为什么临床医生不实施共病物质使用障碍和创伤后应激障碍的综合治疗：一项定性研究。
Why clinicians do not implement integrated treatment for comorbid substance use disorder and posttraumatic stress disorder: a qualitative study.
机构信息
Mondriaan, MAIAR, Heerlen, The Netherlands ; Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
Department of Health, Ethics & Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
出版信息
Eur J Psychotraumatol. 2014 Feb 5;5. doi: 10.3402/ejpt.v5.22821. eCollection 2014.
Abstract
BACKGROUND
Healthcare providers working in addiction facilities do not often implement integrated treatment of comorbid substance use disorder (SUD) and posttraumatic stress disorder (PTSD) while there is empirical evidence to do so.
OBJECTIVE
This study aims to get insight into the views of clinicians with regard to the diagnosis and treatment of PTSD in SUD patients.
METHOD
A qualitative research method was chosen. Fourteen treatment staff members of different wards of an addiction care facility were interviewed by an independent interviewer.
RESULTS
Despite acknowledging adverse consequences of trauma exposure on SUD, severe underdiagnosis of PTSD was mentioned and treatment of PTSD during SUD treatment was not supported. Obstacles related to the underestimation of PTSD among SUD patients and to the perceptions of SUD clinicians concerning the treatment of comorbid SUD/PTSD were reported.
CONCLUSIONS
It is concluded that SUD facilities should train their clinicians to enable them to provide for integrated treatment of SUD/PTSD.
摘要
背景
尽管有实证证据表明，在成瘾治疗机构工作的医疗保健提供者通常不会同时实施共病物质使用障碍（SUD）和创伤后应激障碍（PTSD）的综合治疗，但他们确实这样做了。
目的
本研究旨在深入了解临床医生对 SUD 患者 PTSD 的诊断和治疗的看法。
方法
选择了定性研究方法。对成瘾治疗机构不同病房的 14 名治疗人员进行了独立访谈。
结果
尽管承认创伤暴露对 SUD 的不良后果，但提到了 PTSD 的严重漏诊，并且不支持在 SUD 治疗期间治疗 PTSD。报告了与 SUD 患者中 PTSD 被低估以及 SUD 临床医生对共病 SUD/PTSD 治疗的看法相关的障碍。
结论
结论是，SUD 设施应培训其临床医生，使他们能够提供 SUD/PTSD 的综合治疗。
相似文献
1
Why clinicians do not implement integrated treatment for comorbid substance use disorder and posttraumatic stress disorder: a qualitative study.为什么临床医生不实施共病物质使用障碍和创伤后应激障碍的综合治疗：一项定性研究。
Eur J Psychotraumatol. 2014 Feb 5;5. doi: 10.3402/ejpt.v5.22821. eCollection 2014.
2
Clinicians' perceptions for indicating and contra-indicating integrated treatment for SUD and comorbid PTSD, a vignette study.临床医生对物质使用障碍共病创伤后应激障碍进行综合治疗的指征和禁忌的看法：一项案例研究。
Subst Abuse Treat Prev Policy. 2019 Feb 19;14(1):7. doi: 10.1186/s13011-019-0194-5.
3
Client and staff perceptions of the integration of trauma informed care and specialist posttraumatic stress disorder treatment in residential treatment facilities for substance use: A qualitative study.患者和工作人员对创伤知情关怀与专门创伤后应激障碍治疗在物质使用住院治疗设施中整合的看法：一项定性研究。
Drug Alcohol Rev. 2023 Jan;42(1):181-192. doi: 10.1111/dar.13535. Epub 2022 Sep 6.
4
Study design, interventions, and baseline characteristics for the Substance use and TRauma Intervention for VEterans (STRIVE) trial.退伍军人物质使用与创伤干预（STRIVE）试验的研究设计、干预措施及基线特征
Contemp Clin Trials. 2016 Sep;50:45-53. doi: 10.1016/j.cct.2016.07.017. Epub 2016 Jul 19.
5
Psychological therapies for post-traumatic stress disorder and comorbid substance use disorder.创伤后应激障碍及共病物质使用障碍的心理治疗
Cochrane Database Syst Rev. 2016 Apr 4;4(4):CD010204. doi: 10.1002/14651858.CD010204.pub2.
