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创伤后应激障碍症状群和渴望因主要药物选择而异。

PTSD Symptom Clusters and Craving Differs by Primary Drug of Choice.

机构信息

Graduate Psychology, Pacific University, Hillsboro, Oregon, USA.

出版信息

J Dual Diagn. 2019 Oct-Dec;15(4):233-242. doi: 10.1080/15504263.2019.1637039. Epub 2019 Jul 14.

Abstract

Research has demonstrated a cyclical relationship between posttraumatic stress disorder (PTSD) and substance use disorder. Identifying factors that link PTSD symptom clusters and substance use disorder may illuminate mechanisms underlying the PTSD-substance use disorder relationship, better informing interventions that target this comorbidity. The current study of individuals enrolled in an outpatient aftercare chemical dependency program in King County, Washington, assessed whether overall PTSD symptoms and specific PTSD symptom clusters predicted craving depending on individuals identified primary drug of choice (DOC). Participants eligible for the parent study were at least 18 years of age, fluent in English, medically cleared from substance withdrawal, and able to participate in treatment sessions and agreed to random assignment. Random assignment to either a mindfulness-based relapse prevention group, a standard relapse prevention group, or a treatment as usual group was conducted on a computer randomization program. A secondary analysis of baseline data was employed in the current study to determine which of the PTSD symptom clusters (avoidance, hyperarousal, and intrusion) predicted substance craving. Covarying for severity of dependence, results suggest that overall PTSD scores predicted craving in participants who identified alcohol, stimulants, and opiates as their primary DOC. Further, avoidance-related PTSD symptoms alone predicted a significant proportion of the variability in craving in stimulant users, and hyperarousal symptoms alone predicted a significant proportion of the variability in craving in alcohol users. No specific PTSD cluster significantly predicted a proportion of the variability in craving in marijuana or opiates users. Findings suggest that craving may play a role in maintaining the relationship between specific PTSD symptom clusters and substance use disorder, and the nature of this relationship may differ by primary DOC. The clinical trial on which this secondary analysis of data was conducted is registered as NCT01159535 at www.clinicaltrials.gov.The original trial from which data for this study was drawn was supported by the National Institutes of Health [NIH/NIDA 5 R01 DA025764-02].

摘要

研究表明,创伤后应激障碍(PTSD)和物质使用障碍之间存在周期性关系。确定将 PTSD 症状群和物质使用障碍联系起来的因素可以阐明 PTSD-物质使用障碍关系背后的机制,从而更好地为针对这种共病的干预措施提供信息。本研究对华盛顿金县门诊康复化学依赖项目的参与者进行了研究,评估了整体 PTSD 症状和特定 PTSD 症状群是否根据个体确定的主要药物选择(DOC)预测渴望。有资格参加母研究的参与者年龄至少 18 岁,精通英语,从物质戒断中康复,能够参加治疗课程并同意随机分配。在计算机随机程序上对基于正念的复发预防小组、标准复发预防小组或常规治疗小组进行了随机分组。本研究采用基线数据的二次分析来确定 PTSD 症状群(回避、过度警觉和入侵)中的哪一个预测物质渴望。在考虑了依赖严重程度后,结果表明,对于将酒精、兴奋剂和阿片类药物确定为主要 DOC 的参与者,整体 PTSD 评分预测了渴望。此外,回避相关 PTSD 症状单独预测了兴奋剂使用者渴望变化的很大一部分,而过度警觉症状单独预测了酒精使用者渴望变化的很大一部分。没有特定的 PTSD 集群显著预测了大麻或阿片类药物使用者渴望变化的比例。研究结果表明,渴望可能在维持特定 PTSD 症状群与物质使用障碍之间的关系中发挥作用,并且这种关系的性质可能因主要 DOC 而异。进行这项数据分析的临床试验在 www.clinicaltrials.gov 上注册为 NCT01159535。这项研究的数据来自 NIH/NIDA 5 R01 DA025764-02 资助的原始试验。

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