSD in a UK substance use disorder (SUD) inpatient clinical population; (ii) to identify the characteristics, severity and types of trauma experienced; (iii) to compare SUD patients with and without co-morbid PTSD on substance use and history, psychological/psychiatric and social variables METHOD: This is a cross-sectional study involving interviews with patients and case note review. SUD inpatients were interviewed about traumatic experiences, PTSD, and addiction. RESULTS: Ninety-four percentage reported experiencing one or more PTSD criterion A traumatic experiences. 38.5% met criteria for current PTSD and 51.9% for lifetime PTSD. Significant differences between the PTSD and non-PTSD groups were found in PTSD and trauma-related variables, notably social variables and distress associated with traumatic experiences, but few differences were found in addiction severity (medical and psychiatric composite scores of the ASI) and psychiatric symptomatology. CONCLUSIONS: This study highlights not only the importance of assessment of trauma and PTSD amongst substance misusers but, conversely the need for the assessment of substance abuse among victims of PTSD. Co-morbid psychopathology is common, so trauma histories and PTSD symptoms may become embedded in other co-morbid psychopathology.
背景：美国的研究报告称，创伤后应激障碍（PTSD）与物质（药物和酒精）依赖/滥用共病的发生率很高。通过使用药物和酒精可以避免创伤提示及相关痛苦，或者物质滥用的生活方式可能使此类个体更容易经历创伤事件。这可能对共病物质滥用和创伤后应激障碍患者的治疗与管理产生影响。尽管最近两项针对临床环境中药物和酒精依赖患者的英国研究报告了较高的性虐待和身体虐待发生率，但尚无英国研究关注物质滥用者中创伤性生活事件和创伤后应激障碍的程度。 目的：（i）调查英国物质使用障碍（SUD）住院临床人群中共病创伤后应激障碍的患病率；（ii）确定所经历创伤的特征、严重程度和类型；（iii）比较有和没有共病创伤后应激障碍的物质使用障碍患者在物质使用和病史、心理/精神及社会变量方面的情况。 方法：这是一项横断面研究，包括对患者的访谈和病例记录回顾。对物质使用障碍住院患者进行了关于创伤经历、创伤后应激障碍和成瘾的访谈。 结果：94%的患者报告经历过一项或多项符合创伤后应激障碍A标准的创伤经历。38.5%的患者符合当前创伤后应激障碍的标准，51.9%的患者符合终生创伤后应激障碍的标准。在创伤后应激障碍和与创伤相关的变量方面，尤其是社会变量以及与创伤经历相关的痛苦方面，创伤后应激障碍组和非创伤后应激障碍组之间存在显著差异，但在成瘾严重程度（成瘾严重程度指数的医学和精神综合评分）和精神症状方面差异较小。 结论：本研究不仅强调了在物质滥用者中评估创伤和创伤后应激障碍的重要性，反之也强调了在创伤后应激障碍受害者中评估物质滥用的必要性。共病精神病理学很常见，因此创伤史和创伤后应激障碍症状可能会融入其他共病精神病理学中。
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