PTSD / substance use disorder comorbidity: Treatment options and public health needs.
PTSD / substance use disorder comorbidity: Treatment options and public health needs.
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DOI：
10.1007/s40501-020-00234-8
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发表时间：
2020-12
影响因子：
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通讯作者：
Zweben, Joan E
中科院分区：
文献类型：
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作者：
Najavits, Lisa M;Clark, H Westley;DiClemente, Carlo C;Potenza, Marc N;Shaffer, Howard J;Sorensen, James L;Tull, Matthew T;Zweben, Allen;Zweben, Joan E
创伤后应激障碍（PTSD）通常与物质使用障碍（SUD）同时发生，治疗具有挑战性。我们回顾了目前PTSD/SUD人群中至少一项随机对照试验的所有行为治疗模型。我们确定了选择临床使用模型的因素，强调公共卫生框架，平衡了对证据的需求和对一线环境可行性的需求。7个已发表的模型和6个未发表的模型进行了审查。选择模型的公共卫生考虑因素包括：它是否在广泛的SUD和复杂的SUD患者中进行了研究;它是否可以在小组模式中进行;它对患者和提供者的吸引力;它的成本;劳动力需求;以及它减少物质使用的能力。有两大类模型：那些起源于PTSD领域与SUD领域。总体而言，后者更强的公共卫生因素，更可行的SUD设置。这一类别中已发布的模型包括复发预防，BRENDA和寻求安全。PTSD/SUD研究尚处于早期阶段，需要一种方法来量化试验中的“负担水平”（患者的社会经济劣势）。
Posttraumatic stress disorder (PTSD) commonly co-occurs with substance use disorder (SUD) and is challenging to treat. We review all behavioral therapy models with at least one randomized controlled trial in a current PTSD/SUD population. We identify factors in selecting a model for clinical use, emphasizing a public health framework that balances the need for evidence with the need for feasibility in frontline settings. Seven published models and 6 unpublished models are reviewed. Public health considerations for choosing a model include: whether it’s been studied across a broad range of SUDs and in complex SUD patients; whether it can be conducted in group modality; its appeal to patients and providers; its cost; workforce requirements; and its ability to reduce substance use in addition to PTSD. There are two broad types of models: those that originated in the PTSD field versus the SUD field. Overall, the latter are stronger on public health factors and more feasible in SUD settings. Published models in this category include Relapse Prevention, BRENDA, and Seeking Safety. PTSD/SUD research is at an early stage and there is a need for methodology that quantifies “level of burden” (patients’ socioeconomic disadvantages) across trials.