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Lortye SA, Will JP, Rameckers SA, Marquenie LA, Goudriaan AE, Arntz A, de Waal MM. Types of childhood maltreatment as predictors of posttraumatic stress disorder severity and complex posttraumatic stress disorder in patients with substance use disorders. Eur J Psychotraumatol 2024; 15:2367179. [PMID: 38934350 PMCID: PMC11212561 DOI: 10.1080/20008066.2024.2367179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 05/26/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Childhood maltreatment (CM) can be divided into: emotional abuse (EA), physical abuse (PA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN). CM is associated with (Complex)Posttraumatic stress disorder (PTSD/CPTSD) and substance use disorder (SUD).Objective: This cross-sectional study examined the relationships between CM-subtypes with PTSD-severity and CPTSD in patients with SUD-PTSD.Method: Participants (N = 209) were treatment-seeking SUD-PTSD patients who completed the Childhood Trauma Questionnaire-short form, the Clinician-Administered PTSD Scale for DSM-5 and the International Trauma Questionnaire. Regression analyses and a model selection procedure to select an optimal model were used to examine CM-subtypes as predictors of (C)PTSD, adjusted for sex and age.Results: Total CM and all CM-types significantly predicted PTSD-severity in the univariate regression analysis, with EA begin the strongest predictor. In the multiple regression only SA predicted PTSD-severity. Subsequently, model selection indicated that the optimal model to predict PTSD-severity included EA and SA. In the univariate analyses total CM, EA, and PN significantly predicted CPTSD-classification, and total CM and all CM-types significantly predicted CPTSD-severity. In the multiple regression for CPTSD-classification only EA and PA were significant predictors and for CPTSD-severity EA, PA and SA were significant predictors. In post-hoc multiple regression analyses, only EA was a significant predictor of CPTSD-classification and CPTSD-severity. Finally, in the model selection the most parsimonious model only included EA for both CPTSD-classification and CPTSD-severity. Sex was not a moderator in the relationship between CM and PTSD, nor in CM and CPTSD.Conclusions: These findings indicate that for SUD-PTSD patients, several CM-types have predictive value for (C)PTSD-severity, however SA and especially EA appear to contribute to these complaints. Since EA does not constitute an A-criterion, it is generally more overlooked in PTSD treatment. Its impact should therefore be underlined, and clinicians should be attentive to EA in their treatment.
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Affiliation(s)
- Sera A. Lortye
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Joanne P. Will
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Sophie A. Rameckers
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Loes A. Marquenie
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Anna E. Goudriaan
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marleen M. de Waal
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Maki KA, Crayton CB, Butera G, Wallen GR. Examining the relationship between the oral microbiome, alcohol intake and alcohol-comorbid neuropsychological disorders: protocol for a scoping review. BMJ Open 2024; 14:e079823. [PMID: 38514150 PMCID: PMC10961520 DOI: 10.1136/bmjopen-2023-079823] [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: 09/12/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Heavy alcohol use and alcohol use disorder (AUD) continues to rise as a public health problem and increases the risk for disease. Elevated rates of anxiety, depression, sleep disruption and stress are associated with alcohol use. Symptoms may progress to diagnosed neurophysiological conditions and increase risk for relapse if abstinence is attempted. Research on mechanisms connecting the gastrointestinal microbiome to neuropsychological disorders through the gut-brain axis is well-established. Less is known how the oral microbiome and oral microbial-associated biomarkers may signal to the brain. Therefore, a synthesis of research studying relationships between alcohol intake, alcohol-associated neurophysiological symptoms and the oral microbiome is needed to understand the state of the current science. In this paper, we outline our protocol to collect, evaluate and synthesise research focused on associations between alcohol intake and AUD-related neuropsychological disorders with the oral microbiome. METHODS AND ANALYSIS The search strategy was developed and will be executed in collaboration with a medical research librarian. Studies will be screened by two independent investigators according to the aim of the scoping review, along with the outlined exclusion and inclusion criteria. After screening, data will be extracted and synthesised from the included papers according to predefined demographic, clinical and microbiome methodology metrics. ETHICS AND DISSEMINATION A scoping review of primary sources is needed to synthesise the data on relationships between alcohol use, neuropsychological conditions associated with AUD and the oral microbiome. The proposed scoping review is based on the data from publicly available databases and does not require ethical approval. We expect the results of this synthesis will identify gaps in the growing literature and highlight potential mechanisms linking the oral-brain axis to addiction and other associated neuropsychological conditions. The study findings and results will be disseminated through journals and conferences related to psychology, neuroscience, dentistry and the microbiome.
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Affiliation(s)
- Katherine A Maki
- Clinical Center, Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Chelsea B Crayton
- Clinical Center, Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Gisela Butera
- Division of Library Services, National Institutes of Health, Bethesda, Maryland, USA
| | - Gwenyth R Wallen
- Clinical Center, Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Bethesda, Maryland, USA
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Garrison-Desany HM, Meyers JL, Linnstaedt SD, House SL, Beaudoin FL, An X, Zeng D, Neylan TC, Clifford GD, Jovanovic T, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, Gentile NT, Hudak LA, Pascual JL, Seamon MJ, Harris E, Pearson C, Peak DA, Domeier RM, Rathlev NK, O’Neil BJ, Sergot P, Sanchez LD, Bruce SE, Joormann J, Harte SE, McLean SA, Koenen KC, Denckla CA. Post-traumatic stress and future substance use outcomes: leveraging antecedent factors to stratify risk. Front Psychiatry 2024; 15:1249382. [PMID: 38525258 PMCID: PMC10957776 DOI: 10.3389/fpsyt.2024.1249382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/10/2024] [Indexed: 03/26/2024] Open
Abstract
Background Post-traumatic stress disorder (PTSD) and substance use (tobacco, alcohol, and cannabis) are highly comorbid. Many factors affect this relationship, including sociodemographic and psychosocial characteristics, other prior traumas, and physical health. However, few prior studies have investigated this prospectively, examining new substance use and the extent to which a wide range of factors may modify the relationship to PTSD. Methods The Advancing Understanding of RecOvery afteR traumA (AURORA) study is a prospective cohort of adults presenting at emergency departments (N = 2,943). Participants self-reported PTSD symptoms and the frequency and quantity of tobacco, alcohol, and cannabis use at six total timepoints. We assessed the associations of PTSD and future substance use, lagged by one timepoint, using the Poisson generalized estimating equations. We also stratified by incident and prevalent substance use and generated causal forests to identify the most important effect modifiers of this relationship out of 128 potential variables. Results At baseline, 37.3% (N = 1,099) of participants reported likely PTSD. PTSD was associated with tobacco frequency (incidence rate ratio (IRR): 1.003, 95% CI: 1.00, 1.01, p = 0.02) and quantity (IRR: 1.01, 95% CI: 1.001, 1.01, p = 0.01), and alcohol frequency (IRR: 1.002, 95% CI: 1.00, 1.004, p = 0.03) and quantity (IRR: 1.003, 95% CI: 1.001, 1.01, p = 0.001), but not with cannabis use. There were slight differences in incident compared to prevalent tobacco frequency and quantity of use; prevalent tobacco frequency and quantity were associated with PTSD symptoms, while incident tobacco frequency and quantity were not. Using causal forests, lifetime worst use of cigarettes, overall self-rated physical health, and prior childhood trauma were major moderators of the relationship between PTSD symptoms and the three substances investigated. Conclusion PTSD symptoms were highly associated with tobacco and alcohol use, while the association with prospective cannabis use is not clear. Findings suggest that understanding the different risk stratification that occurs can aid in tailoring interventions to populations at greatest risk to best mitigate the comorbidity between PTSD symptoms and future substance use outcomes. We demonstrate that this is particularly salient for tobacco use and, to some extent, alcohol use, while cannabis is less likely to be impacted by PTSD symptoms across the strata.
