PTSD and Predictors of Residential Drug Treatment Drop Out

描述（由申请人提供）：物质使用障碍（SUDs）与创伤后应激障碍（PTSD; Kessler et al., 1995）高度共病，这种特殊的共病与物质使用治疗失败的更大可能性相关（例如，Ouimette et al., 1998）。此外，研究表明，不是创伤性暴露本身使药物使用者面临更大的治疗失败风险，而是是否存在创伤后应激障碍（Chilcoat & Breslau, 1998）。尽管有一些证据表明，PTSD的存在对药物使用治疗的过程和结果有负面影响，但研究尚未全面检查这种增加的风险是由于当前的PTSD，过去的PTSD，还是仅仅是过去严重创伤暴露的结果。此外，研究尚未探索这种风险增加的具体机制。机制可以从物质使用的自我用药模式中确定（Brady等人，2004）。基于这一模型，患有当前PTSD的SUD患者可能面临退出治疗的风险，因为他们表现出的情绪脆弱性表现为(a)情绪放松；(b)焦虑敏感性；(c)遇险不容忍；(d)情绪回避；和/或e)下丘脑轴功能障碍。为了检验这些变量在治疗退出中的中介作用，我们将对居住治疗中心的四组（n = 50/组）吸毒者进行研究：(1)没有DSM-IV PTSD标准a创伤暴露史的SUD患者；(2)有DSM-IV PTSD诊断标准a型创伤暴露史但不符合当前或既往PTSD诊断标准的SUD患者；(3)有DSM-IV PTSD诊断标准a型创伤暴露史的PTSD患者，不符合当前PTSD诊断标准（过去一个月），但符合过去PTSD诊断标准（一个月前符合PTSD诊断标准）；(4)符合当前PTSD标准的SUD患者（包括标准A创伤性暴露）。我们预计，与所有其他组相比，患有当前PTSD的SUD患者将表现出最高的治疗退出率。此外，情绪失调、焦虑敏感性、情绪回避、低痛苦耐受性和下丘脑轴功能障碍将介导这种关系，即使在控制与治疗失败相关的变量（例如，人口统计学、负面影响、治疗准备、过去创伤暴露的严重程度、药物依赖水平、精神合并症）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).