Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA.
J Trauma Stress. 2020 Aug;33(4):465-476. doi: 10.1002/jts.22546. Epub 2020 Jun 29.
Despite research demonstrating the benefit of exposure-based therapy for posttraumatic stress disorder (PTSD) in patients with co-occurring substance use disorders, there remains a strong clinical expectation that this treatment will exacerbate substance use or other psychiatric symptoms. The present study evaluated within-session and session-to-session changes in (a) craving and use of substances for a range of drug classes and (b) symptoms of PTSD and other psychiatric distress in a sample of 44 SUD patients who received prolonged exposure (PE) therapy for PTSD. Visual analog scales showed no within-session increases in craving, except for cocaine, within Session 8. Across sessions, craving scores dropped for heroin, methadone, benzodiazepines, and cocaine; no increases in craving were found. Past-week substance use reported at each session did not differ. The severity of PTSD symptoms and self-reported serious emotional problems decreased from Session 1 to subsequent sessions, with no increases or decreases in other psychiatric, social, or medical problems. Finally, PTSD severity was unrelated to substance use reported 1 or 2 weeks later. Substance use during the past week was associated with higher PTSD severity scores at the next session, B = 6.86 (SE = 2.87), p = .018, but was not associated 2 weeks later. These findings indicate that the concern that exposure therapy for PTSD will increase SUD patients' substance use or other psychiatric symptoms may be unwarranted, and, thus, SUD patients, including those who are actively using, should have access to effective treatments for PTSD, like PE.
尽管研究表明，暴露疗法对同时存在物质使用障碍的创伤后应激障碍（PTSD）患者有益，但临床上仍强烈期望这种治疗会加重物质使用或其他精神症状。本研究评估了 44 名 SUD 患者在接受 PTSD 延长暴露（PE）治疗期间（a）对各种药物类别的物质的渴望和使用情况以及（b）PTSD 和其他精神困扰症状的变化，这些患者接受了延长暴露治疗。视觉模拟量表显示，在第 8 节会话中，除可卡因外，渴望程度没有在会话期间增加。在整个会话中，对海洛因、美沙酮、苯二氮䓬类药物和可卡因的渴望评分下降；没有发现渴望增加的情况。每个会话中报告的过去一周的物质使用情况没有差异。从第 1 节到随后的节次，PTSD 症状的严重程度和自我报告的严重情绪问题有所下降，其他精神、社会或医学问题没有增加或减少。最后，PTSD 严重程度与 1 或 2 周后报告的物质使用无关。过去一周的物质使用与下一个会话的 PTSD 严重程度评分较高有关，B = 6.86（SE = 2.87），p =.018，但在 2 周后没有关联。这些发现表明，担心 PTSD 的暴露治疗会增加 SUD 患者的物质使用或其他精神症状可能是没有根据的，因此，包括那些正在使用物质的 SUD 患者，应该有机会获得 PTSD 的有效治疗，如 PE。
