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Hoover GG, Teer A, Lento R, Ward P, Zakarian RJ, Tinney W, Sanders W, Echevarria K, Bonvie J, Dunford K, Covitz J, Tanev KS. Innovative outpatient treatment for veterans and service members and their family members. Front Psychiatry 2024; 15:1377433. [PMID: 39114738 PMCID: PMC11303280 DOI: 10.3389/fpsyt.2024.1377433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 07/09/2024] [Indexed: 08/10/2024] Open
Abstract
In 2009, Massachusetts General Hospital and the Red Sox Foundation launched Home Base, a nonprofit dedicated to providing care to veterans, service members, and their loved ones who struggle with the invisible wounds of war free of charge. Significant needs exist for mental health services in each of these populations, and a need for innovative approaches to address shortcomings in existing treatment models. Three inventive components of our programming are highlighted herein: a Veteran Outreach Team, which helps to engage patients in care, programming, and services specifically for family members, and an intensive outpatient substance use treatment program. More than 4,000 patients, 3,031 veterans and service members, and 1,025 family members have engaged in treatment at Home Base. Patients were asked to complete post-treatment self-measures, including a satisfaction questionnaire via an electronic data collection system. The vast majority of individuals who engaged in our treatment model were satisfied with the care they received (>92%) and would refer their peers to the Home Base program (>75%). Data from 78 individuals who completed the dual diagnosis services demonstrated large effect sizes in reductions in alcohol use and comorbid mental health symptoms. These data suggest that novel components to the standard outpatient mental health model might provide substantive benefits for the patients served. While internal data is prone to a lack of generalizability, these additional offerings help ameliorate patients' expressed shortcomings with existing models; present literature that describes the benefits that these additions provide is also reviewed. The lessons learned and limitations are discussed.
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Gournay LR, Ferretti ML, Nguyen AM, Bilsky S, Shields GS, Mann E, Williams P, Woychesin S, Bonn-Miller M, Leen-Feldner EW. The effects of acute versus repeated cannabidiol administration on trauma-relevant emotional reactivity: A double-blind, randomized, placebo-controlled trial. J Trauma Stress 2024. [PMID: 38959155 DOI: 10.1002/jts.23072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 07/05/2024]
Abstract
Despite the widespread use and perceived efficacy of cannabidiol (CBD) as an anxiolytic, few controlled studies have evaluated the effects of CBD on anxiety-relevant indications, and only one has done so in the context of trauma-related symptoms. The current study was designed to address this gap in the literature. Participants were 42 trauma-exposed individuals (Mage = 23.12 years, SDage = 6.61) who endorsed elevated stress. They were randomly assigned to take 300 mg of oral CBD or placebo daily for 1 week. Acute (i.e., following an initial 300 mg dose) and repeated (i.e., following 1 week of daily 300 mg dosing) effects of CBD were evaluated in relation to indicators of anxious arousal (i.e., anxiety, distress, heart rate) in response to idiographic trauma script presentation. The results of the current study suggest that relative to placebo, 300 mg CBD did not significantly reduce anxiety, B = 13.37, t(37) = 1.71, p = .096, d = 0.09, Bayes factor (BF10) = 0.54; distress, B = 15.20, t(37) = 1.31, p = .197, d = 0.07, BF10 = 0.51; or heart rate, B = -1.09, t(36) = -0.32, p = .755, d = 0.02, BF10 = 0.29, evoked by idiographic trauma script presentation in the context of acute or repeated administration. These data suggest that CBD may not effectively reduce trauma-relevant emotional arousal; however, more work is needed to confidently assert such claims due to the small sample size. The current study extends the groundwork for additional studies in this important area.
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Affiliation(s)
- L Riley Gournay
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
| | - Morgan L Ferretti
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
| | - Anna-Marie Nguyen
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
- Behavioral Health Services, Denver Health Medical Center, Denver, Colorado, USA
| | - Sarah Bilsky
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
| | - Grant S Shields
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
| | - Eric Mann
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Parker Williams
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
| | - Sydney Woychesin
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
| | | | - Ellen W Leen-Feldner
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
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Back SE, Jarnecke AM, Norman SB, Zaur AJ, Hien DA. State of the Science: Treatment of comorbid posttraumatic stress disorder and substance use disorders. J Trauma Stress 2024. [PMID: 38857125 DOI: 10.1002/jts.23049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 06/12/2024]
Abstract
Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) co-occur at high rates, with research showing that up to nearly 60% of individuals with PTSD also suffer from an alcohol and/or drug use disorder. PTSD/SUD is complex; associated with adverse health, social, and economic outcomes; and can be challenging to treat. Over the past decade, the landscape of treatment research addressing PTSD/SUD has significantly expanded. Ongoing efforts aimed at developing and evaluating novel treatments for PTSD/SUD, encompassing both psychotherapy and pharmacotherapy approaches, are steadily advancing. As such, this State of the Science paper reviews the literature on the latest scientific advances in treating PTSD/SUD. Clinical practice guidelines for the treatment of PTSD/SUD are discussed, along with evidence-based psychotherapies and emerging interventions. Rigorously conducted clinical trials demonstrate that individual, manualized, trauma-focused treatments are the most efficacious psychotherapies to use among individuals with PTSD/SUD. Moreover, patients do not need to be abstinent to initiate or benefit from evidence-based PTSD treatment. To date, no medications have been established for this comorbidity. We highlight ongoing research on novel treatments for PTSD/SUD, such as new forms of integrated trauma-focused psychotherapies, pharmacological augmentation strategies, and technology-based enhancements. Finally, promising future directions for the field are discussed.
