Dworkin Emily R, Zambrano-Vazquez Laura, Cunningham Sarah R, Pittenger Samantha L, Schumacher Julie A, Stasiewicz Paul R, Coffey Scott F
University of Mississippi Medical Center, Jackson MS.
G.V. (Sonny) Montgomery Veteran Affairs Medical Center, Jackson MS.
Rural Ment Health. 2017 Apr;41(2):136-151. doi: 10.1037/rmh0000057. Epub 2017 Jun 5.
The co-occurrence of posttraumatic stress disorder and substance use disorder (PTSD-SUD) can pose significant problems for rural pregnant and postpartum women (PPW) and the well-being of their children. Although effective treatments exist, PPW experience limitations in their ability to access and engage in treatment that may be compounded by various aspects of rural settings, so providers must be attentive to these barriers in order to address this pressing public health need. In addition, as part of increasing rural access to care, it is important to consider the costs and benefits to PPW of selecting exposure-based techniques (e.g., prolonged exposure) to disseminate. The current article discusses the treatment of PTSD-SUD in rural PPW in the context of the authors' experiences providing an exposure-based cognitive behavioral treatment for PTSD in this population. Barriers to treatment access and engagement are discussed and recommendations are provided.
创伤后应激障碍与物质使用障碍（PTSD-SUD）共病会给农村地区的孕妇和产后妇女（PPW）及其子女的福祉带来重大问题。尽管存在有效的治疗方法，但PPW在获得和接受治疗方面存在能力限制，而农村环境的各个方面可能会使这些限制更加复杂，因此医疗服务提供者必须关注这些障碍，以满足这一紧迫的公共卫生需求。此外，作为增加农村地区医疗服务可及性的一部分，重要的是要考虑向PPW推广基于暴露的技术（如延长暴露疗法）的成本和收益。本文结合作者为该人群提供基于暴露的创伤后应激障碍认知行为治疗的经验，探讨了农村PPW中PTSD-SUD的治疗。文中讨论了治疗可及性和参与度方面的障碍并给出了建议。
