Trauma treatment for veterans in buprenorphine maintenance treatment for opioid use disorder
Trauma treatment for veterans in buprenorphine maintenance treatment for opioid use disorder
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DOI：
10.1016/j.addbeh.2018.09.010
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发表时间：
2019-02-01
影响因子：
4.4
通讯作者：
Rosen, Marc I.
中科院分区：
文献类型：
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作者：
Meshberg-Cohen, Sarah;Black, Anne C.;Rosen, Marc I.
简介：退伍军人中阿片类药物使用障碍 (OUD) 的比例很高。创伤后应激障碍（PTSD）在退伍军人中也很普遍；有合并症的人比没有合并症的人结果更差。本研究评估了开始 OUD 治疗的退伍军人的丁丙诺啡保留率，将没有 PTSD 的退伍军人与接受并发创伤治疗的患有 PTSD 的退伍军人进行比较。 方法：本回顾性图表审查检查了连续转诊丁丙诺啡维持治疗的情况 (N = 140)。通过图表审查确定 PTSD 诊断，保留定义为入院后 6 个月持续维持丁丙诺啡。 Logistic 回归分析比较了没有 PTSD 的退伍军人和接受并发创伤治疗的 PTSD 诊断退伍军人与未接受创伤治疗的 PTSD 诊断退伍军人的丁丙诺啡保留情况。根据阿片类药物类型、年龄和服务相关状态调整模型。结果：67 名 (47.9%) 寻求丁丙诺啡的退伍军人患有 PTSD 诊断；只有 31.3% (n = 21) 在丁丙诺啡维持治疗期间接受创伤治疗，其中 11.9% (n = 8) 接受针对 PTSD 的循证心理治疗。在接受创伤治疗的 PTSD 诊断退伍军人中，90.5% (n = 19/21) 在 6 个月时接受丁丙诺啡维持治疗，而未接受创伤治疗的 PTSD 诊断退伍军人中这一比例为 23.9% (rt = 11/46)，未接受创伤治疗的退伍军人中这一比例为 46.6% (n = 34/73)。在完整模型中，接受创伤治疗的退伍军人继续接受丁丙诺啡治疗的几率是参考组的 43.36 倍。 结论：大多数在丁丙诺啡治疗中诊断为 PTSD 的退伍军人没有接受创伤治疗。那些同时接受创伤治疗的人有更好的记忆力，这表明 OUD 和创伤可以同时得到解决。未来的临床试验应该调查针对患有 PTSD 并寻求丁丙诺啡治疗 OUD 的退伍军人的创伤集中治疗。
Introduction: Opioid use disorder (OUD) rates are high among veterans. PTSD is also prevalent among veterans; those with comorbidity have worse outcomes than those without comorbidity. This study assessed buprenorphine retention rates in veterans initiating OUD treatment, comparing veterans without PTSD to veterans with PTSD who were receiving versus not receiving concurrent trauma treatment.Methods: This retrospective chart review examined consecutive referrals to buprenorphine maintenance (N = 140). PTSD diagnosis was identified by chart review and retention was defined as continuous buprenorphine maintenance 6-months post-admission. Logistic regression analyses compared buprenorphine retention for veterans without PTSD and PTSD-diagnosed veterans who received concurrent trauma treatment to a reference group of PTSD-diagnosed veterans who did not receive trauma treatment. Models adjusted for opioid type, age, and service-connected status.Results: Sixty-seven (47.9%) buprenorphine-seeking veterans carried a PTSD diagnosis; only 31.3% (n = 21) received trauma treatment while in buprenorphine maintenance, with 11.9% (n = 8) receiving evidence-based psychotherapy for PTSD. Among PTSD-diagnosed veterans who received trauma treatment, 90.5% (n = 19/21) were in buprenorphine maintenance at 6-months, compared to 23.9% (rt = 11/46) of PTSD-diagnosed veterans without trauma treatment, and 46.6% (n = 34/73) of veterans without PTSD. In the full model, veterans with trauma treatment had 43.36 times greater odds of remaining in buprenorphine treatment than the reference group.Conclusions: Most PTSD-diagnosed veterans in buprenorphine treatment were not receiving trauma treatment. Those receiving concurrent trauma treatment had better retention, suggesting OUD and trauma can be simultaneously addressed. Future clinical trials should investigate trauma-focused treatment for veterans with comorbid PTSD who are seeking buprenorphine for OUD.