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创伤后应激障碍合并物质使用障碍的退伍军人:单一物质使用障碍与多种物质使用障碍是否会影响治疗效果?

Veterans with PTSD and comorbid substance use disorders: Does single versus poly-substance use disorder affect treatment outcomes?

机构信息

Department of Behavioral Sciences and Psychiatry, Division of Addiction Sciences, Medical University of South Carolina, 5 Charleston Center Dr., Suite 151, Charleston, SC, 29401 USA.

Department of Behavioral Sciences and Psychiatry, Division of Addiction Sciences, Medical University of South Carolina, 5 Charleston Center Dr., Suite 151, Charleston, SC, 29401 USA.

出版信息

Drug Alcohol Depend. 2019 Jun 1;199:70-75. doi: 10.1016/j.drugalcdep.2019.04.001. Epub 2019 Apr 9.


DOI:10.1016/j.drugalcdep.2019.04.001
PMID:31009834
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6534455/
Abstract

INTRODUCTION: Substance use disorders (SUD) frequently co-occur with posttraumatic stress disorder (PTSD). Little is known, however, about how individuals with a single SUD diagnosis (relating to only one substance) compare to individuals with poly-SUD diagnoses (relating to more than one substance) on substance use and PTSD treatment outcomes. To address this gap in the literature, we utilized data from a larger study investigating a 12-week integrated, exposure-based treatment (i.e., Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure, or COPE) to examine treatment outcomes by single vs. poly-SUD status. METHOD: Participants were 54 Veterans (92.6% male, average age = 39.72) categorized as having single SUD (n = 39) or poly-SUD (n = 15). T-tests characterized group differences in baseline demographics and presenting symptomatology. Multilevel models examined differences in treatment trajectories between participants with single vs. poly-SUD. RESULTS: Groups did not differ on baseline frequency of substance use, PTSD symptoms, or treatment retention; however, individuals with poly-SUD evidenced greater reductions in percent days using substances than individuals with a single SUD, and individuals with a single SUD had greater reductions in PTSD symptoms than individuals with poly-SUD over the course of treatment. DISCUSSION: The findings from this exploratory study suggest that Veterans with PTSD and co-occurring poly-SUD, as compared to a single-SUD, may experience greater improvement in substance use but less improvement in PTSD symptoms during integrated treatment. Future research should identify ways to enhance treatment outcomes for individuals with poly-SUD, and to better understand mechanisms of change for this population.

摘要

简介:物质使用障碍(SUD)经常与创伤后应激障碍(PTSD)共病。然而,对于仅有单一 SUD 诊断(仅与一种物质相关)的个体与具有多 SUD 诊断(与多种物质相关)的个体在物质使用和 PTSD 治疗结果方面的差异,我们知之甚少。为了弥补文献中的这一空白,我们利用了一项更大规模研究的数据,该研究调查了一种为期 12 周的综合、基于暴露的治疗方法(即,使用延长暴露治疗 PTSD 和物质使用障碍,COPE),以检查单一 SUD 与多 SUD 状态下的治疗结果。 方法:参与者为 54 名退伍军人(92.6%为男性,平均年龄为 39.72 岁),分为具有单一 SUD(n=39)或多 SUD(n=15)。T 检验描述了基线人口统计学和表现症状方面的组间差异。多层次模型检查了具有单一 SUD 与多 SUD 的参与者之间治疗轨迹的差异。 结果:两组在基线物质使用频率、PTSD 症状或治疗保留方面没有差异;然而,与具有单一 SUD 的个体相比,具有多 SUD 的个体在物质使用的天数百分比减少方面表现出更大的改善,而在治疗过程中,具有单一 SUD 的个体在 PTSD 症状方面的改善大于具有多 SUD 的个体。 讨论:这项探索性研究的结果表明,与单一 SUD 相比,患有 PTSD 和共病多 SUD 的退伍军人在综合治疗中可能在物质使用方面有更大的改善,但 PTSD 症状的改善较少。未来的研究应确定如何提高多 SUD 个体的治疗效果,并更好地理解该人群的变化机制。

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引用本文的文献

[1]
Post-traumatic stress disorder: a psychiatric disorder requiring urgent attention.

Med Rev (2021). 2022-8-2

[2]
Patterns of polysubstance use and clinical comorbidity among persons seeking substance use treatment: An observational study.

J Subst Use Addict Treat. 2023-3

[3]
Problematic Gambling Behavior in a Sample with Substance Use Disorder: The Role of Attachment Style and Alexithymia.

J Gambl Stud. 2023-6

[4]
Cross-lagged effects of posttraumatic stress disorder symptom severity and cigarette smoking among OEF/OIF/OND veterans.

Depress Anxiety. 2020-11

[5]
The Role of Attachment in Poly-Drug Use Disorder: An Overview of the Literature, Recent Findings and Clinical Implications.

Front Psychiatry. 2019-8-27

本文引用的文献

[1]
Concurrent treatment of substance use disorders and PTSD using prolonged exposure: A randomized clinical trial in military veterans.

Addict Behav. 2018-11-27

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