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Affiliation(s)
- Henri M. Garrison-Desany
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Jacquelyn L. Meyers
- Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, New York City, NY, United States
| | - Sarah D. Linnstaedt
- Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Stacey L. House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Francesca L. Beaudoin
- Department of Epidemiology, Brown University, Providence, RI, United States
- Department of Emergency Medicine, Brown University, Providence, RI, United States
| | - Xinming An
- Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Thomas C. Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, United States
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Laura T. Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
- The Many Brains Project, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Kenneth A. Bollen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Scott L. Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, McLean Hospital, Belmont, MA, United States
| | - John P. Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Paul I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Phyllis L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, United States
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, United States
| | - Christopher W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Brittany E. Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, United States
| | - Robert A. Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, United States
| | - Nina T. Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Lauren A. Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Jose L. Pascual
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Mark J. Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Erica Harris
- Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA, United States
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, United States
| | - David A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Robert M. Domeier
- Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, MI, United States
| | - Niels K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, United States
| | - Brian J. O’Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, United States
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center, Houston, TX, United States
| | - Leon D. Sanchez
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, United States
| | - Steven E. Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, United States
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, United States
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Samuel A. McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Psychiatry, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Christy A. Denckla
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Watkins LE, Patton SC, Wilcox T, Drexler K, Rauch SAM, Rothbaum BO. Substance Use after Completion of an Intensive Treatment Program with Concurrent Treatment for Posttraumatic Stress Disorder and Substance Use among Veterans: Examining the Role of PTSD Symptoms. J Dual Diagn 2024; 20:16-28. [PMID: 38122816 DOI: 10.1080/15504263.2023.2290167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) are costly and highly co-occurring diagnoses, particularly among veterans, suggesting a need to understand this comorbidity and effectively treat both disorders among this population. METHODS The current study aimed to examine substance use outcomes among post-9/11 veterans and service members (N = 48) who completed a two-week intensive outpatient program with concurrent treatment for and PTSD using Prolonged Exposure and substance use. Substance use was assessed at two weeks and three months posttreatment. RESULTS The intensive program had high completion rates and demonstrated decreases in substance use at two weeks and three months posttreatment. Additionally, lower PTSD symptoms at treatment completion were related to less substance use posttreatment. CONCLUSIONS Concurrent intensive treatment of PTSD and SUDs can lead to symptom improvement in a short period of time. Findings support the self-medication model, such that PTSD symptoms at treatment completion were related to substance use at follow-up.
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Affiliation(s)
| | | | - Tiffany Wilcox
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Karen Drexler
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sheila A M Rauch
- Atlanta VA Medical Center, Emory University School of Medicine, Atlanta, Georgia, USA
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Dell'Aquila A, Berle D. Predictors of alcohol and substance use among people with post-traumatic stress disorder (PTSD): findings from the NESARC-III study. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1509-1522. [PMID: 37133523 PMCID: PMC10460312 DOI: 10.1007/s00127-023-02472-6] [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: 01/14/2023] [Accepted: 03/30/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE The self-medication hypothesis suggests people may develop Alcohol Use Disorder (AUD) or Non-Alcohol Substance Use Disorder (NA-SUD) following PTSD as a maladaptive way of coping with PTSD symptoms. Given that an accumulation of trauma experiences and interpersonal trauma increase the likelihood and severity of PTSD, we sought to determine whether the number and type of traumas additionally predict AUD and NA-SUD following PTSD. METHODS We analysed data from 36,309 adult participants in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) study (M = 45.63 years, SD = 17.53, 56.3% female) who were administered semi-structured diagnostic interviews of trauma exposure and PTSD, AUD and NA-SUD symptoms. RESULTS Individuals with PTSD were more likely to have an AUD or NA-SUD than those without PTSD. Endorsement of a greater number of traumas was associated with greater odds of having PTSD, AUD, or NA-SUD. Experience of interpersonal trauma was related to greater odds of having PTSD and subsequent AUD or NA-SUD than not experiencing interpersonal trauma. Multiple experiences of interpersonal trauma compared to one interpersonal trauma exposure also increased the odds of having PTSD followed by AUD or NA-SUD. CONCLUSIONS Interpersonal trauma and multiple experiences of interpersonal trauma may result in individuals turning to alcohol and substances as a way to alleviate intolerable PTSD symptomology, aligning with the self-medication hypothesis. Our findings highlight the importance of ensuring services and support for interpersonal trauma survivors and for those who have experienced multiple traumas given their increased for unfavourable outcomes.
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Affiliation(s)
- Adriana Dell'Aquila
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - David Berle
- Graduate School of Health, University of Technology Sydney, Sydney, Australia.
- School of Medicine and Psychology, Australian National University, Canberra, Australia.
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Shmulewitz D, Stohl M, Greenstein E, Roncone S, Walsh C, Aharonovich E, Wall MM, Hasin DS. Validity of the DSM-5 craving criterion for alcohol, tobacco, cannabis, cocaine, heroin, and non-prescription use of prescription painkillers (opioids). Psychol Med 2023; 53:1955-1969. [PMID: 35506791 PMCID: PMC9096712 DOI: 10.1017/s0033291721003652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although the DSM-5 was adopted in 2013, the validity of the new substance use disorder (SUD) diagnosis and craving criterion has not been investigated systematically across substances. METHODS Adults (N = 588) who engaged in binge drinking or illicit drug use and endorsed at least one DSM-5 SUD criterion were included. DSM-5 SUD criteria were assessed for alcohol, tobacco, cannabis, cocaine, heroin, and opioids. Craving was considered positive if "wanted to use so badly that could not think of anything else" (severe craving) or "felt a very strong desire or urge to use" (moderate craving) was endorsed. Baseline information on substance-related variables and psychopathology was collected, and electronic daily assessment queried substance use for the following 90 days. For each substance, logistic regression estimated the association between craving and validators, i.e. variables expected to be related to craving/SUD, and whether association with the validators differed for DSM-5 SUD diagnosed with craving as a criterion v. without. RESULTS Across substances, craving was associated with most baseline validators (p values<0.05); neither moderate nor severe craving consistently showed greater associations. Baseline craving predicted subsequent use [odds ratios (OR): 4.2 (alcohol) - 234.3 (heroin); p's ⩽ 0.0001], with stronger associations for moderate than severe craving (p's < 0.05). Baseline DSM-5 SUD showed stronger associations with subsequent use when diagnosed with craving than without (p's < 0.05). CONCLUSION The DSM-5 craving criterion as operationalized in this study is valid. Including craving improves the validity of DSM-5 SUD diagnoses, and clinical relevance, since craving may cause impaired control over use and development and maintenance of SUD.
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Affiliation(s)
- D Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - M Stohl
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - E Greenstein
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - S Roncone
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - C Walsh
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - E Aharonovich
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - MM Wall
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - DS Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
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Belfrage A, Mjølhus Njå AL, Lunde S, Årstad J, Fodstad EC, Lid TG, Erga AH. Traumatic experiences and PTSD symptoms in substance use disorder: A comparison of recovered versus current users. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:61-75. [PMID: 36793481 PMCID: PMC9893129 DOI: 10.1177/14550725221122222] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/09/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction: The aim of this study was to investigate the prevalence of traumatic experiences and symptoms of posttraumatic stress disorder (PTSD) in treatment-seeking individuals with ongoing substance use disorder (SUD) compared to individuals who have recovered from SUD. Methods: Patients with SUD recruited from the STAYER study (N = 114) underwent an examination of alcohol and drug use, childhood trauma, negative life events and PTSD symptomatology. In this study, only participants with 12-month concurrent polysubstance use was included. Using historical data from the STAYER study, alcohol and drug trajectories were dichotomised as (1) current SUD (current SUD) or (2) recovered from substance use disorder (recovered SUD). Crosstabs and chi-tests were used to measure differences between groups. Results: Childhood maltreatment, traumatic experiences later in life and symptoms of concurrent PTSD were highly prevalent in the study population. We found no significant difference between the current and recovered SUD groups. Recovered women reported a lower prevalence of physical neglect (p = 0.031), but a higher prevalence of multiple lifetime traumas (p = 0.019) compared to women with current SUD. Both women with current SUD and recovered women reported a significantly higher prevalence of sexual aggression than men (p < 0.001 and p < 0.001, respectively). In addition, men who have recovered from SUD reported a lower prevalence of PTSD symptoms over cut-off 38 (p = 0.017), of re-experiencing (p = 0.036) and of avoidance (p = 0.015), compared to recovered women. Conclusion: Reported trauma did not differ between persons with current SUD and those who had recovered from SUD. Gender differences discovered in this study indicate the importance of developing individualised and gender-specific treatment models for comorbid PTSD/SUD.
