Najavits Lisa M, Krinsley Karen, Waring Molly E, Gallagher Matthew W, Skidmore Christopher
a Veterans Affairs Boston Healthcare System , Boston , Massachusetts , USA.
b Department of Psychiatry , Boston University School of Medicine , Boston , Massachusetts , USA.
Subst Use Misuse. 2018 Sep 19;53(11):1788-1800. doi: 10.1080/10826084.2018.1432653. Epub 2018 Feb 20.
Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) co-occur in military veterans and other populations.
To conduct a randomized controlled trial to compare a new past-focused treatment (Creating Change; CC), to a well-established, evidence-based present-focused treatment for PTSD/SUD (Seeking Safety; SS), on symptoms of both disorders. CC guides patients to process the past through exploration of PTSD/SUD life themes and memories whereas SS focuses on coping skills in the present.
Fifty-two male and female veterans with current PTSD/SUD were randomized (n = 26 per treatment) and assessed at baseline, end-of-treatment and 3-month follow-up. They received 17 individual one-hour sessions.
Intent-to-treat analyses indicated that both conditions improved over time, with no difference between conditions, on PTSD, alcohol use, and drug use (our primary outcomes) as well as mental health symptoms, quality of life, self-efficacy, and SUD cognitions. Effect sizes were medium except for alcohol use, which was large. Change over time reflected improvement from baseline to end-of-treatment, with gains sustained at follow-up, although alcohol use showed continued improvement from end-of-treatment to follow-up. Both treatments evidenced a strong safety profile; and attendance, alliance, and treatment satisfaction were also very strong. Conclusions/importance: CC has promise as a PTSD/SUD therapy with strong public health relevance and the potential to fill important gaps in the field. We used minimal exclusionary criteria to obtain a real-world sample, which was severe-predominantly substance-dependent with chronic PTSD and additional psychiatric diagnoses. Future research is warranted, especially on nonveteran samples and treatment mechanisms of action.
创伤后应激障碍（PTSD）和物质使用障碍（SUD）在退伍军人及其他人群中共同存在。
开展一项随机对照试验，比较一种新的聚焦于过去的治疗方法（创造改变；CC）与一种成熟的、基于证据的聚焦于当下的PTSD/SUD治疗方法（寻求安全；SS）对两种障碍症状的影响。CC引导患者通过探索PTSD/SUD生活主题和记忆来处理过去，而SS则侧重于当下的应对技能。
52名患有当前PTSD/SUD的男性和女性退伍军人被随机分组（每组治疗26人），并在基线、治疗结束时和3个月随访时进行评估。他们接受了17次每次一小时的个体治疗。
意向性分析表明，随着时间的推移，两种治疗条件下的PTSD、酒精使用、药物使用（我们的主要结局）以及心理健康症状、生活质量、自我效能和SUD认知均有所改善，且两种条件之间无差异。除酒精使用的效应量为大外，其他效应量均为中等。随时间的变化反映了从基线到治疗结束的改善，随访时保持了改善，尽管酒精使用从治疗结束到随访仍持续改善。两种治疗方法都显示出很强的安全性；出勤率、治疗联盟和治疗满意度也都很高。结论/重要性：CC有望成为一种具有很强公共卫生相关性且有可能填补该领域重要空白的PTSD/SUD治疗方法。我们使用了最少的排除标准来获取一个真实世界的样本，该样本严重——主要是物质依赖，伴有慢性PTSD和其他精神科诊断。未来有必要进行研究，特别是针对非退伍军人样本和治疗作用机制的研究。
