Do Treatment Improvements in PTSD Severity Affect Substance Use Outcomes? A Secondary Analysis From a Randomized Clinical Trial in NIDA's Clinical Trials Network
Do Treatment Improvements in PTSD Severity Affect Substance Use Outcomes? A Secondary Analysis From a Randomized Clinical Trial in NIDA's Clinical Trials Network
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DOI：
10.1176/appi.ajp.2009.09091261
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发表时间：
2010-01-01
影响因子：
17.7
通讯作者：
Nunes, Edward V.
中科院分区：
文献类型：
--
作者：
Hien, Denise A.;Jiang, Huiping;Nunes, Edward V.
目的：探讨门诊药物滥用治疗女性创伤后应激障碍(PTSD)和药物使用障碍症状改善的时间进程。方法：将353名女性随机分为创伤组和健康教育组，每组12个疗程。在治疗期间、治疗后1周、3个月、6个月和12个月进行创伤后应激障碍和物质使用评估。连续马尔科夫模型适用于四个已定义的反应类别(无反应、物质使用反应、创伤后应激反应或总体反应[创伤后应激障碍和物质使用的改善])，以调查研究治疗阶段创伤后应激障碍的改善与物质使用症状严重程度之间的时间关联。结果：表现为无反应、物质使用反应或总体反应的受试者倾向于保持原有的分类；表现为创伤后应激障碍反应的受试者随着时间的推移更有可能转变为整体反应，这表明持续的创伤后应激障碍改善与随后的物质使用改善有关。创伤为重点的治疗在改善物质使用方面明显比健康教育更有效，但仅限于那些在基线水平上使用大量物质并已显著减少创伤后应激障碍的人。结论：创伤后应激障碍严重程度的降低更可能与物质使用的改善有关，只有极少的证据表明物质使用症状减少改善了创伤后应激障碍症状。结果支持应对创伤后应激障碍症状的自我用药模式，并为综合干预改善严重症状患者的药物使用结果提供了经验基础。
Objective: The purpose of the analysis was to examine the temporal course of improvement in symptoms of posttraumatic stress disorder ( PTSD) and substance use disorder among women in outpatient substance abuse treatment.Method: Participants were 353 women randomly assigned to 12 sessions of either trauma-focused or health education group treatment. PTSD and substance use assessments were conducted during treatment and posttreatment at 1 week and after 3, 6, and 12 months. A continuous Markov model was fit on four defined response categories (non-response, substance use response, PTSD response, or global response [ improvement in both PTSD and substance use]) to investigate the temporal association between improvement in PTSD and substance use symptom severity during the study's treatment phase. A generalized linear model was applied to test this relationship over the follow-up period.Results: Subjects exhibiting non-response, substance use response, or global response tended to maintain original classification; subjects exhibiting PTSD response were significantly more likely to transition to global response over time, indicating maintained PTSD improvement was associated with subsequent substance use improvement. Trauma-focused treatment was significantly more effective than health education in achieving substance use improvement, but only among those who were heavy substance users at baseline and had achieved significant PTSD reductions.Conclusions: PTSD severity reductions were more likely to be associated with substance use improvement, with minimal evidence of substance use symptom reduction improving PTSD symptoms. Results support the self-medication model of coping with PTSD symptoms and an empirical basis for integrated interventions for improved substance use outcomes in patients with severe symptoms.