The efficacy of an intervention for PTSD among illicit drug users

澳大利亚和国际文献都清楚地认识到，在患有非法药物使用障碍(IDUD)的人中，创伤后应激障碍(PTSD)的高流行率。在澳大利亚，33%的阿片类药物使用障碍者和24%的苯丙胺使用障碍者患有共病的创伤后应激障碍。另一方面，酒精使用障碍患者的患病率相对较低(5%)。尽管创伤后应激障碍在iDud患者中的患病率很高，但对这一重大问题的治疗反应的研究很少。患有这种共病的个人对药物滥用治疗提供者构成了一个重大挑战，因为他们的临床特征较差，治疗结果也较差，包括较高的再住院率。因此，它们是医疗保健系统的代价高昂的负担。通过实施一种同时处理这两种疾病的综合治疗方法，可以大大降低个人患者和社会的这种共病的成本。然而，很少有研究指导如何最好地治疗iDud和创伤后应激障碍。虽然已经开发和试验了少量干预措施，但没有一项干预措施在澳大利亚的环境中进行过评估。一种在美国显示出希望的干预措施是同时治疗创伤后应激障碍和物质使用障碍(CTPSD)。初步研究表明，CTPSD可以安全使用，并在治疗可卡因依赖患者的PTSD方面有效。该计划的完成者显示，从基线到治疗结束，所有创伤后应激障碍症状群和可卡因使用量显着减少，并在6个月的随访中保持不变。抑郁症状的显著减少也被观察到。尽管有这些有希望的结果，CTPSD还没有进行随机对照试验。这项拟议的研究是一项关于CTPSD在澳大利亚环境下疗效的随机对照试验。

The high prevalence of PTSD among people with illicit drug use disorders (IDUD) has been clearly recognised in both the Australian and international literature. In Australia, 33% of those with opioid use disorders and 24% of those with amphetamine use disorders have comorbid PTSD. The prevalence among people with alcohol use disorders on the other hand, is comparably low (5%). Despite the high prevalence of PTSD among people with IDUD, research on treatment responses to this significant problem is sparse. Individuals with this comorbidity present a significant challenge to substance abuse treatment providers as they present with a poorer clinical profile, and have poorer treatment outcomes, including higher readmission rates. Consequently, they are a costly burden to the health care system. The costs of this comorbidity to individual sufferers and society may be reduced substantially by the implementation of an integrated treatment that addresses both disorders concurrently. There is however, little research to guide how best to treat comorbid IDUD and PTSD. Although a small number of interventions have been developed and trialled, none have been evaluated in an Australian setting. One intervention which has shown promise in the United States is Concurrent Treatment of PTSD and Substance Use Disorder (CTPSD). Preliminary research has shown that CTPSD can be used safely and is effective in the treatment of PTSD among individuals with cocaine dependence. Completers of the program have demonstrated significant reductions in all PTSD symptom clusters and cocaine use from baseline to end of treatment which were maintained at 6 month follow-up. Significant reductions in depressive symptoms were also observed. Despite these promising results, CTPSD is yet to undergo a randomised controlled trial. The proposed study is a randomised controlled trial of the efficacy of CTPSD in the Australian setting.