6
Comparative effectiveness of trauma-focused and non-trauma-focused psychotherapy for PTSD among veterans with comorbid substance use disorders: Protocol & rationale for a randomized clinical trial.创伤聚焦与非创伤聚焦心理治疗对合并物质使用障碍的退伍军人 PTSD 的比较效果：一项随机临床试验的方案与理论基础。
Contemp Clin Trials. 2022 Sep;120:106876. doi: 10.1016/j.cct.2022.106876. Epub 2022 Aug 18.
7
Effectiveness of EMDR in patients with substance use disorder and comorbid PTSD: study protocol for a randomized controlled trial.眼动脱敏再处理疗法对物质使用障碍合并创伤后应激障碍患者的疗效：一项随机对照试验的研究方案
BMC Psychiatry. 2017 Mar 16;17(1):95. doi: 10.1186/s12888-017-1255-9.
8
Differential relationships of PTSD and childhood trauma with the course of substance use disorders.创伤后应激障碍和儿童期创伤与物质使用障碍病程的差异关系。
J Subst Abuse Treat. 2018 Oct;93:57-63. doi: 10.1016/j.jsat.2018.07.010. Epub 2018 Jul 21.
9
Does trauma-focused exposure therapy exacerbate symptoms among patients with comorbid PTSD and substance use disorders?创伤聚焦暴露疗法是否会加重共病 PTSD 和物质使用障碍患者的症状？
Behav Cogn Psychother. 2020 Jan;48(1):38-53. doi: 10.1017/S1352465819000304. Epub 2019 Apr 23.
10
No Wrong Doors: Findings from a Critical Review of Behavioral Randomized Clinical Trials for Individuals with Co-Occurring Alcohol/Drug Problems and Posttraumatic Stress Disorder.无错门：对患有酒精/药物问题并发创伤后应激障碍的个体进行行为随机临床试验的批判性综述结果
Alcohol Clin Exp Res. 2017 Apr;41(4):681-702. doi: 10.1111/acer.13325. Epub 2017 Feb 10.
引用本文的文献
1
Written Exposure Therapy for PTSD Integrated with Cognitive Behavioral Coping Skills for Cannabis Use Disorder After Recent Sexual Assault: A Case Series.近期性侵犯后创伤后应激障碍的书面暴露疗法与大麻使用障碍的认知行为应对技能相结合：病例系列
Behav Sci (Basel). 2025 Jun 27;15(7):877. doi: 10.3390/bs15070877.
2
Concurrent Treatment of Posttraumatic Stress Disorder and Alcohol Use Disorder in Women: A Randomized Clinical Trial.女性创伤后应激障碍与酒精使用障碍的联合治疗：一项随机临床试验
JAMA Netw Open. 2025 Jul 1;8(7):e2521087. doi: 10.1001/jamanetworkopen.2025.21087.
3
Predictors of evidence-based psychotherapy initiation among veterans with co-occurring PTSD and substance use disorder.患有创伤后应激障碍（PTSD）和物质使用障碍的退伍军人中基于证据的心理治疗启动的预测因素。
Front Psychiatry. 2024 Aug 16;15:1432361. doi: 10.3389/fpsyt.2024.1432361. eCollection 2024.
4
Direct and Indirect Exposure to Trauma, Posttraumatic Stress Disorder Symptoms, and Poor Subjective Sleep Quality in Patients with Substance Use Disorder.物质使用障碍患者的直接和间接创伤暴露、创伤后应激障碍症状及不良主观睡眠质量
Psychiatry Clin Psychopharmacol. 2022 Sep 1;32(3):188-195. doi: 10.5152/pcp.2022.22368. eCollection 2022 Sep.
5
Supporting the implementation of written exposure therapy for posttraumatic stress disorder in an obstetrics-substance use disorder clinic in the Northeastern United States.在美国东北部一家产科-物质使用障碍诊所支持创伤后应激障碍书面暴露疗法的实施。
SSM Ment Health. 2023 Dec 15;4. doi: 10.1016/j.ssmmh.2023.100256. Epub 2023 Aug 22.
6
Cannabis use and trauma-focused treatment for co-occurring posttraumatic stress disorder and substance use disorders: A meta-analysis of individual patient data.大麻使用与创伤聚焦治疗共病创伤后应激障碍和物质使用障碍：一项个体患者数据的荟萃分析。
J Anxiety Disord. 2024 Mar;102:102827. doi: 10.1016/j.janxdis.2024.102827. Epub 2024 Jan 10.
7
Project harmony: A systematic review and network meta-analysis of psychotherapy and pharmacologic trials for comorbid posttraumatic stress, alcohol, and other drug use disorders.项目和谐：创伤后应激障碍共病、酒精和其他药物使用障碍的心理治疗和药物试验的系统评价和网络荟萃分析。
Psychol Bull. 2024 Mar;150(3):319-353. doi: 10.1037/bul0000409. Epub 2023 Nov 16.
