Concurrent treatment of substance use disorders and PTSD using prolonged exposure: A randomized clinical trial in military veterans
Concurrent treatment of substance use disorders and PTSD using prolonged exposure: A randomized clinical trial in military veterans
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DOI：
10.1016/j.addbeh.2018.11.032
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发表时间：
2019-03-01
影响因子：
4.4
通讯作者：
Brady, Kathleen T.
中科院分区：
文献类型：
--
作者：
Back, Sudie E.;Killeen, Therese;Brady, Kathleen T.
目的：相当数量的物质使用障碍（SUD）患者也符合创伤后应激障碍（PTSD）的标准。长期暴露（PE）是一种有效的，循证的治疗PTSD，但有有限的数据，其使用的个人与当前的酒精或药物使用障碍。本研究评估了一个综合治疗，包括PE（同时治疗PTSD和物质使用障碍，使用延长暴露或科普）之间veterination.Method：军事退伍军人（N = 81，90.1%男性）与当前SUD和PTSD的疗效被随机分配到12个会议的科普或复发预防（RP）。主要结果包括临床医生管理的PTSD量表（CAPS），PTSD检查表军事版本（PCL-M），和时间轴随访（TLFB）。结果：平均而言，参与者参加了12个会议中的8个，并有没有保留组差异。意向治疗分析显示，与RP相比，科普导致CAPS（d = 1.4，p <0.001）和PCL-M评分（d = 1.3，p = 0.01）显著更大的降低，以及PTSD诊断缓解率更高（OR = 5.3，p <0.01）。治疗期间，两组SUD严重程度均显著降低且具有可比性。在6个月的随访中，参与者在科普证明了显着减少饮料每饮酒日比参与者在RP（p = .05）。结论：这项研究是第一次报告使用的综合，基于安全的治疗并发SUD和创伤后应激障碍的退伍军人样本。研究结果表明，综合的，基于创伤的治疗是可行的，有效的退伍军人与SUD和PTSD。临床实践的影响进行了讨论。
Objective: A substantial amount of individuals with substance use disorders (SUD) also meet criteria for post traumatic stress disorder (PTSD). Prolonged Exposure (PE) is an effective, evidence-based treatment for PTSD, but there is limited data on its use among individuals with current alcohol or drug use disorders. This study evaluated the efficacy of an integrated treatment that incorporates PE (Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure or COPE) among veterans.Method: Military veterans (N = 81, 90.1% male) with current SUD and PTSD were randomized to 12 sessions of COPE or Relapse Prevention (RP). Primary outcomes included the Clinician Administered PTSD Scale (CAPS), PTSD Checklist-Military version (PCL-M), and the Timeline Follow-back (TLFB).Results: On average, participants attended 8 out of 12 sessions and there were no group differences in retention. Intent-to-treat analyses revealed that COPE, in comparison to RP, resulted in significantly greater reductions in CAPS (d = 1.4, p < .001) and PCL-M scores (d = 1.3, p = .01), as well as higher rates of PTSD diagnostic remission (OR = 5.3, p < .01). Both groups evidenced significant and comparable reductions in SUD severity during treatment. At 6-months follow-up, participants in COPE evidenced significantly fewer drinks per drinking day than participants in RP (p = .05).Conclusions: This study is the first to report on the use of an integrated, exposure-based treatment for co-occurring SUD and PTSD in a veteran sample. The findings demonstrate that integrated, exposure-based treatments are feasible and effective for military veterans with SUD and PTSD. Implications for clinical practice are discussed.