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Affiliation(s)
- Anna Belfrage
- Anna Belfrage, Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway.
| | | | | | | | - Elise Constance Fodstad
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway; and Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway
| | - Torgeir Gilje Lid
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway; and Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Aleksander Hagen Erga
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway; The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway; and Department of Biological and Medical Psychology, University of Bergen, Norway
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Jagielski CH, Harer KN. Working with Trauma in the Gastroenterology Setting. Gastroenterol Clin North Am 2022; 51:867-883. [PMID: 36376001 DOI: 10.1016/j.gtc.2022.07.012] [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] [Indexed: 11/15/2022]
Abstract
Patients with gastrointestinal (GI) complaints report high rates of previous psychological trauma such as physical, emotional abuse and neglect, sexual trauma, and other traumatic experiences. History of trauma is considered a risk factor for the development of disorders of gut-brain interaction, including irritable bowel syndrome. This article discusses key points for providers in understanding how various aspects of trauma can affect patients' physical and mental health and medical interactions, as well as trauma-informed strategies providers can use to increase patient comfort, improve communication, and improve effectiveness of treatment.
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Affiliation(s)
- Christina H Jagielski
- Division of Gastroenterology and Hepatology, University of Michigan/Michigan Medicine, 1500 East Medical Center Drive, 3912, SPC 5362, Ann Arbor 48109 - 5362, USA.
| | - Kimberly N Harer
- Division of Gastroenterology and Hepatology, University of Michigan/Michigan Medicine, 1500 East Medical Center Drive, 3912, SPC 5362, Ann Arbor 48109 - 5362, USA
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Rosansky JA, Borgogna NC, Kraus SW, Grubbs JB. Cross-Sectional and Longitudinal Associations Between Posttraumatic Stress Symptoms and Hypersexual Behaviors Among Individuals Who have Gambled in Their Lifetimes. J Sex Med 2022; 19:1813-1823. [PMID: 36216746 DOI: 10.1016/j.jsxm.2022.09.003] [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: 04/04/2022] [Revised: 08/12/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Exposure to traumatic experiences represent one factor that may contribute to the development of hypersexual behaviors. AIM We investigated the associations between posttraumatic stress symptoms and hypersexual behaviors by analyzing survey data from 2 samples. METHOD The first sample consisted of n = 585 college students, and the second consisted of n = 786 adults recruited via Amazon's Mechanical Turk (MTurk), n = 337 of whom completed a 6-month follow-up survey. We conducted 3 hierarchical regression analyses adjusting for age, gender, sexual orientation, impulsivity, drug use, alcohol use, and gambling. OUTCOMES The primary outcomes for this investigation were associations between posttraumatic stress symptoms, measured using the PTSD Checklist for DSM-IV and DSM-5 (PCL-C and PCL-5), and hypersexual behaviors, measured using the Hypersexual Behavior Inventory (HBI). RESULTS A significant regression, R2 = 0.230, R2adjusted = 0.211, F (14,570) = 12.17, P < .001, revealed posttraumatic stress symptoms were associated with hypersexual behaviors in the university student sample (β = 0.154). A significant regression using the MTurk sample, R2 = 0.403, R2adjusted = 0.392, F (14,771) = 37.13, P < .001, confirmed this finding (β = 0.259). In addition, a significant regression, R2 = 0.562, R2adjusted = 0.541, F (15,321) = 27.42, P < .001, indicated that posttraumatic stress symptoms were longitudinally associated with increased hypersexual behaviors (β = .190) after adjusting for all variables, including baseline hypersexuality. CLINICAL TRANSLATION Results suggest that individuals experiencing posttraumatic stress symptoms are at increased risk for current and future hypersexual behaviors. STRENGTHS & LIMITATIONS This investigation involved secondary analyses of adults who had gambled at least once in their lives and findings may not generalize to those who have never gambled. Furthermore, longitudinal findings may be impacted by selection bias (42% completion rate) and may not generalize to follow up periods longer than 6-months. CONCLUSION This study provides support for the hypothesis that posttraumatic stress symptoms are associated with increased hypersexual behavior, and further research is indicated to explore the etiology and directionality of this relationship. Rosansky JA, Borgogna NC, Kraus SW, et al. Cross-Sectional and Longitudinal Associations Between Posttraumatic Stress Symptoms and Hypersexual Behaviors Among Individuals Who have Gambled in Their Lifetimes. J Sex Med 2022;19:1813-1823.
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Affiliation(s)
- Joseph A Rosansky
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Psychology, Bowling Green State University, Bowling Green, OH, USA.
| | - Nicholas C Borgogna
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Shane W Kraus
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Joshua B Grubbs
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
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10
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Opie E, Werbeloff N, Hayes J, Osborn D, Pitman A. Suicidality in patients with post-traumatic stress disorder and its association with receipt of specific secondary mental healthcare treatments. Int J Psychiatry Clin Pract 2022:1-10. [PMID: 36369845 DOI: 10.1080/13651501.2022.2140679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a risk factor for suicidality (suicidal ideation, and suicide attempt). This study described the prevalence of suicidality amongst a representative sample of individuals with PTSD and the association between suicidality and receipt of five PTSD treatments. METHODS We analysed deidentified data for patients being treated for PTSD at Camden and Islington NHS Foundation Trust between 2009 and 2017 obtained via the Clinical Record Interactive Search tool. We described the sample's sociodemographic and clinical characteristics and used stepwise logistic regression to investigate the association between suicidality and receipt of four, specific PTSD treatments: psychotherapy, antidepressant/antianxiety medication, antipsychotics, benzodiazepines. We used Cox proportional hazards regression to investigate the association between suicidality and hospital/crisis team admission. RESULTS Of 745 patients diagnosed with PTSD, 60% received psychotherapy and 66% received psychotropic medication. Those who reported suicidality (6%) were no more likely than those who did not to be prescribed antidepressant/antianxiety medication, but were more likely to receive antipsychotics (AOR = 2.27, 95% CI 1.15 - 4.47), benzodiazepines (AOR 2.28, 95% CI 1.17 - 4.44), psychotherapy (AOR 2.60, 95% CI 1.18 - 5.73) and to be admitted to hospital/crisis team (AOR 2.84, 95% 1.82 - 4.45). CONCLUSION In this sample, patients with PTSD and suicidality were more likely to receive psychiatric medication, psychotherapy and psychiatric admission than those who were not suicidal. Overall patients were more likely to receive psychotropic medication than psychotherapy. Adherence to clinical guidelines is important in this population to improve treatment outcomes and reduce the risk of suicide.KEY POINTSNICE guidelines recommend psychological therapy be first line treatment for PTSD, yet we identified that fewer people diagnosed with PTSD received therapy compared to psychotropic medication.Patients with suicidality were more likely to receive antipsychotics and benzodiazepines, yet not antidepressant/antianxiety medication although given that suicidality is characteristic of severe depression, it might be assumed from stepped care models that antidepressant/antianxiety medication be prescribed before antipsychotics.The high proportion of patients prescribed antipsychotics suggests a need for better understanding of psychosis symptoms among trauma-exposed populations.Identifying which combinations of symptoms are associated with suicidal thoughts could help tailor trauma-informed approaches to discussing therapy and medication.
