Scott F. Coffey

Financial and Social Circumstances and the Incidence and Course of PTSD in Mississippi During the First Two Years After Hurricane Katrina

Hurricane Katrina was the most devastating natural disaster to hit the United States in the past 75 years. The authors conducted interviews of 810 persons who were representative of adult residents living in the 23 southernmost counties of Mississippi before Hurricane Katrina. The prevalence of posttraumatic stress disorder (PTSD) since Hurricane Katrina was 22.5%. The determinants of PTSD were female gender, experience of hurricane-related financial loss, postdisaster stressors, low social support, and postdisaster traumatic events. Kaplan-Meier survival curves suggest that exposure to both hurricane-related traumatic events and to financial and social stressors influenced the duration of PTSD symptoms. Postdisaster interventions that aim to improve manipulable stressors after these events may influence the onset and course of PTSD.

Substance Abuse and Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) frequently co-occur. Among individuals seeking treatment for SUDs, approximately 36% to 50% meet criteria for lifetime PTSD. The self-medication and susceptibility hypotheses are two of the hypotheses that have been proposed to help explain the etiological relationship between PTSD and SUDs. It is also possible that common factors, such as genetic, neurobiological, or environmental factors, contribute to the high rate of PTSD-SUD co-occurrence. Preliminary results from integrated psychotherapy approaches for the treatment of patients with both disorders show promise. This article reviews these and other advances in the study of comorbid PTSD and SUDs, and suggests areas for future work.

Cocaine Dependence with and without Post-traumatic Stress Disorder: A Comparison of Substance Use, Trauma History and Psychiatric Comorbidity

This study examined the relationship between substance use, trauma history, post-traumatic stress disorder (PTSD), and psychiatric comorbidity in a treatment seeking sample of cocaine dependent individuals (N = 91). Structured clinical interviews revealed that 42.9% of the sample met DSM-III-R criteria for lifetime PTSD. Comparisons between individuals with and without lifetime PTSD revealed that individuals with PTSD had significantly higher rates of exposure to traumatic events, earlier age of first assault, more severe symptomatology, and higher rates of Axis I and Axis II diagnoses. The results illustrate a high incidence of PTSD among cocaine dependent individuals. Routine assessment of trauma history and PTSD may assist in the identification of a subgroup of cocaine users in need of special prevention and treatment efforts.

Screening for PTSD in a substance abuse sample: Psychometric properties of a modified version of the PTSD symptom scale self-report

The high rate of posttraumatic stress disorder (PTSD) among substance use disorder (SUD) patients has been documented in research protocols, but there is evidence that it is markedly under-diagnosed in clinical settings. To address the need for a brief self-report measure to identify SUD patients who may benefit from further assessment and/or treatment for PTSD, the psychometric properties of a modified version of the PTSD Symptom Scale Self-Report (PSSSR) were examined in a treatment-seeking SUD sample (N = 118). The modified version of the PSS-SR, which measures both frequency and severity of PTSD symptoms, demonstrated good internal consistency reliability and was correlated with other self-report measures of trauma-related symptomatology. Comparisons between a structured PTSD diagnostic interview and the modified PSS-SR indicated that 89% of the PTSD positive patients were correctly classified by the modified PSS-SR. The clinical relevance of these findings was discussed.

Psychometric Properties of the Posttraumatic Cognitions Inventory (PTCI): A Replication With Motor Vehicle Accident Survivors.

This study examined the factor structure, internal consistency, concurrent validity, discriminant validity, and discriminative validity of the Posttraumatic Cognitions Inventory (PTCI; E. B. Foa, A. Ehlers, D. M. Clark, D. F. Tolin, and S. M. Orsillo, 1999) in a sample of 112 individuals who had experienced a serious motor vehicle accident. Results generally supported the 3-factor structure of the PTCI: (a) Negative Cognitions About Self, (b) Negative Cognitions About the World, and (c) Self-Blame. Subscales reflecting negative thoughts of the self and world showed adequate internal consistency, as well as good concurrent, discriminant, and discriminative validity. However, difficulties with the subscale representing self-blame emerged, specifically poor concurrent and discriminant validity. Potential reasons for this finding are discussed. The PTCI seems to be a promising measure of negative and dysfunctional posttrauma cognitions, which deserves continuing attention.

Trauma-focused imaginal exposure for individuals with comorbid posttraumatic stress disorder and alcohol dependence: revealing mechanisms of alcohol craving in a cue reactivity paradigm.

