Kline Alexander C, Straus Elizabeth, Lyons Robert C, Angkaw Abigail C, Davis Brittany C, Haller Moira, Hien Denise, Norman Sonya B
VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA; University of California San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92037, USA.
VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA; University of California San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92037, USA.
J Subst Abuse Treat. 2021 May;124:108278. doi: 10.1016/j.jsat.2021.108278. Epub 2021 Jan 7.
Comorbid post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) is common, defined by greater severity and impairment than either disorder alone, and associated with poor treatment attendance. Exposure therapies are effective in treating PTSD+AUD, yet substance use is still cited as a potential contraindication for exposure. This study examined substance use-related predictors of session attendance among veterans (N = 119) randomized to receive integrated exposure therapy (Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure [COPE]; Back et al., 2015) or integrated coping skills therapy (Seeking Safety [SS]; Najavits, 2002) in a clinical trial for comorbid PTSD+AUD (Norman et al., 2019). At baseline, greater percentage of heavy drinking days (β = -0.23, p = .011) and greater AUD severity per structured clinical interview for DSM-IV-TR (β = -0.21, p = .019) predicted fewer sessions across both treatments. Treatment type did not moderate the relationship between predictors and attendance, except for a trend for craving (p = .057), where greater craving predicted fewer sessions in SS (β = -0.31, p = .02) but not COPE (β = 0.14, p = .28). Percentage of abstinence days, AUD duration, and living in a controlled environment (e.g., recovery home) at the start of therapy were not associated with attendance in either treatment condition. Only a subset of substance use characteristics predicted attendance. Findings did not support the notion that alcohol use leads to lower attendance in exposure therapy compared to nonexposure therapy.
创伤后应激障碍（PTSD）和酒精使用障碍（AUD）共病的情况很常见，其严重程度和损害程度比单独的任何一种障碍都要大，并且与治疗出勤率低有关。暴露疗法在治疗PTSD+AUD方面是有效的，但物质使用仍被视为暴露疗法的潜在禁忌症。本研究在一项针对PTSD+AUD共病的临床试验中（Norman等人，2019年），考察了随机接受综合暴露疗法（使用延长暴露同时治疗PTSD和物质使用障碍[COPE]；Back等人，2015年）或综合应对技能疗法（寻求安全[SS]；Najavits，2002年）的退伍军人（N = 119）中与物质使用相关的治疗出勤率预测因素。在基线时，重度饮酒天数的比例较高（β = -0.23，p = 0.011）以及根据DSM-IV-TR结构化临床访谈得出的AUD严重程度较高（β = -0.21，p = 0.019）预测了两种治疗的治疗次数均较少。治疗类型并没有调节预测因素与出勤率之间的关系，但渴望程度存在一种趋势（p = 0.057），即渴望程度较高预测了SS组的治疗次数较少（β = -0.31，p = 0.02），而COPE组则不然（β = 0.14，p = 0.28）。戒酒天数的比例、AUD持续时间以及治疗开始时生活在受控环境（如康复之家）中与两种治疗条件下的出勤率均无关。只有一部分物质使用特征预测了出勤率。研究结果并不支持与非暴露疗法相比，酒精使用会导致暴露疗法出勤率较低这一观点。