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Affiliation(s)
- Sudie E Back
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson VA Healthcare System, Charleston, South Carolina, USA
| | - Amber M Jarnecke
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, California, USA
| | - Angela J Zaur
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Denise A Hien
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, New Brunswick, New Jersey, USA
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Hill ML, Kline AC, Saraiya TC, Gette J, Ruglass LM, Norman SB, Back SE, Saavedra LM, Hien DA, Morgan-López AA. Cannabis use and trauma-focused treatment for co-occurring posttraumatic stress disorder and substance use disorders: A meta-analysis of individual patient data. J Anxiety Disord 2024; 102:102827. [PMID: 38266511 PMCID: PMC11138203 DOI: 10.1016/j.janxdis.2024.102827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/22/2023] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
High rates of cannabis use among people with posttraumatic stress disorder (PTSD) have raised questions about the efficacy of evidence-based PTSD treatments for individuals reporting cannabis use, particularly those with co-occurring alcohol or other substance use disorders (SUDs). Using a subset of four randomized clinical trials (RCTs) included in Project Harmony, an individual patient meta-analysis of 36 RCTs (total N = 4046) of treatments for co-occurring PTSD+SUD, we examined differences in trauma-focused (TF) and non-trauma-focused (non-TF) treatment outcomes for individuals who did and did not endorse baseline cannabis use (N = 410; 70% male; 33.2% endorsed cannabis use). Propensity score-weighted mixed effects modeling evaluated main and interactive effects of treatment assignment (TF versus non-TF) and baseline cannabis use (yes/no) on attendance rates and within-treatment changes in PTSD, alcohol, and non-cannabis drug use severity. Results revealed significant improvements across outcomes among participants in all conditions, with larger PTSD symptom reductions but lower attendance among individuals receiving TF versus non-TF treatment in both cannabis groups. Participants achieved similar reductions in alcohol and drug use across all conditions. TF outperformed non-TF treatments regardless of recent cannabis use, underscoring the importance of reducing barriers to accessing TF treatments for individuals reporting cannabis use.
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Affiliation(s)
- Melanie L Hill
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
| | | | - Tanya C Saraiya
- Center of Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jordan Gette
- Center of Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA
| | - Lesia M Ruglass
- Center of Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA; Department of Psychology, The City College of New York, New York, NY, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; National Center for PTSD, Executive Division, White River Junction, VT, USA
| | - Sudie E Back
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Healthcare System, Charleston, SC, USA
| | | | - Denise A Hien
- Center of Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA
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Afifi TO, Taillieu T, Salmon S, Stewart-Tufescu A, Sareen J, Enns MW, Mota N, Bolton SL, Carleton RN, Heber A, VanTil L. Child Maltreatment History, Deployment-Related Traumatic Events, and Past 12-Month Cannabis Use Among Veterans in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:116-125. [PMID: 37563976 PMCID: PMC10789231 DOI: 10.1177/07067437231192740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Cannabis use among veterans in Canada is an understudied public health priority. The current study examined cannabis use prevalence and the relationships between child maltreatment histories and deployment-related traumatic events (DRTEs) with past 12-month cannabis use including sex differences among Canadian veterans. METHOD Data were drawn from the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (response rate 68.7%; veterans only n = 1,992). Five child maltreatment types and 9 types of DRTEs were assessed in relation to the past 12-month cannabis use. RESULTS The prevalence of lifetime and past 12-month cannabis use was 49.4% and 16.7%, respectively. Females were less likely than males to report lifetime cannabis use (41.9% vs. 50.4%; odds ratio [OR] 0.71; 95% CI, - 0.59 to 0.86). No sex differences were noted for past 12-month cannabis use (14.1% vs. 17.0%; OR 0.80; 95% CI, 0.60 to 1.07). Physical abuse, sexual abuse, neglect, any child maltreatment, most individual DRTEs, and any DRTE were associated with increased odds of past 12-month cannabis use after adjusting for sociodemographic and military variables. Some models were attenuated and/or nonsignificant after further adjustments for mental disorders and chronic pain conditions. Sex did not statistically significantly moderate these relationships. Cumulative effects of having experienced both child maltreatment and DRTEs compared to DRTEs alone increased the odds of past 12-month cannabis use. Statistically significant interaction effects between child maltreatment history and DRTE on cannabis use were not found. CONCLUSIONS Child maltreatment histories and DRTEs increased the likelihood of past 12-month cannabis use among Canadian veterans. A history of child maltreatment, compared to DRTEs, indicated a more robust relationship. Understanding the links between child maltreatment, DRTEs, and cannabis use along with mental disorders and chronic pain conditions is important for developing interventions and improving health outcomes among veterans.
