Schnitt J M, Nocks J J
J Subst Abuse Treat. 1984;1(3):179-89. doi: 10.1016/0740-5472(84)90021-7.
Vietnam veterans with alcoholism and Post-Traumatic Stress Disorder (PTSD) are a clinically problematic population. Early self-medication of the PTSD with alcohol led for some to alcohol abuse and dependency. These may often be treated in an intensive alcoholism program. At evaluation both diagnoses are made, and patients are told that alcohol or drug use is not tolerated. The program first focuses on traditional alcoholism treatment issues. Early and consistent support to enhance self-esteem and to reduce guilt helps the patient later to tolerate the gradual investigation of the anger and self-loathing associated with both disorders. Important forces include family and peer support, effective limit setting in a structured milieu, supportive confrontation of alcoholic denial through multidisciplinary treatment in the absence of alcohol. Outpatient follow-up treatment groups include other PTSD sufferers and focus on establishing trust, interweaving the issues of adjustment to sobriety with discussion of the combat experience in a safe, accepting environment, with careful modulation of anxiety by the clinician. Medication must be conservative; benzodiazepines are not used after the detoxification period.
患有酒精成瘾和创伤后应激障碍（PTSD）的越战老兵是临床上存在问题的群体。一些人早期用酒精自我治疗创伤后应激障碍，导致酒精滥用和依赖。这些人通常可以在强化酒精成瘾治疗项目中接受治疗。在评估时会做出两种诊断，并告知患者不允许饮酒或使用药物。该项目首先关注传统的酒精成瘾治疗问题。早期持续的支持以增强自尊和减轻内疚感，有助于患者日后忍受对与这两种疾病相关的愤怒和自我厌恶的逐步探究。重要的力量包括家庭和同伴的支持、在结构化环境中进行有效的界限设定、在不饮酒的情况下通过多学科治疗对酒精成瘾否认进行支持性对抗。门诊后续治疗小组包括其他创伤后应激障碍患者，重点是建立信任，在安全、包容的环境中，将适应清醒的问题与战斗经历的讨论交织在一起，由临床医生仔细调节焦虑情绪。用药必须保守；脱毒期过后不使用苯二氮䓬类药物。