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Affiliation(s)
- Elena Opie
- UCL Division of Psychiatry, University College London, UK
- Whittington Health, London, UK
| | - Nomi Werbeloff
- UCL Division of Psychiatry, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Tel Aviv, Israel
| | - Joseph Hayes
- UCL Division of Psychiatry, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - David Osborn
- UCL Division of Psychiatry, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Alexandra Pitman
- UCL Division of Psychiatry, University College London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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11
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Lespine LF, Bramness JG, Pignon B, Vaiva G, Thomas P, Roelandt JL, Benradia I, Amad A, Geoffroy PA, Rolland B. Gender-related associations between psychiatric disorders and alcohol use disorder: Findings from the french "Mental health in the general population" survey. Arch Womens Ment Health 2022; 25:895-902. [PMID: 36083520 DOI: 10.1007/s00737-022-01253-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/03/2022] [Indexed: 11/26/2022]
Abstract
Women with alcohol use disorder (AUD) might be particularly vulnerable to psychiatric comorbidities. However, population surveys have yielded disparate findings. We used data from the French Mental Health in the General Population survey to investigate gender-related risks of psychiatric comorbidities associated with AUD. A cross-sectional survey based on face-to-face interviews, including the Mini International Neuropsychiatric Interview, was conducted among 38,717 subjects. Logistic regression models were used to assess risks of psychiatric comorbidities associated with AUD. After adjustment for socio-demographics and other psychiatric disorders, both women and men with AUD were at higher risk of comorbid depressive disorder (odds ratio [OR] = 2.6, 95% confidence interval [CI]: 2.0-3.4 in women, and OR = 2.0, 95% CI: 1.7-2.4 in men), bipolar I disorder (2.5; 1.4-4.4 in women vs. 2.6; 1.9-3.4 in men), and psychotic disorder (1.6; 1.01-2.5 in women vs. 1.8; 1.4-2.3 in men). Women with AUD exhibited an increased risk of comorbid panic disorder (OR = 1.6, 95% CI: 1.1-2.2) while the increased risk of post-traumatic stress disorder (PTSD) was significant in men only (OR = 2.6, 95% CI: 1.6-4.2). The increased risk of comorbid substance use disorder (SUD) was more elevated in women, compared to men (12.9; 8.1-18.1 vs. 4.8; 4.0-5.8 in men). Most of psychiatric conditions were over-represented in both women and men with AUD, relative to controls. Gender-specific findings were that women with AUD had an increased risk of comorbid SUD or panic disorder, while men had a significantly higher risk of comorbid PTSD.
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Affiliation(s)
- Louis-Ferdinand Lespine
- Service Universitaire d'Addictologie de Lyon (SUAL), Hospices Civils de Lyon, Centre Hospitalier Le Vinatier, 95 Bd Pinel, 69500, Bron, France.
- UCBL1, INSERM, U1028, CNRS, UMR5292, CRNL, PSYR2, Lyon, France.
| | - Jørgen G Bramness
- Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- Norwegian National Advisory Unit On Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Baptiste Pignon
- DMU IMPACT, Univ Paris Est Creteil, INSERM, IMRB, AP-HP, Hôpitaux Universitaires « H. Mondor», Fondation FondaMental, Créteil, France
| | - Guillaume Vaiva
- Lille Neuroscience & Cognition (LilNCog), Université Lille, Inserm, CHU Lille, U1172, 59000, Lille, France
| | - Pierre Thomas
- Centre National de Ressources & Résilience Pour Les Psychotraumatismes (Cn2r Lille Paris), 59000, Lille, France
| | - Jean-Luc Roelandt
- Centre Collaborateur de L'Organisation Mondiale de La Santé Pour La Recherche Et La Formation en Santé Mentale, EPSM Lille Métropole, 211 rue Roger Salengro, 59 260, Hellemmes, France
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
| | - Imane Benradia
- Centre Collaborateur de L'Organisation Mondiale de La Santé Pour La Recherche Et La Formation en Santé Mentale, EPSM Lille Métropole, 211 rue Roger Salengro, 59 260, Hellemmes, France
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
| | - Ali Amad
- Centre National de Ressources & Résilience Pour Les Psychotraumatismes (Cn2r Lille Paris), 59000, Lille, France
| | - Pierre-Alexis Geoffroy
- Service de Psychiatrie Et dAddictologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Bichat, Paris, France
- Université de Paris, Inserm, 75019, NeuroDiderot, Paris, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), Hospices Civils de Lyon, Centre Hospitalier Le Vinatier, 95 Bd Pinel, 69500, Bron, France
- UCBL1, INSERM, U1028, CNRS, UMR5292, CRNL, PSYR2, Lyon, France
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12
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Watkins LE, Patton SC, Drexler K, A. M. Rauch S, Rothbaum BO. Clinical Effectiveness of an Intensive Outpatient Program for Integrated Treatment of Comorbid Substance Abuse and Mental Health Disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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13
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Goudriaan AE, de Waal MM. Commentary on Nower et al: Patterns in pathways: underlying comorbidities and the importance of assessment. Addiction 2022; 117:2009-2010. [PMID: 35315144 PMCID: PMC9314676 DOI: 10.1111/add.15859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/24/2022] [Indexed: 12/18/2022]
Affiliation(s)
- Anna E. Goudriaan
- Arkin Mental Health Care, Jellinekand Amsterdam Institute for Addiction ResearchAmsterdamThe Netherlands,Amsterdam UMC, Department of PsychiatryUniversity of AmsterdamAmsterdamThe Netherlands,Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - Marleen M. de Waal
- Arkin Mental Health Care, Jellinekand Amsterdam Institute for Addiction ResearchAmsterdamThe Netherlands,Amsterdam UMC, Department of PsychiatryUniversity of AmsterdamAmsterdamThe Netherlands,Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
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14
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Kapfhammer HP. [Comorbidity of posttraumatic stress disorder and addiction from a biopsychosocial perspective]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2022; 36:1-18. [PMID: 33439473 PMCID: PMC8916999 DOI: 10.1007/s40211-020-00384-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
Posttraumatic stress disorder and substance use disorder often co-occur within the health care system. Their comorbidity is associated with more serious acute clinical symptomatology, more frequent hospital admissions in state of emergency and significantly lower chances of improvement by psychological and pharmacological treatment. Their comorbidity contributes to dramatically unfavourable courses of illness as regards all biopsychosocial levels. The survey presented will discuss empirical findings from various perspectives: general epidemiology, substance use disorder as risk factor of trauma and PTSD, trauma and PTSD as risk factor of SUD, neurobiological effects of SUD converging towards neurobiology of PTSD, shared common factors of genetics/epigenetics, personality traits, and early developmental stress and trauma. The main focus of analysis will be put on processes that are intrinsically linked to the development and course of both disorders.
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Affiliation(s)
- Hans-Peter Kapfhammer
- Universitätsklinik für Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Auenbruggerplatz 31, 8036, Graz, Österreich.
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15
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Molina G, Whittaker A. Treatment of post-traumatic stress disorder and substance use disorder in adults with a history of adverse childhood experiences: A systematic review of psychological interventions. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 2:100028. [PMID: 36845903 PMCID: PMC9948894 DOI: 10.1016/j.dadr.2022.100028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/12/2021] [Accepted: 01/17/2022] [Indexed: 11/18/2022]
Abstract
Background Adverse childhood experiences (ACEs) have long-term effects on adult health, including unresolved trauma and substance use disorder (SUD). There are hypotheses of a mediating role of emotion regulation. This systematic literature review and narrative synthesis assessed the effectiveness of psychological interventions on emotion regulation, PTSD and SUD symptoms. Methods Searches were conducted using the Cochrane Handbook for Systematic Reviews methodology. Eligible studies were randomised controlled trials (RCTs) and quasi-experimental psychological interventions published between 2009 and 2019. Study characteristics, results and methodological quality were systematically analysed. Results Thirteen studies, including nine RCTs, were selected. Integrated SUD and PTSD treatments consisted of Seeking Safety, exposure-based treatment, Trauma Recovery and Empowerment Model, and integrated cognitive behavioural therapy. Two studies reported emotion regulation. Five studies found a small to medium positive effect size of psychological interventions on PTSD outcomes. Two studies had a small positive effect size on SUD outcomes and two a small negative effect size. Attrition was high across most studies. Characteristics likely to affect the applicability of the review were described. Conclusion The review found some evidence of a small inconsistent positive effect of psychological interventions on PTSD outcomes, and no evidence of effect on SUD outcomes. The range of theoretical models was narrow. Overall quality was low with high clinical heterogeneity and missing key information, particularly on emotion regulation, an important transdiagnostic feature. Further research is required to establish interventions that can treat these multiple conditions with a focus on effectiveness, acceptability, and implementation in real life clinical practice.