With a sample (N = 43) of participants meeting current diagnostic criteria for both alcohol dependence and posttraumatic stress disorder (PTSD), the authors tested the hypothesis that alcohol craving elicited by a trauma cue might be attenuated if trauma-elicited negative emotion were reduced following trauma-focused imaginal exposure. In a laboratory-based experiment, participants were randomly assigned to either trauma-focused imaginal exposure or imagery-based relaxation. A cue reactivity paradigm was used to assess alcohol craving prior to, and after completion of, the 6 clinical sessions. Attrition was high but did not differ between experimental conditions. For study completers, PTSD symptoms decreased in the exposure condition but not in the relaxation condition. Alcohol craving and distress elicited by trauma images decreased in the exposure condition but did not change in the relaxation condition. Results support the hypothesis that negative emotion is a mechanism of alcohol craving.

The use of divalproex in alcohol relapse prevention: a pilot study.

Anticonvulsant agents show promise in the treatment of the acute symptoms of alcohol withdrawal and may also treat some symptoms associated with the protracted abstinence syndrome. Impulsivity, hostility and irritability are common characteristics of alcohol-dependent individuals, and there is some evidence that anticonvulsant agents decrease these traits in individuals with a number of different psychiatric disorders. This pilot study is a 12-week, double-blind, placebo-controlled trial of an anticonvulsant agent, divalproex (DVPX), in alcohol-dependent individuals. Alcohol use (Timeline Follow Back), impulsivity (Barratt Impulsivity Scale), irritability and aggression (Buss-Durkee Hostility Index; and Anger, Irritability, Aggression Scale) were measured at baseline and throughout the 12-week treatment period. Drinking decreased significantly in both the placebo and the DVPX-treated groups. In the DVPX group, a significantly smaller percentage of individuals relapsed to heavy drinking, but there were no significant differences in other alcohol-related outcomes. There were significantly greater decreases in irritability in the DVPX-treated group and a trend towards greater decreases on measures of lability and verbal assault. There were no significant between-group differences on measures of impulsivity. While DVPX did not have a robust effect on alcohol-related outcomes, it did have modest impact on a measure of irritability. This is consistent with the findings of other investigators exploring the use of DVPX in schizophrenia, personality disorder and a number of other psychiatric disorders.

Acute and protracted cocaine abstinence in an outpatient population: a prospective study of mood, sleep and withdrawal symptoms.

This study addresses unresolved questions about cocaine withdrawal by prospectively assessing monitored cocaine abstinence over 28 days in a sample of 24 male and female cocaine-dependent outpatients. Based on results from urine drug screens and self-reported substance use, it is likely that these patients were abstinent from cocaine during the assessment period. Abstinence-related symptoms were monitored at 2, 5, 10, 14, 21, and 28 days following last cocaine use. For patients who were known to relapse, assessments began again after the last day of cocaine use. Consistent with findings from inpatient studies of cocaine abstinence, linear improvements in negative affect, low cocaine craving, and increases in cognitive skills were reported over the 28 days. Also consistent with inpatient studies of cocaine withdrawal, a phasic withdrawal syndrome was not observed in this outpatient sample. Unlike inpatient studies, no disturbances in sleep were reported.

Psychometric properties of the IES-R in traumatized substance dependent individuals with and without PTSD

Posttraumatic stress disorder (PTSD) is common among treatment-seeking substance abusers. Despite the high prevalence of these co-occurring conditions, few PTSD screening tools have been evaluated for their utility in identifying PTSD in substance use disorder (SUD) populations. The present study evaluated the psychometric properties of the Impact of Event Scale-Revised (IES-R) in a sample of 124 substance dependent individuals. All participants had a history of a DSM-IV Criterion A traumatic event, and 71 individuals met diagnostic criteria for PTSD. Participants with comorbid PTSD reported significantly more symptoms of anxiety, depression, and PTSD compared to substance dependent individuals without PTSD. Acceptable internal consistency and convergent validity of the IES-R were established among a substance dependent sample. Examination of diagnostic effectiveness suggested a cutoff value of 22 as optimal for a substance using population, resulting in adequate classification accuracy, sensitivity, and specificity.

Exposure Therapy for Substance Abusers with PTSD: Translating Research to Practice.

Epidemiological research indicates that there is substantial comorbidity between posttraumatic stress disorder (PTSD) and substance use disorder (SUD). Moreover, there is growing evidence that having a comorbid PTSD diagnosis is associated with greater substance use problem severity and poorer outcomes from SUD treatment. In an attempt to improve the treatment outcome for individuals with PTSD-SUD, recently developed treatments combine exposure therapy for PTSD with an empirically supported treatment for SUD. This article describes one of the treatments and discusses treatment modifications that have been incorporated when translating this research-based therapy to practice in an inner-city community mental health center.