Renaud Fabien, Jakubiec Louise, Swendsen Joel, Fatseas Melina
Pôle Inter-établissement d'addictologie, CHU de Bordeaux et Centre Hospitalier Charles Perrens, Bordeaux, France.
University of Bordeaux/CNRS-UMR 5287, Bordeaux, France.
Front Psychiatry. 2021 Dec 14;12:786664. doi: 10.3389/fpsyt.2021.786664. eCollection 2021.
The frequent co-occurrence of post-traumatic stress disorder (PTSD) and substance use disorders (SUDs) leads to manifestations of both conditions that are more severe and more resistance to treatment than single disorders. One hypothesis to explain this synergy is the impact of intrusive memories on craving which, in turn, increases the risk of relapse among patients with substance use disorders. The aim of this systematic review is to examine this possibility by assessing the impact of PTSD and its symptoms on craving among dual disorder patients. Using PRISMA criteria, four databases were comprehensively searched up to June, 2021, in order to identify all candidate studies based on broad key words. Resulting studies were then selected if they examined the impact of PTSD or PTSD symptoms on craving, and if they used standardized assessments of PTSD, SUD, and craving. Twenty-seven articles matched the selection criteria and were included in this review. PTSD was found to be significantly associated with increased craving levels among patients with alcohol, cannabis, cocaine, tobacco, and other substance use disorders. Exposition to traumatic cues among dual disorder patients was also shown to trigger craving, with an additive effect on craving intensity when exposure to substance-related cues occurred. In addition, certain studies observed a correlation between PTSD symptom severity and craving intensity. Concerning mechanisms underlying these associations, some findings suggest that negative emotional states or emotion dysregulation may play a role in eliciting craving after traumatic exposure. Moreover, these studies suggest that PTSD symptoms may, independently of emotions, act as powerful cues that trigger craving. These findings argue for the need of dual disorder treatment programs that integrate PTSD-focused approaches and emotion regulation strategies, in addition to more traditional interventions for craving management.
创伤后应激障碍（PTSD）与物质使用障碍（SUDs）经常同时出现，导致这两种疾病的表现比单一疾病更严重，且更难治疗。一种解释这种协同作用的假说是侵入性记忆对渴望的影响，这反过来又增加了物质使用障碍患者复发的风险。本系统综述的目的是通过评估PTSD及其症状对双重障碍患者渴望的影响来检验这种可能性。根据PRISMA标准，全面检索了截至2021年6月的四个数据库，以便根据广泛的关键词识别所有候选研究。如果研究考察了PTSD或PTSD症状对渴望的影响，并且使用了PTSD、SUD和渴望的标准化评估，则选择这些研究。27篇文章符合选择标准并被纳入本综述。研究发现，PTSD与酒精、大麻、可卡因、烟草和其他物质使用障碍患者的渴望水平增加显著相关。双重障碍患者接触创伤线索也会引发渴望，当接触与物质相关的线索时，对渴望强度有累加效应。此外，一些研究观察到PTSD症状严重程度与渴望强度之间存在相关性。关于这些关联的潜在机制，一些研究结果表明，负面情绪状态或情绪失调可能在创伤暴露后引发渴望中起作用。此外，这些研究表明，PTSD症状可能独立于情绪，作为引发渴望的有力线索。这些发现表明，除了更传统的渴望管理干预措施外，还需要将以PTSD为重点的方法和情绪调节策略纳入双重障碍治疗项目。
