PTSD and Predictors of Residential Drug Treatment Drop Out

描述(由申请人提供)：物质使用障碍(SODS)与创伤后应激障碍(PTSD；Kessler等人，1995)高度并存，这种特殊的共病与物质使用治疗失败的可能性更大相关(例如，Ouimette等人，1998)。此外，研究表明，创伤性暴露本身并不会使吸毒者面临治疗失败的更大风险，而是无论是否存在创伤后应激障碍(Chilcoat&Breslau，1998)。尽管有一些证据表明，创伤后应激障碍的存在有一些独特的东西，会对药物使用治疗的过程和结果产生负面影响，但研究尚未全面检查这种风险增加是由于当前的创伤后应激障碍、过去的创伤后应激障碍，还是仅仅是过去严重的创伤暴露的结果。此外，研究还没有探索这种风险增加背后的具体机制。机制可以从物质使用的自我用药模式中确定(Brady等人，2004年)。根据这一模型，目前患有创伤后应激障碍的SUD患者可能面临退出治疗的风险，因为他们在以下方面表现出情绪脆弱性：(A)情绪放松；(B)焦虑敏感；(C)痛苦不耐受；(D)情绪回避；和/或e)HPA轴功能障碍。为了测试这些变量在治疗退出中的中介作用，我们将在一个社区治疗中心检查四组(n=50/组)市内吸毒者：(1)无DSM-IV PTSD标准A创伤性暴露史的SUD患者；(2)有DSM-IV PTSD标准A创伤性暴露但不符合现在或过去PTSD标准的SUD患者；(3)有DSM-IV创伤后应激障碍病史的患者创伤暴露不符合当前创伤后应激障碍的标准(过去一个月)，但符合既往创伤后应激障碍的标准(一个月前符合创伤后应激障碍的诊断标准)；以及(4)符合当前创伤后应激障碍的诊断标准(包括存在A标准创伤后应激障碍)。我们预计，与所有其他组相比，目前患有创伤后应激障碍的SUD患者将表现出最高的治疗辍学率。此外，情绪失调、焦虑敏感性、情绪回避、低痛苦耐受性和HPA轴功能障碍将调节这种关系，即使在控制了经常与治疗失败相关的变量(例如，人口统计学、负面情绪、治疗准备情况、既往创伤暴露的严重程度、药物依赖程度、精神疾病)时也是如此。

DESCRIPTION (provided by applicant): Substance use disorders (SUDs) are highly comorbid with posttraumatic stress disorder (PTSD; Kessler et al., 1995), and this particular comorbidity is associated with a greater likelihood of substance use treatment failure (e.g., Ouimette et al., 1998). Further, research suggests that it is not traumatic exposure per se that puts substance users at greater risk for treatment failure, but whether or not PTSD is present (Chilcoat & Breslau, 1998). Despite some evidence that there is something unique to the presence of PTSD that negatively affects the course and outcome of substance use treatment, studies have not yet comprehensively examined whether this heightened risk is due to current PTSD, past PTSD, or simply a consequence of severe past traumatic exposure. Further, studies have yet to explore the specific mechanisms underlying this increased risk. Mechanisms may be identified from the self-medication model of substance use (Brady et al., 2004). Building from this model, SUD patients with current PTSD may be at risk for treatment drop-out to the extent to which they exhibit emotional vulnerabilities in the form of (a) emotion deregulation; (b) anxiety sensitivity; (c) distress intolerance; (d) emotional avoidance; and/or e) HPA axis dysfunction. To test the mediational role of these variables in treatment drop-out, we will examine four groups (n = 50/group) of inner-city drug users in a residential treatment center: (1) SUD patients with no history of DSM-IV PTSD criterion A traumatic exposure; (2) SUD patients with a history of DSM-IV PTSD criterion A traumatic exposure but not meeting criteria for current or past PTSD; (3) SUD patients with a history of DSM-IV PTSD criterion A traumatic exposure not meeting criteria for current PTSD (past month), but meeting criteria for past PTSD (criteria met for a PTSD diagnosis before one month ago); and (4) SUD patients meeting criteria for current PTSD (which includes the presence of criterion A traumatic exposure). We expect that SUD patients with current PTSD, as compared to all other groups, will exhibit the highest rates of treatment drop-out. Further, emotion dysregulation, anxiety sensitivity, emotional avoidance, low distress tolerance, and HPA axis dysfunction will mediate this relationship, even when controlling for variables often associated with treatment failure (e.g., demographics, negative affect, treatment readiness, severity of past traumatic exposure, level of drug dependence, psychiatric comorbidity).