Pamela J. Brown

Trauma and substance abuse : causes, consequences, and treatment of comorbid disorders

Over the past decade, research on the epidemiology, nature, and meaning of the comorbidity between trauma, posttraumatic stress disorder (PTSD), and substance abuse has burgeoned. Changes in the political and social climate of the United States during this time have brought with them new challenges. Changes in the definitions of both PTSD and substance abuse have been proposed by those involved with diagnosing and treating people with these issues; some of these changes are expected to be reflected in future diagnostic systems. Trauma and Substance Abuse: Causes, Consequences, and Treatment of Comorbid Disorders, Second Edition offers a broad overview of current trends in the field of co-occurring substance abuse and PTSD from both clinical and research perspectives. The goal of this volume, newly revised to include special settings, such as court systems and disasters, and special populations, such as veterans, is to clarify issues specific to trauma, PTSD, and substance abuse and to translate both quantitative and qualitative data into specific recommendations for clinicians, researchers, and administrators.

PTSD Substance abuse comorbidity and treatment utilization

The present study investigates the prevalence of posttraumatic stress disorder (PTSD) among a sample of treatment-seeking substance abusers and examines the relationship between PTSD comorbidity and rates of inpatient substance abuse treatment. Eighty-four patients (48 male and 36 female) admitted for detoxification at a private hospital were administered self-report measures of lifetime stressor events, PTSD symptomatology, and prior treatment history. Approximately one quarter of the sample was found to present with significant PTSD symptomatology. Women were more likely than men to have been physically and sexually abused, and women reported experiencing a greater number of traumatic events. Consequently, more women than men were classified as having possible PTSD. With respect to inpatient substance abuse treatment admission rates, the PTSD group reported a greater number of hospitalizations than their non-PTSD counterparts. Implications of these findings for routine trauma screening and more effective treatment for substance abusers with concomitant PTSD are highlighted.

Substance use disorder and posttraumatic stress disorder comorbidity: Addiction and psychiatric treatment rates.

This study compares substance use disorder (SUD) patients with and without a comorbid diagnosis of posttraumatic stress disorder (PTSD) on their use of addiction and psychiatric services over the 6-month period before an inpatient substance abuse admission. Compared with non-PTSD patients, PTSD patients had a greater number of hospital overnights for addiction treatment. Given no significant between-groups differences on any substance use indexes, PTSD patients apparently overuse costly inpatient addiction services. Despite their greater rates of psychiatric comorbidity, PTSD patients did not receive treatment for psychiatric problems at greater rates than did non-PTSD patients. Among PTSD patients, use of PTSD treatment was low. Assessment of psychiatric comorbidity and referral to treatment targeting co-occurring PTSD and other disorders are suggested as possible ways to reduce the high treatment costs associated with SUD-PTSD comorbidity.

Posttraumatic Stress Disorder and War-Zone Exposure as Correlates of Perceived Health in Female Vietnam War Veterans.

Previous studies have identified traumatic exposure and posttraumatic stress disorder (PTSD) as predictors of physical health complaints without considering the relationship between exposure and PTSD. This study examined the unique associations of war-zone exposure and PTSD with perceived physical health outcomes in a nontreatment-seeking sample of 109 female veterans of the Vietnam War who responded to a series of psychological, exposure, and health questionnaires. Both PTSD and exposure were associated with reports of negative health outcomes when each variable was not adjusted for the other. The effects associated with exposure decreased when PTSD was controlled for, whereas the effects associated with PTSD remained when exposure was controlled for. Results suggest that effects of traumatic exposure on perceived health are partially mediated by increases in PTSD after exposure, supporting studies on the effects of stress on health.

Substance use disorder-PTSD comorbidity. Patients' perceptions of symptom interplay and treatment issues.

Forty-two patients with both a current substance use disorder (SUD) and posttraumatic stress disorder (PTSD) were asked about the interrelationship of their two disorders, their treatment preferences and experiences, as well as possible deterrents to receiving PTSD treatment. Patients perceived their two disorders to be functionally related. They reported that when one disorder worsened, their other disorder was more likely to worsen; when one disorder improved, the other disorder similarly improved. Consistent with these perceptions, SUD-PTSD patients favored simultaneous treatment of their two disorders. The majority of SUD-PTSD patients were never referred to PTSD treatment. Although several possible deterrents to PTSD treatment were identified, only lack of trust appeared to differentiate PTSD treatment compliers versus noncompliers. Implications of these findings on referral and treatment practices are discussed.

Outcome in Female Patients with Both Substance Use and Post-Traumatic Stress Disorders

Abstract The present study examines six-month treatment outcomes for substance use disordered (SUD) female patients with a comorbid diagnosis of Post-Traumatic Stress Disorder (PTSD). Patients completed a baseline assessment while receiving inpatient substance use treatment and were reinterviewed six-months post-treatment. Approximately one-half the women had relapsed on alcohol and/or drugs during the follow-up period. One-quarter had remitted from PTSD at follow-up. Logistic regressions showed that baseline severity of PTSD reexperiencing symptoms is a significant predictor of both alcohol/drug relapse and PTSD status (remitted/unremitted). No baseline measure of substance use emerged as a significant predictor of PTSD remitted/unremitted status at follow-up. Our results suggest that treatment targeting comorbid PTSD might result in improved outcomes for both disorders.

Determinants of Research Follow-Up Participation in an Alcohol Treatment Outcome Trial

This study examined factors associated with research attrition in a long-term follow-up study (48 months). Researchers attempted to contact all randomized participants, not just those who completed treatment. The processes by which baseline characteristics, early treatment-research experiences, and short-term outcome affected subsequent participations were examined using logistic regression. The analyses deal primarily with refusal, the main reason for attrition. Baseline characteristics had small effects on likelihood of refusal; research engagement had some impact; but treatment participation had strong effect. Short-term outcome did not predict refusal. These findings, if generalizable, have implications for the conduct and reporting of outcome studies. By directly studying bias, rather than presuming its absence on skimpy evidence, researchers can achieve a better understanding of the strengths and limitations of outcome results.