Driessen Martin, Schulte Silke, Luedecke Christel, Schaefer Ingo, Sutmann Frauke, Ohlmeier Martin, Kemper Ulrich, Koesters Gertrud, Chodzinski Claudia, Schneider Udo, Broese Thomas, Dette Christian, Havemann-Reinecke Ulla
Clinic of Psychiatry and Psychotherapy Bethel, Ev. Hospital Bielefeld, Bielefeld, Germany.
Alcohol Clin Exp Res. 2008 Mar;32(3):481-8. doi: 10.1111/j.1530-0277.2007.00591.x. Epub 2008 Jan 22.
We investigated (1) the prevalence of posttraumatic stress disorder (PTSD) in treatment-seeking subjects with substance use dependence (SUD), (2) the association between comorbid PTSD and the severity and course of addiction and psychopathology, and (3) this association in patients with subsyndromal PTSD, and in trauma exposure without PTSD.
In this cross-sectional study, 459 subjects in 14 German addiction treatment centers participated with alcohol-dependence (A) in 39.7%, drug-dependence (D) in 33.6%, or both (AD) 26.8%. The diagnostic measures included the International Diagnostic Checklists (IDCL), Posttraumatic Diagnostic Scale (PDS), Addiction Severity Index (ASI), and the Brief Psychiatric Rating Scale (BPRS). Associations between independent characteristics and outcomes were analysed by univariate and multivariate statistics.
25.3% of the subjects had PTSD confirmed by both IDCL and PDS with higher rates in the AD (34.1%) and D (29.9%) groups compared with group A (15.4%, p < 0.001). In 22.8%, PTSD was subsyndromal (either IDCL or PDS positive) without significant differences between SUD groups, and 18.3% met PTSD trauma criteria A without PTSD (exposure). After controlling for SUD and gender, trauma subgroups significantly differed regarding the onset of alcohol-related symptoms (p < 0.02), numbers of previous admissions (p < 0.03), severity of SUD (p < 0.001), current craving (p < 0.02), and psychopathology (p < 0.001). We observed the worst outcome in PTSD, while trauma exposure had no effects.
The prevalence of PTSD is higher in drug than in alcohol dependence. The more strictly PTSD is diagnosed (by interviewer and questionnaire) the more clearly are associations with characteristics of SUD. PTSD seems to be an independent risk factor for an unfavorable outcome of SUD.
我们调查了（1）寻求治疗的物质使用障碍（SUD）患者中创伤后应激障碍（PTSD）的患病率；（2）共病PTSD与成瘾及精神病理学严重程度和病程之间的关联；以及（3）亚综合征PTSD患者和有创伤暴露但无PTSD患者中的这种关联。
在这项横断面研究中，德国14个成瘾治疗中心的459名受试者参与了研究，其中酒精依赖（A）者占39.7%，药物依赖（D）者占33.6%，两者皆有（AD）者占26.8%。诊断措施包括国际诊断清单（IDCL）、创伤后诊断量表（PDS）、成瘾严重程度指数（ASI）和简明精神病评定量表（BPRS）。通过单变量和多变量统计分析独立特征与结果之间的关联。
25.3%的受试者经IDCL和PDS确诊患有PTSD，AD组（34.1%）和D组（29.9%）的患病率高于A组（15.4%，p<0.001）。22.8%的患者为亚综合征PTSD（IDCL或PDS呈阳性），各SUD组之间无显著差异，18.3%的患者符合PTSD创伤标准A但无PTSD（暴露）。在控制了SUD和性别因素后，创伤亚组在酒精相关症状的发作（p<0.02）、既往入院次数（p<0.03）、SUD严重程度（p<0.001）、当前渴求（p<0.02）和精神病理学（p<0.001）方面存在显著差异。我们观察到PTSD患者的结局最差，而创伤暴露则无影响。
药物依赖中PTSD的患病率高于酒精依赖。PTSD诊断越严格（通过访谈者和问卷），与SUD特征的关联就越明显。PTSD似乎是SUD不良结局的一个独立危险因素。
