Najavits L M, Gastfriend D R, Barber J P, Reif S, Muenz L R, Blaine J, Frank A, Crits-Christoph P, Thase M, Weiss R D
Department of Psychiatry, Harvard Medical School, Boston, USA.
Am J Psychiatry. 1998 Feb;155(2):214-9. doi: 10.1176/ajp.155.2.214.
This study examined the prevalence of lifetime traumatic events and current symptoms of posttraumatic stress disorder (PTSD) among treatment-seeking cocaine-dependent outpatients and compared patients with and without PTSD on current substance use, psychopathology, and sociodemographic characteristics.
The subjects were 122 adult cocaine-dependent outpatients participating in a treatment outcome study of psychosocial therapy. In addition to standard self-report and interview measures of psychopathology and substance use, the subjects completed the Trauma History Questionnaire and the PTSD Checklist before entering treatment.
These patients experienced a large number of lifetime traumatic events (mean = 5.7); men experienced more general disasters and crime-related traumas than women, and women experienced more physical and sexual abuse than men. According to self-report measures, 20.5% of the subjects currently met the DSM-III-R criteria for PTSD; the rate of PTSD was 30.2% among women and 15.2% among men. Patients with PTSD had significantly higher rates of co-occurring axis I and axis II disorders, interpersonal problems, medical problems, resistance to treatment, and psychopathology symptoms than patients without PTSD. Psychopathology symptoms represented the most consistent difference between the two groups and provided the best prediction of PTSD status in a logistic regression. However, the groups did not differ significantly in current substance use or sociodemographic characteristics.
These findings underscore the value of screening substance abusers for PTSD, because it can identify a small but substantial number who might require additional treatment. Further studies of the relationship between PTSD and substance abuse appear warranted.
本研究调查了寻求治疗的可卡因依赖门诊患者一生中创伤性事件的发生率以及创伤后应激障碍（PTSD）的当前症状，并比较了有无PTSD的患者在当前物质使用、精神病理学和社会人口学特征方面的差异。
研究对象为122名参与心理社会治疗疗效研究的成年可卡因依赖门诊患者。除了采用标准的自我报告和访谈方式评估精神病理学和物质使用情况外，研究对象在进入治疗前还完成了创伤史问卷和PTSD检查表。
这些患者一生中经历了大量创伤性事件（平均=5.7）；男性经历的一般灾难和与犯罪相关的创伤比女性多，而女性经历的身体和性虐待比男性多。根据自我报告测量，20.5%的研究对象目前符合DSM-III-R的PTSD标准；女性的PTSD发生率为30.2%，男性为15.2%。与无PTSD的患者相比，患有PTSD的患者共病轴I和轴II障碍、人际问题、医疗问题、治疗抵抗和精神病理学症状的发生率显著更高。精神病理学症状是两组之间最一致的差异，并且在逻辑回归中对PTSD状态的预测效果最佳。然而，两组在当前物质使用或社会人口学特征方面没有显著差异。
这些发现强调了对药物滥用者进行PTSD筛查的价值，因为它可以识别出一小部分但数量可观的可能需要额外治疗的人。对PTSD与药物滥用之间关系的进一步研究似乎很有必要。
