Polysubstance Use Among Veterans in Intensive PTSD Programs: Association With Symptoms and Outcomes Following Treatment
Polysubstance Use Among Veterans in Intensive PTSD Programs: Association With Symptoms and Outcomes Following Treatment
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DOI：
10.1080/15504263.2018.1535150
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发表时间：
2019-01-02
影响因子：
2.2
通讯作者：
Rosenheck, Robert A.
中科院分区：
文献类型：
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作者：
Bhalla, Ish P.;Stefanovics, Elina A.;Rosenheck, Robert A.
目的：最近描述了一组独特的患者，他们经历了以使用多种成瘾物质为特征的多物质使用障碍。本研究探讨了一组这样的患者在专门密集的退伍军人健康管理局创伤后应激障碍（PTSD）项目的基线特征和纵向结果，并在出院后4个月随访。研究方法：在PTSD症状严重程度和功能方面，将诊断为PTSD或亚综合征PTSD的患者与基线时使用单一物质的患者与使用两种或三种以及三种以上不同成瘾物质的患者进行比较。比较还针对任何物质使用的总天数和其他潜在混杂因素的差异进行了调整。根据随访时使用的物质数量对患者进行重新分类，并再次比较症状和功能。结果如下：基线数据的双变量分析（N = 8，240）显示频繁使用多种物质（n = 3，695，占样本的44.8%），并且使用更多数量的物质与更严重的创伤后应激障碍症状以及更多的总天数有关物质使用。在治疗后随访时，对58.2%的原始样本（n = 4，797）进行了评估。多种物质的使用频率较低（n = 756，15.8%的后续样本），但表现出类似的关联更严重的症状，虽然差异减弱后调整物质使用的总天数。结论：多物质的使用，概念化的多morphine的角度来看，与增加的严重程度的创伤后应激障碍症状的退伍军人与双重诊断需要复杂的干预措施，评估将需要创新的试验设计。
Objective: A distinct group of patients has recently been described who experience polysubstance use disorder characterized by use of multiple addictive substances. This study examines baseline characteristics and longitudinal outcomes of a group of such patients in specialized intensive Veterans Health Administration posttraumatic stress disorder (PTSD) programs and followed 4 months after discharge. Methods: Patients with diagnosed PTSD or subsyndromal PTSD and who used a single substance at baseline were compared to those who used two or three and more than three different addictive substances on measures of PTSD symptom severity and functioning. Comparisons were also adjusted for differences in total days of any substance use and other potentially confounding factors. Patients were reclassified according to the number of substances used at follow-up and again compared on symptoms and functioning. Results: Bivariate analysis of baseline data (N = 8,240) showed frequent polysubstance use (n = 3,695, 44.8% of the sample) and that use of greater numbers of substances was associated with more severe PTSD symptoms as well as more total days of substance use. At follow-up after treatment, 58.2% of the original sample (n = 4,797) was assessed. Polysubstance use was less frequent (n = 756, 15.8% of the follow-up sample), but showed a similar association with more severe symptoms, although differences were attenuated after adjusting for total days of substance use. Conclusions: Polysubstance use, conceptualized within the multimorbidity perspective, is associated with increased severity of PTSD symptoms among veterans with dual diagnoses requiring complex interventions, the evaluation of which will require innovative trial designs.