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Key Words
- ACEs, adverse childhood experiences
- AEs, adverse events
- ATREM, Attachment-informed TREM
- CBT, Cognitive–Behavioural Therapy
- CI, confidence intervals
- CPTSD, complex PTSD
- DERS, Difficulties in Emotion Regulation Scale
- EMDR, eye movement desensitisation and reprocessing
- ER, emotion regulation
- FSP, family and social problems
- ICBT, Integrated CBT
- M, mean
- OR, odds ratio
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- PTSD, post-traumatic stress disorder
- RCT, randomised control trial
- SD, standard deviation
- SS, Seeking Safety
- SUD, substance use disorder
- SWiM, Synthesis Without Meta-Analysis
- TREM, Trauma Recovery and Empowerment Model
- adverse childhood experiences
- emotion regulation
- posttraumatic stress disorder
- psychological interventions
- substance use disorder
- systematic review
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Affiliation(s)
- Genevieve Molina
- CeGIDD, Pôle Santé Publique et Médecine Sociale, CHU Toulouse, Hôpital La Grave, TSA 60033, 31059 Toulouse Cedex 9, France
- Corresponding author.
| | - Anne Whittaker
- NMAHP Research Unit, Faculty of Health Sciences and Sport, Pathfoot Building, University of Stirling, FK9 4LA, Stirling, Scotland, UK
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16
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Hien DA, Fitzpatrick S, Saavedra LM, Ebrahimi CT, Norman SB, Tripp J, Ruglass LM, Lopez-Castro T, Killeen TK, Back SE, Morgan-López AA. What's in a name? A data-driven method to identify optimal psychotherapy classifications to advance treatment research on co-occurring PTSD and substance use disorders. Eur J Psychotraumatol 2021; 13:2001191. [PMID: 34992759 PMCID: PMC8725709 DOI: 10.1080/20008198.2021.2001191] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/18/2021] [Accepted: 10/23/2021] [Indexed: 11/05/2022] Open
Abstract
Background/Objective The present study leveraged the expertise of an international group of posttraumatic stress and substance use disorder (PTSD+SUD) intervention researchers to identify which methods of categorizing interventions which target SUD, PTSD, or PTSD+SUD for populations with both PTSD+SUD may be optimal for advancing future systematic reviews, meta-analyses, and comparative effectiveness studies which strive to compare effects across a broad variety of psychotherapy types. Method A two-step process was used to evaluate the categorization terminology. First, we searched the literature for pre-existing categories of PTSD+SUD interventions from PTSD+SUD clinical trials, systematic and literature reviews. Then, we surveyed international trauma and substance use subject matter experts about their opinions on pre-existing intervention categorization and ideal categorization nomenclature. Results Mixed method analyses revealed that a proliferation of PTSD+SUD treatment research over the last twenty years brought with it an abundance of ways to characterize the treatments that have been evaluated. Results from our survey of experts (N = 27) revealed that interventions for PTSD+SUD can be classified in many ways that appear to overlap highly with one another. Many experts (11/27; 41%) selected the categories of 'trauma-focused and non-trauma focused' as an optimal way to distinguish treatment types. Although several experts reinforced this point during the subsequent meeting, it became clear that no method of categorizing treatments is without flaws. Conclusion One possible categorization (trauma-focused/non-trauma focused) was identified. Revised language and nomenclature for classification of PTSD+SUD treatments are needed in order to accommodate the needs of this advancing field.
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Affiliation(s)
- Denise A. Hien
- Center of Alcohol & Substance Use Studies, Rutgers University–New Brunswick, Piscataway, NJ, USA
| | | | | | - Chantel T. Ebrahimi
- Center of Alcohol & Substance Use Studies, Rutgers University–New Brunswick, Piscataway, NJ, USA
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | - Sonya B. Norman
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Jessica Tripp
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Lesia M. Ruglass
- Center of Alcohol & Substance Use Studies, Rutgers University–New Brunswick, Piscataway, NJ, USA
- Department of Psychology, City College of New York, New York, NY, USA
| | | | - Therese K. Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Sudie E. Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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17
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Chana SM, Wolford-Clevenger C, Faust A, Hemberg J, Ramaswamy M, Cropsey K. Associations among betrayal trauma, dissociative posttraumatic stress symptoms, and substance use among women involved in the criminal legal system in three US cities. Drug Alcohol Depend 2021; 227:108924. [PMID: 34333280 PMCID: PMC8464486 DOI: 10.1016/j.drugalcdep.2021.108924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Betrayal trauma, as defined by (Freyd, 1996), refers to a subcategory of trauma characterized by a significant violation of trust surrounding interpersonal maltreatment (physical, sexual, or emotional). Previous research has shown that people with betrayal trauma histories experience greater dissociative symptoms of posttraumatic stress disorder and co-morbid substance use disorder symptoms. Women in the criminal legal system commonly have significant histories of betrayal trauma and related posttraumatic stress symptoms and substance use. However, no studies have specifically explored the impact of dissociative posttraumatic stress symptoms on substance use outcomes in this population. Additionally, no studies have explored whether betrayal trauma relates to nonfatal overdoses. METHODS This cross-sectional survey study of N = 508 women with criminal legal system involvement examined the indirect effects of betrayal trauma history on substance use outcomes through dissociative posttraumatic stress symptoms. RESULTS Multivariate analyses supported an indirect effect of betrayal trauma on substance use severity, daily substance use, and history of overdose, but not alcohol use severity, through dissociative symptoms. CONCLUSIONS Women in the criminal legal system with betrayal trauma and dissociative symptoms may be at risk for substance use and related outcomes (i.e., overdose). Future work is needed to examine whether targeting such symptoms may improve substance use treatment and prevention of serious outcomes in this population.
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Affiliation(s)
- Sofía Mildrum Chana
- Department of Psychiatry and Behavioral Neurobiology, Volker Hall L107, 1670 University Blvd., Birmingham, Alabama 35233 USA
| | - Caitlin Wolford-Clevenger
- Department of Psychiatry and Behavioral Neurobiology, Volker Hall L107, 1670 University Blvd., Birmingham, Alabama 35233 USA
| | - Alexandra Faust
- Department of Psychiatry and Behavioral Neurobiology, Volker Hall L107, 1670 University Blvd., Birmingham, Alabama 35233 USA
| | - Jordana Hemberg
- Community Health and Implementation Research Program, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, California 94704 USA
| | - Megha Ramaswamy
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd, MS 1008, Kansas City, Kansas 66160
| | - Karen Cropsey
- Department of Psychiatry and Behavioral Neurobiology, Volker Hall L107, 1670 University Blvd., Birmingham, Alabama 35233 USA
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18
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Lortye SA, Will JP, Marquenie LA, Goudriaan AE, Arntz A, de Waal MM. Treating posttraumatic stress disorder in substance use disorder patients with co-occurring posttraumatic stress disorder: study protocol for a randomized controlled trial to compare the effectiveness of different types and timings of treatment. BMC Psychiatry 2021; 21:442. [PMID: 34493253 PMCID: PMC8423329 DOI: 10.1186/s12888-021-03366-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) have high comorbidity. Although prior research indicated that PTSD can effectively be treated with Prolonged Exposure (PE) in these patients, reported effects are small and treatment dropout rates high. Eye Movement Desensitization and Reprocessing (EMDR) and Imagery Rescripting (ImRs) are other promising treatment options for PTSD, that have not yet been examined in this patient group. Furthermore, it is unclear whether PTSD treatment is most effective when offered simultaneous to or after SUD treatment. METHODS In this article, the Treatment Of PTSD and Addiction (TOPA) study is described: a Dutch randomized controlled trial (RCT) that studies the effectiveness of PTSD treatment as an add-on to regular SUD treatment in patients with SUD and co-occurring PTSD. Effects of PE, EMDR, ImRs, and a 3-month SUD treatment only condition will be compared, as well as simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment. The primary outcome measure is PTSD symptoms. Secondary outcomes are: treatment completion, psychological distress, substance use, interpersonal problems, emotion dysregulation, and trauma-related emotions guilt, shame, and anger. DISCUSSION This study is the first to compare effects of PE, EMDR, and ImRs in one study and to compare simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment as well. This RCT will provide more knowledge about the effectiveness of different treatment strategies for PTSD in patients with co-occurring SUD and will ultimately improve treatment outcomes for patients with this common co-morbidity worldwide. TRIAL REGISTRATION Netherlands Trial Register (NTR), Identifier: NL7885 . Registered 22 July 2019.
