Flanagan Julianne C, Jones Jennifer L, Jarnecke Amber M, Back Sudie E
Julianne C. Flanagan, Ph.D., is an associate professor in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. Jennifer L. Jones, M.D., is a postdoctoral fellow in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. Amber M. Jarnecke, Ph.D., is a postdoctoral fellow in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. Sudie E. Back, Ph.D., is a professor in the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and a staff psychologist at the Ralph H. Johnson VA Medical Center, Charleston, South Carolina.
Alcohol Res. 2018;39(2):181-192.
Alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD) are highly prevalent and debilitating psychiatric conditions that commonly co-occur. Individuals with comorbid AUD and PTSD incur heightened risk for other psychiatric problems (e.g., depression and anxiety), impaired vocational and social functioning, and poor treatment outcomes. This review describes evidence-supported behavioral interventions for treating AUD alone, PTSD alone, and comorbid AUD and PTSD. Evidence-based behavioral interventions for AUD include relapse prevention, contingency management, motivational enhancement, couples therapy, 12-step facilitation, community reinforcement, and mindfulness. Evidence-based PTSD interventions include prolonged exposure therapy, cognitive processing therapy, eye movement desensitization and reprocessing, psychotherapy incorporating narrative exposure, and present-centered therapy. The differing theories behind sequential versus integrated treatment of comorbid AUD and PTSD are presented, as is evidence supporting the use of integrated treatment models. Future research on this complex, dual-diagnosis population is necessary to improve understanding of how individual characteristics, such as gender and treatment goals, affect treatment outcome.
酒精使用障碍(AUD)和创伤后应激障碍(PTSD)是高度普遍且使人衰弱的精神疾病,它们常常同时出现。患有共病性AUD和PTSD的个体出现其他精神问题(如抑郁和焦虑)、职业和社会功能受损以及治疗效果不佳的风险更高。这篇综述描述了用于单独治疗AUD、单独治疗PTSD以及治疗共病性AUD和PTSD的循证行为干预措施。针对AUD的循证行为干预措施包括预防复发、应急管理、动机增强、夫妻治疗、12步促进法、社区强化和正念。针对PTSD的循证干预措施包括延长暴露疗法、认知加工疗法、眼动脱敏再处理疗法、结合叙事暴露的心理治疗以及以当下为中心的治疗。文中介绍了共病性AUD和PTSD的序贯治疗与综合治疗背后的不同理论,以及支持使用综合治疗模式的证据。有必要对这一复杂的双重诊断人群开展未来研究,以增进对个体特征(如性别和治疗目标)如何影响治疗结果的理解。