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Affiliation(s)
- Tracie O. Afifi
- Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, MN, Canada
| | - Tamara Taillieu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MN, Canada
| | - Samantha Salmon
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MN, Canada
| | | | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, MN, Canada
| | - Murray W. Enns
- Department of Psychiatry, University of Manitoba, Winnipeg, MN, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MN, Canada
| | - Shay-Lee Bolton
- Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, MN, Canada
| | | | - Alexandra Heber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Linda VanTil
- Veterans Affairs Canada, Charlottetown, PE, Canada
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Livne O, Mannes ZL, McDowell YE, Shmulewitz D, Malte CA, Saxon AJ, Hasin DS. Mental and Physical Health Conditions Among U.S. Veterans with Cannabis Use and Cannabis Use Disorders. CURRENT ADDICTION REPORTS 2023; 10:441-457. [PMID: 38149223 PMCID: PMC10751043 DOI: 10.1007/s40429-023-00490-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 12/28/2023]
Abstract
Purpose of Review Veterans are a large population that is disproportionately affected by various physical and mental health conditions. The primary aim of this review is to provide a concise overview of recent literature on the prevalence of cannabis use and cannabis use disorder (CUD) among US Veterans, and associations with mental and physical health conditions. We also addressed gaps in the literature by investigating associations between CUD and mental and physical health conditions in 2019 data from the Veterans Health Administration (VHA; N=5,657,277). Recent Findings In total, 25 studies were reviewed. In 2019, the prevalence of Veteran cannabis use ranged from 11.9%-18.7%. Cannabis use and CUD were associated with bipolar disorders, psychotic disorders, suicidality, pain conditions, and other substance use, but less consistently associated with depressive disorders, anxiety disorders, and posttraumatic stress disorder. Analyses of 2019 VHA data indicated that CUD was strongly associated with a broad array of physical and mental health conditions and mortality. Summary Cannabis use and CUD are prevalent and highly comorbid with other conditions among US Veterans. Harm reduction methods tailored to these populations are needed.
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Affiliation(s)
- Ofir Livne
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Zachary L. Mannes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Yoanna E. McDowell
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA
| | - Dvora Shmulewitz
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Carol A. Malte
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA
| | - Andrew J. Saxon
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Deborah S. Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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Ney LJ, Akosile W, Davey C, Pitcher L, Felmingham KL, Mayo LM, Hill MN, Strodl E. Challenges and considerations for treating PTSD with medicinal cannabis: the Australian clinician's perspective. Expert Rev Clin Pharmacol 2023; 16:1093-1108. [PMID: 37885234 DOI: 10.1080/17512433.2023.2276309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/24/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Preclinical and experimental research have provided promising evidence that medicinal cannabis may be efficacious in the treatment of posttraumatic stress disorder (PTSD). However, implementation of medicinal cannabis into routine clinical therapies may not be straightforward. AREAS COVERED In this review, we describe some of the clinical, practical, and safety challenges that must be addressed for cannabis-based treatment of PTSD to be feasible in a real-world setting. These issues are especially prevalent if medicinal cannabis is to be combined with trauma-focused psychotherapy. EXPERT OPINION Future consideration of the clinical and practical considerations of cannabis use in PTSD therapy will be essential to both the efficacy and safety of the treatment protocols that are being developed. These issues include dose timing and titration, potential for addiction, product formulation, windows of intervention, and route of administration. In particular, exposure therapy for PTSD involves recall of intense emotions, and the interaction between cannabis use and reliving of trauma memories must be explored in terms of patient safety and impact on therapeutic outcomes.
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Affiliation(s)
- Luke J Ney
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Wole Akosile
- Greater Brisbane Clinical School, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Chris Davey
- Department of Psychiatry, Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | | | - Kim L Felmingham
- School of Psychological Sciences, Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Leah M Mayo
- Department of Psychiatry, Mathison Centre for Mental Health Research, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Matthew N Hill
- Department of Psychiatry, Mathison Centre for Mental Health Research, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Esben Strodl
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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