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Affiliation(s)
- Sera A. Lortye
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Joanne P. Will
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Loes A. Marquenie
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Anna E. Goudriaan
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands ,grid.7177.60000000084992262Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XAmsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Arnoud Arntz
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marleen M. de Waal
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
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Lawson S, Griffiths H. A Grounded Theory Study: How Non-Treatment-Seeking Substance Users Make Sense of Their Behaviour “I Want To Be Me but I Don’t Know Who Me Is”. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00592-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractDespite the global impact of substance misuse, there are inadequate levels of specialist service provision and continued difficulties with treatment engagement. Within policy and research, there is substantial consideration of the importance of these factors. However, there is little empirical evidence of the views of non-treatment-seeking substance users, who make up the majority of the substance using population. The aim of this study was to understand how these individuals make sense of their behaviour and their reasons for not accessing treatment. A constructivist grounded theory approach was used to interview eight individuals who were currently using substances and not seeking help to stop. The analysis highlighted the importance of attachment to an identity associated with substance use, and relational variables such as connectedness to others, for treatment decisions for individuals who use substances. Understanding these influences, through trauma- and attachment-informed service provision, may reduce barriers to help-seeking and improve treatment uptake.
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20
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Wamel AV, Lempens A, Neven A. Integrated treatment of dual disorders in The Netherlands: a qualitative study of client experiences. ADVANCES IN DUAL DIAGNOSIS 2021. [DOI: 10.1108/add-12-2020-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Many clients who suffer from severe mental health problems also struggle with alcohol and drug use. And although there seems to be a consensus in most European countries that integrated treatment models (especially the integrated treatment of dual disorder clients model) are best fitted to help these clients, none of these have strong evidence, mostly owing to methodological limitations in the studies. This study aims to contribute to the knowledge of why integrated treatment is helpful by conducting in-depth interviews with dual disorder clients who are currently receiving integrated treatment.
Design/methodology/approach
This study is a qualitative thematic analysis using a timeline tool to elicit participants’ responses. In the interviews, dual diagnosis clients with severe problems reflected on their situation at admission, the care they received in integrated treatment and their opinions on positive and negative elements. The interviews were coded and analysed with MAXQDA.
Findings
In the analyses of the interviews, this study found three clusters of elements that clients indicated were the most helpful during their treatment and recovery process: trusting and meaningful relationship with the team, components of integrated treatment and organisation of care.
Originality/value
The findings emphasized the importance of working relationship in the treatment of complex and long-term problems. This has implications for the evaluation of these integrated treatment models which so far mainly focuses on specific interventions.
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Goytan A, Lee W, Dong H, Hayashi K, Milloy MJ, Kerr T. The impact of PSTD on service access among people who use drugs in Vancouver, Canada. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:53. [PMID: 34174927 PMCID: PMC8233608 DOI: 10.1186/s13011-021-00390-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Settings throughout the United States and Canada are contending with high rates of drug-related overdose. This in turn has prompted efforts to more effectively engage people who use drugs (PWUD) in treatment and care. However, while co-morbid mental disorders are prevalent among PWUD and can undermine access to services, the impact of post-traumatic stress disorder (PTSD) on service access is not known. Therefore, we sought to assess whether PTSD is associated with difficulties accessing health and social services among PWUD in Vancouver, Canada. METHODS Survey data was derived from two prospective cohorts of PWUD in Vancouver, Canada for the period of April 2017 to November 2018. PTSD was assessed using the PTSD Checklist for the DSM-V (PCL-5). Generalized estimating equations (GEE) was used to estimate the relationship between PTSD and self-reported inability to access health and social services, after adjustment for confounders. RESULTS Among 810 participants included in our analysis, 316 (39.0%) participants qualified for a provisional PSTD diagnosis, and 117 (14.4%) reported difficulties accessing services. In a multivariable GEE analysis, a PTSD diagnosis (adjusted odds ratio = 1.69, 95% confidence interval: 1.12-2.55) was independently associated with difficulties accessing services. CONCLUSIONS We found high rates of PTSD and self-reported difficulties accessing services among PWUD in Vancouver, as well as a positive association between PTSD and difficulties with service access. These findings highlight the need for trauma-informed approaches to service delivery for PWUD, as well as enhanced provider training specific to PTSD.
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Affiliation(s)
- Annemarie Goytan
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - William Lee
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - M J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada. .,Department of Medicine, University of British Columbia, Vancouver, Canada.
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22
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Panza KE, Kline AC, Norman GJ, Pitts M, Norman SB. Subgroups of comorbid PTSD and AUD in U.S. military veterans predict differential responsiveness to two integrated treatments: A latent class analysis. J Psychiatr Res 2021; 137:342-350. [PMID: 33756376 DOI: 10.1016/j.jpsychires.2021.02.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 01/19/2023]
Abstract
Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co-occur. Integrated treatments are effective, but not all patients respond and predicting outcome remains difficult. In this study, latent class analysis (LCA) identified symptom-based subgroups of comorbid PTSD/AUD among 119 veterans with PTSD/AUD from a randomized controlled trial of integrated exposure therapy (I-PE) versus integrated coping skills therapy (I-CS). Multilevel models compared subgroups on PTSD severity and percentage of heavy drinking days at post-treatment and 3- and 6-month follow-up. LCA revealed three subgroups best fit the data: Moderate PTSD/Low AUD Impairment (21%), High PTSD/High AUD Impairment (48%), and Low PTSD/High AUD Impairment (31%). There was a three-way interaction between time, treatment condition, and subgroup in predicting PTSD outcomes (p < .05). For the Moderate PTSD/Low AUD Impairment class, outcomes at post-treatment and 3-months were similar (ds = 0.17, 0.55), however I-PE showed greater reductions at 6-months (d = 1.36). For the High PTSD/High AUD Impairment class, I-PE demonstrated better post-treatment (d = 0.83) but comparable follow-up (ds = -0.18, 0.49) outcomes. For the Low PTSD/High AUD Impairment class, I-PE demonstrated stronger outcomes at every timepoint (ds = 0.82-1.15). Heavy drinking days declined significantly through follow-up, with an effect of subgroup, but not treatment, on timing of response. This was the first study modeling how PTSD and AUD symptoms might cluster together in a treatment sample of veterans with PTSD/AUD. Symptom-based subgroups show promise in helping understand variability in treatment response among patients with PTSD/AUD and deserve further study.
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Affiliation(s)
- Kaitlyn E Panza
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Alexander C Kline
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Gregory J Norman
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Michelle Pitts
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
| | - Sonya B Norman
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA; National Center for Posttraumatic Stress Disorder, 163 Veterans Drive, White River Junction, VT, 05009, USA
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23
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Alcohol to down-regulate negative and positive emotions: Extending our understanding of the functional role of alcohol in relation to posttraumatic stress disorder. Addict Behav 2021; 115:106777. [PMID: 33359633 DOI: 10.1016/j.addbeh.2020.106777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Functional models of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) underscore the role of internally-driven negative reinforcement. However, with the focus of these models being on negative emotions broadly, there is limited understanding of the effect of alcohol use to down-regulate specific forms of negative emotions or positive emotions generally. Among populations characterized by PTSD, there is growing evidence that positive emotions may elicit aversive reactions and thus be intentionally reduced, including via alcohol use. OBJECTIVE The current study examined the associations among PTSD symptom severity, alcohol use to down-regulate both negative (i.e., despondency and anger) and positive emotions, and alcohol misuse. METHOD Data were collected from 320 trauma-exposed, substance-using individuals in the community (M age = 35.78, 46.9% women). RESULTS Individuals with greater PTSD symptom severity reported significantly higher alcohol use to down-regulate despondency, anger, and positive emotions, which, in turn, were linked to greater alcohol misuse. CONCLUSIONS Alcohol use may serve to down-regulate both negative (i.e., despondency and anger) and positive emotions, and these functions may help to explain the association of PTSD symptom severity to alcohol misuse. PTSD-AUD models may benefit from specifying a negatively reinforcing function of alcohol use in the context of positive emotions.