8
Primary Care Treatment Integrating Motivation and Exposure for PTSD Symptoms and Hazardous Alcohol Use: A Case Series.整合动机与暴露疗法治疗创伤后应激障碍症状及有害酒精使用的初级保健治疗：病例系列
Cogn Behav Pract. 2023 Aug;30(3):551-563. doi: 10.1016/j.cbpra.2022.02.020. Epub 2022 Apr 4.
9
A retrospective chart review of trauma-related documentation in an Australian substance use treatment service.澳大利亚物质使用治疗服务中创伤相关文件的回顾性图表审查。
Drug Alcohol Rev. 2023 Feb;42(2):373-383. doi: 10.1111/dar.13575. Epub 2022 Nov 14.
10
Client and staff perceptions of the integration of trauma informed care and specialist posttraumatic stress disorder treatment in residential treatment facilities for substance use: A qualitative study.患者和工作人员对创伤知情关怀与专门创伤后应激障碍治疗在物质使用住院治疗设施中整合的看法：一项定性研究。
Drug Alcohol Rev. 2023 Jan;42(1):181-192. doi: 10.1111/dar.13535. Epub 2022 Sep 6.
本文引用的文献
1
Prevalence of post-traumatic stress disorder among patients with substance use disorder: it is higher than clinicians think it is.物质使用障碍患者创伤后应激障碍的患病率：高于临床医生认为的患病率。
Eur J Psychotraumatol. 2012;3. doi: 10.3402/ejpt.v3i0.17734. Epub 2012 Aug 8.
2
Integrated exposure-based therapy for co-occurring posttraumatic stress disorder and substance dependence: a randomized controlled trial.共病创伤后应激障碍和物质依赖的基于暴露的综合治疗：一项随机对照试验。
JAMA. 2012 Aug 15;308(7):690-9. doi: 10.1001/jama.2012.9071.
3
Treatment of co-occurring posttraumatic stress disorder and substance use disorders.共病创伤后应激障碍和物质使用障碍的治疗。
Curr Psychiatry Rep. 2012 Oct;14(5):469-77. doi: 10.1007/s11920-012-0300-0.
4
Psychological treatments for concurrent posttraumatic stress disorder and substance use disorder: a systematic review.同时患有创伤后应激障碍和物质使用障碍的心理治疗：系统评价。
Clin Psychol Rev. 2012 Apr;32(3):202-14. doi: 10.1016/j.cpr.2012.01.004. Epub 2012 Feb 10.
5
Developing the tools of implementation science in substance use disorders treatment: applications of the consolidated framework for implementation research.开发物质使用障碍治疗中的实施科学工具：实施研究综合框架的应用。
Psychol Addict Behav. 2011 Jun;25(2):262-8. doi: 10.1037/a0022765.
6
Counselors' knowledge of the adoption of tobacco cessation medications in substance abuse treatment programs.咨询师对物质滥用治疗计划中戒烟药物采用的了解。
Am J Addict. 2011 Jan-Feb;20(1):56-62. doi: 10.1111/j.1521-0391.2010.00095.x. Epub 2010 Nov 12.
7
Psychological trauma and substance abuse: the need for an integrated approach.心理创伤与物质滥用：需要采取综合方法。
Trauma Violence Abuse. 2010 Oct;11(4):202-13. doi: 10.1177/1524838010381252.
8
Co-occurring mental and substance abuse disorders: a review on the potential predictors and clinical outcomes.共病的精神和物质滥用障碍：潜在预测因素和临床结局的综述。
Psychiatry Res. 2011 Apr 30;186(2-3):159-64. doi: 10.1016/j.psychres.2010.07.042. Epub 2010 Aug 21.
9
Improving PTSD/substance abuse treatment in the VA: a survey of providers.改善退伍军人事务部创伤后应激障碍/物质滥用治疗：一项提供者调查。
Am J Addict. 2010 May-Jun;19(3):257-63. doi: 10.1111/j.1521-0391.2010.00039.x.
10
Exposure therapy for posttraumatic stress disorder in a residential substance use treatment facility.在一家住院戒毒治疗机构中针对创伤后应激障碍的暴露疗法。
Prof Psychol Res Pr. 2010 Feb 1;41(1):34-40. doi: 10.1037/a0018235.
Zotero 插件