Kaczkurkin Antonia N, Asnaani Anu, Alpert Elizabeth, Foa Edna B
University of Pennsylvania, Philadelphia, PA 19104, USA.
University of Pennsylvania, Philadelphia, PA 19104, USA.
Behav Res Ther. 2016 Apr;79:7-14. doi: 10.1016/j.brat.2016.02.001. Epub 2016 Feb 15.
Given the high rates of comorbidity between posttraumatic stress disorder (PTSD) and substance use disorder (SUD), we investigated an integrated treatment for these disorders. Individuals with comorbid PTSD and alcohol dependence were randomized to receive naltrexone or placebo, with or without prolonged exposure (PE). All participants also received BRENDA (supportive counseling). The naltrexone plus PE group showed a greater decline in alcohol craving symptoms than those in the placebo with no PE group. The PE plus placebo and the naltrexone without PE groups did not differ significantly from the placebo with no PE group in terms of alcohol craving. No treatment group differences were found for percentage of drinking days. Alcohol craving was moderated by PTSD severity, with those with higher PTSD symptoms showing faster decreases in alcohol craving. Both PTSD and alcohol use had a lagged effect on alcohol craving, with changes in PTSD symptoms and percentage of days drinking being associated with subsequent changes in craving. These results support the relationship between greater PTSD symptoms leading to greater alcohol craving and suggest that reducing PTSD symptoms may be beneficial to reducing craving in those with co-occurring PTSD/SUD.
鉴于创伤后应激障碍（PTSD）与物质使用障碍（SUD）之间的高共病率，我们研究了针对这些障碍的综合治疗方法。患有PTSD和酒精依赖共病的个体被随机分配接受纳曲酮或安慰剂治疗，同时接受或不接受延长暴露疗法（PE）。所有参与者还接受了BRENDA（支持性咨询）。与未接受PE的安慰剂组相比，纳曲酮加PE组的酒精渴望症状下降幅度更大。在酒精渴望方面，PE加安慰剂组和未接受PE的纳曲酮组与未接受PE的安慰剂组没有显著差异。各治疗组在饮酒天数百分比方面未发现差异。PTSD严重程度调节了酒精渴望，PTSD症状较高的个体酒精渴望下降更快。PTSD和酒精使用对酒精渴望都有滞后效应，PTSD症状的变化和饮酒天数百分比与随后的渴望变化相关。这些结果支持了PTSD症状越严重导致酒精渴望越强烈之间的关系，并表明减轻PTSD症状可能有利于减轻同时患有PTSD/SUD者的渴望。