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24
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Karsberg S, Hesse M, Pedersen MM, Charak R, Pedersen MU. The impact of poly-traumatization on treatment outcomes in young people with substance use disorders. BMC Psychiatry 2021; 21:140. [PMID: 33685430 PMCID: PMC7941934 DOI: 10.1186/s12888-021-03129-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is believed that clients with psychological trauma experiences have a poor prognosis with regard to treatment participation and outcomes for substance use disorders. However, knowledge on the effect of the number of trauma experiences is scarce. METHODS Using data from drug use disorder (DUD) treatment in Denmark, we assessed the impact of having experienced multiple potentially traumatic experiences on DUD treatment efficacy. Baseline and follow-up data from 775 young participants (mean age = 20.2 years, standard deviation = 2.6) recruited at nine treatment centers were included in analyses. RESULTS Analyses showed that participants who were exposed multiple trauma experiences also reported a significantly higher intake of cannabis at treatment entry, and a lower well-being score than participants who reported less types or no types of victimization experiences. During treatment, patients with multiple types of trauma experiences showed a slower rate of reduction of cannabis than patients with few or no trauma experiences. The number of trauma types was not associated with number of sessions attended or the development of well-being in treatment. CONCLUSION Overall, the results show that although traumatized youth in DUD treatment show up for treatment, helping them to reduce substance use during treatment is uniquely challenging. TRIAL REGISTRATION ISRCTN88025085 , date of registration: 29.08.2016, retrospectively registered.
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Affiliation(s)
- Sidsel Karsberg
- grid.7048.b0000 0001 1956 2722Centre for Alcohol and Drug Research, Aarhus University, Bartholins Allé 10, 8000 Aarhus, Denmark
| | - Morten Hesse
- Centre for Alcohol and Drug Research, Aarhus University, Bartholins Allé 10, 8000, Aarhus, Denmark.
| | - Michael Mulbjerg Pedersen
- grid.7048.b0000 0001 1956 2722Centre for Alcohol and Drug Research, Aarhus University, Bartholins Allé 10, 8000 Aarhus, Denmark
| | - Ruby Charak
- grid.449717.80000 0004 5374 269XDepartment of Psychological Science, The University of Texas Rio Grande Valley, 1201 W. University Dr, Edinburg, TX USA
| | - Mads Uffe Pedersen
- grid.7048.b0000 0001 1956 2722Centre for Alcohol and Drug Research, Aarhus University, Bartholins Allé 10, 8000 Aarhus, Denmark
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25
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Can the migration process influence the clinical expression of heroin use disorder in migrants to Italy? CNS Spectr 2021; 26:62-70. [PMID: 31969204 DOI: 10.1017/s1092852919001846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND For some time now, there has been a strong consensus that the migration process can influence the onset, course, development, outcome, and clinical aspects of psychiatric pathologies. METHODS In this study, we have analyzed the influence of the migration process on the clinical expression of heroin use disorder (HUD). In a naturalistic case-control study, we compared, both at univariate and multivariate level, 30 migrant HUD (M-HUD) patients with 30 age/gender-matched Italian HUD (IT-HUD) patients. We also analyzed demographic data, drug addiction history, psychopathological symptoms, addictive behavior, and emotional reactivity to life events. RESULTS Compared with IT-HUD pairs, at HUD Agonist Opioid Treatment, M-HUD patients were characterized by inadequate income and the presence of legal problems. They were more frequently at stage 3 of heroin addiction, with a concomitantly less frequent use of stimulants. Their age at the onset of heroin use was greater than that of subjects in the IT-HUD group. HUD post-traumatic stress disorder spectrum was present and was more severe in all M-HUD patients, but grief reactions and maladaptive behavior were the most discriminant traits. No differences were found in terms of addictive behaviors related to heroin craving or with respect to the severity/typology of psychopathology specific to HUD. CONCLUSIONS The migratory process does not seem to be correlated with addictive behaviors or with psychopathology specific to HUD. It partly affects HUD history, and specifically correlates with emotional reactivity to loss and traumatic life events, so suggesting that in M-HUD individuals, the link between the migratory syndrome and HUD is very close.
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Renaud F, Jakubiec L, Swendsen J, Fatseas M. The Impact of Co-occurring Post-traumatic Stress Disorder and Substance Use Disorders on Craving: A Systematic Review of the Literature. Front Psychiatry 2021; 12:786664. [PMID: 34970169 PMCID: PMC8712572 DOI: 10.3389/fpsyt.2021.786664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/16/2021] [Indexed: 12/29/2022] Open
Abstract
The frequent co-occurrence of post-traumatic stress disorder (PTSD) and substance use disorders (SUDs) leads to manifestations of both conditions that are more severe and more resistance to treatment than single disorders. One hypothesis to explain this synergy is the impact of intrusive memories on craving which, in turn, increases the risk of relapse among patients with substance use disorders. The aim of this systematic review is to examine this possibility by assessing the impact of PTSD and its symptoms on craving among dual disorder patients. Using PRISMA criteria, four databases were comprehensively searched up to June, 2021, in order to identify all candidate studies based on broad key words. Resulting studies were then selected if they examined the impact of PTSD or PTSD symptoms on craving, and if they used standardized assessments of PTSD, SUD, and craving. Twenty-seven articles matched the selection criteria and were included in this review. PTSD was found to be significantly associated with increased craving levels among patients with alcohol, cannabis, cocaine, tobacco, and other substance use disorders. Exposition to traumatic cues among dual disorder patients was also shown to trigger craving, with an additive effect on craving intensity when exposure to substance-related cues occurred. In addition, certain studies observed a correlation between PTSD symptom severity and craving intensity. Concerning mechanisms underlying these associations, some findings suggest that negative emotional states or emotion dysregulation may play a role in eliciting craving after traumatic exposure. Moreover, these studies suggest that PTSD symptoms may, independently of emotions, act as powerful cues that trigger craving. These findings argue for the need of dual disorder treatment programs that integrate PTSD-focused approaches and emotion regulation strategies, in addition to more traditional interventions for craving management.
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Affiliation(s)
- Fabien Renaud
- Pôle Inter-établissement d'addictologie, CHU de Bordeaux et Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Louise Jakubiec
- Pôle Inter-établissement d'addictologie, CHU de Bordeaux et Centre Hospitalier Charles Perrens, Bordeaux, France.,University of Bordeaux/CNRS-UMR 5287, Bordeaux, France
| | - Joel Swendsen
- University of Bordeaux/CNRS-UMR 5287, Bordeaux, France.,EPHE, PSL Research University, Paris, France
| | - Melina Fatseas
- Pôle Inter-établissement d'addictologie, CHU de Bordeaux et Centre Hospitalier Charles Perrens, Bordeaux, France.,University of Bordeaux/CNRS-UMR 5287, Bordeaux, France
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27
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Kpelly E, Schauder S, Masson J, Kokou-Kpolou CK, Moukouta C. Influence de l’attachement et des psychotraumatismes dans les addictions aux drogues. ANNALES MEDICO-PSYCHOLOGIQUES 2020. [DOI: 10.1016/j.amp.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Raj N, Verthein U, Grundmann J, Lotzin A, Hiller P, Schulte B, Driessen M, Hillemacher T, Scherbaum N, Schäfer M, Schneider B, Schäfer I. Internalizing and externalizing subtypes in female patients with co-occurring post-traumatic stress disorder and substance use disorders. J Subst Abuse Treat 2020; 121:108198. [PMID: 33357607 DOI: 10.1016/j.jsat.2020.108198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research has described subtypes with more internalizing and more externalizing symptoms in samples of patients with post-traumatic stress disorder (PTSD) and samples of patients with substance use disorders (SUD). OBJECTIVE This study sought to examine the respective subtypes in female PTSD-SUD patients and potential relationships with substance use characteristics. METHODS We performed a latent class analysis (LCA) in 343 adult female participants of a multisite therapy trial on PTSD and SUD. We derived externalizing symptoms from the Assessment of DSM-IV Personality Disorders (ADP-IV) questionnaire. We assessed internalization using the Symptom Checklist-27 (SCL-27) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). We collected substance use-related information using the Addiction Severity Index-Lite (ASI-lite). RESULTS LCA suggested four latent classes including an externalizing (10.8%), a moderately internalizing class (31.0%), and a highly internalizing class (22.0%), as well as a class with a low severity of psychological symptoms (36.3%). Externalizing participants used more substances than any other class, while the duration of substance use did not differ between groups. Regular use started at a significantly younger age among the members of the highly internalizing subgroup compared to the moderately internalizing and low severity participants, but at an older age compared to the externalizing group members. CONCLUSIONS The finding of two internalizing subgroups along with an externalizing and a low severity class emphasizes the heterogeneity and complexity of populations with PTSD and SUD. This heterogeneity bears implications for research among this group of patients, but also for their treatment, especially considering our results on differences in substance use.
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Affiliation(s)
- Naily Raj
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Uwe Verthein
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Johanna Grundmann
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Annett Lotzin
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Philipp Hiller
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Bernd Schulte
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy Bethel, Ev. Klinikum Bielefeld, Burgsteig 13, 33617 Bielefeld, Germany.
| | - Thomas Hillemacher
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; Department of Psychiatry and Psychotherapy, Paracelsus University Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419 Nürnberg, Germany.
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Virchowstrasse 174, 45147 Essen, Germany.
| | - Martin Schäfer
- Department of Psychiatry, Psychosomatics and Addiction Medicine, Evang. Kliniken Essen-Mitte, Henricistrasse 92, 45136 Essen, Germany.
| | - Barbara Schneider
- Department of Addictive Disorders, Psychiatry and Psychotherapy, LVR-Klinik Cologne, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany.
| | - Ingo Schäfer
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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Yildiz D, Ciftci A, Yalcin O. The Association between Trauma History, Trauma-Related Psychopathology and Treatment Completion at an Adolescent Inpatient Substance Abuse Treatment Center in Turkey. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2020. [DOI: 10.1080/1067828x.2020.1837319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Deniz Yildiz
- School of Health Sciences, Istanbul Gelisim University, Istanbul, Turkey
| | - Arzu Ciftci
- Istanbul Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurology, Neurosurgery Research and Trainee Hospital, İstanbul, Turkey
| | - Ozhan Yalcin
- Ankara University Faculty of Medicine, Ankara, Turkey
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30
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Blanco L, Sió A, Hogg B, Esteve R, Radua J, Solanes A, Gardoki-Souto I, Sauras R, Farré A, Castillo C, Valiente-Gómez A, Pérez V, Torrens M, Amann BL, Moreno-Alcázar A. Traumatic Events in Dual Disorders: Prevalence and Clinical Characteristics. J Clin Med 2020; 9:E2553. [PMID: 32781718 PMCID: PMC7466030 DOI: 10.3390/jcm9082553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/24/2020] [Accepted: 07/31/2020] [Indexed: 12/11/2022] Open
Abstract
Psychological trauma has been identified in substance use disorders (SUD) as a major etiological risk factor. However, detailed and systematic data about the prevalence and types of psychological trauma in dual disorders have been scarce to date. In this study, 150 inpatients were recruited and cross-sectionally screened on their substance use severity, psychological trauma symptoms, comorbidities, and clinical severity. One hundred patients fulfilled criteria for a dual disorder, while 50 patients were diagnosed with only SUD. Ninety-four percent of the whole sample suffered from at least one lifetime traumatic event. The prevalence rates of Posttraumatic Stress Disorder diagnosis for dual disorder and only SUD was around 20% in both groups; however, patients with dual disorder presented more adverse events, more childhood trauma, more dissociative symptoms, and a more severe clinical profile than patients with only SUD. Childhood maltreatment can also serve as a predictor for developing a dual disorder diagnosis and as a risk factor for developing a more complex and severe clinical profile. These data challenge our current clinical practice in the treatment of patients suffering from dual disorder or only SUD diagnosis and favor the incorporation of an additional trauma-focused therapy in this population. This may improve the prognosis and the course of the illness in these patients.
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Affiliation(s)
- Laura Blanco
- Benito Menni Complex Assistencial en Salut Mental, Sant Boi de Llobregat, 08830 Barcelona, Spain; (L.B.); (A.S.)
- Department of Personality, Evaluation and Psychological Treatments, University of Barcelona, 08007 Barcelona, Spain
| | - Albert Sió
- Benito Menni Complex Assistencial en Salut Mental, Sant Boi de Llobregat, 08830 Barcelona, Spain; (L.B.); (A.S.)
| | - Bridget Hogg
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, 08019 Barcelona, Spain; (B.H.); (I.G.-S.); (A.V.-G.); (A.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (V.P.); (M.T.)
| | - Ricard Esteve
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, 08003 Barcelona, Spain; (R.E.); (R.S.); (A.F.); (C.C.)
| | - Joaquim Radua
- Imaging of Mood and Anxiety-Related Disorders (IMARD) group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (J.R.); (A.S.)
- Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R2LS, UK
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Solna, 17177 Stockholm, Sweden
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
| | - Aleix Solanes
- Imaging of Mood and Anxiety-Related Disorders (IMARD) group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (J.R.); (A.S.)
| | - Itxaso Gardoki-Souto
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, 08019 Barcelona, Spain; (B.H.); (I.G.-S.); (A.V.-G.); (A.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (V.P.); (M.T.)
| | - Rosa Sauras
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, 08003 Barcelona, Spain; (R.E.); (R.S.); (A.F.); (C.C.)
| | - Adriana Farré
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, 08003 Barcelona, Spain; (R.E.); (R.S.); (A.F.); (C.C.)
| | - Claudio Castillo
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, 08003 Barcelona, Spain; (R.E.); (R.S.); (A.F.); (C.C.)
| | - Alicia Valiente-Gómez
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, 08019 Barcelona, Spain; (B.H.); (I.G.-S.); (A.V.-G.); (A.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (V.P.); (M.T.)
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, 08003 Barcelona, Spain; (R.E.); (R.S.); (A.F.); (C.C.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
- Department of Psychiatry, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - Víctor Pérez
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (V.P.); (M.T.)
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, 08003 Barcelona, Spain; (R.E.); (R.S.); (A.F.); (C.C.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
- Department of Psychiatry, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - Marta Torrens
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (V.P.); (M.T.)
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, 08003 Barcelona, Spain; (R.E.); (R.S.); (A.F.); (C.C.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
- Department of Psychiatry, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
- RETICS-Redes Temáticas de Investigación Cooperativa en Salud en Trastornos Adictivos, 08003 Barcelona, Spain
| | - Benedikt L. Amann
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, 08019 Barcelona, Spain; (B.H.); (I.G.-S.); (A.V.-G.); (A.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (V.P.); (M.T.)
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, 08003 Barcelona, Spain; (R.E.); (R.S.); (A.F.); (C.C.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
- Department of Psychiatry, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - Ana Moreno-Alcázar
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, 08019 Barcelona, Spain; (B.H.); (I.G.-S.); (A.V.-G.); (A.M.-A.)
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (V.P.); (M.T.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
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Fox R, Hyland P, McHugh Power J, Coogan AN. Patterns of comorbidity associated with ICD-11 PTSD among older adults in the United States. Psychiatry Res 2020; 290:113171. [PMID: 32526516 DOI: 10.1016/j.psychres.2020.113171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/30/2020] [Accepted: 05/30/2020] [Indexed: 11/16/2022]
Abstract
Little research has been conducted on posttraumatic stress disorder (PTSD) comorbidity among older adults regarding the description of PTSD in the 11th version of the International Classification of Diseases (ICD-11). This study sought to provide evidence of a dimensional model of psychopathology using the 'Hierarchical Taxonomy of Psychopathology' (HiTOP) model as a theoretical framework to explain patterns of ICD-11 PTSD comorbidity. Distinct patterns of ICD-11 PTSD comorbidity among a nationally representative sample (n = 530) of adults aged 60 years and older from the United States were examined using latent class analysis (LCA). Covariates associated with comorbidity classes were assessed through multinomial logistic regression. ICD-11 PTSD was highly comorbid with other psychopathologies. LCA results favoured a two-class solution. Class 1 (71.7%) was characterised by moderate probabilities for major depressive disorder and alcohol use disorder; Class 2 (28.3%) was characterised by a moderate-high probability of general psychopathology and was associated with lower social support, spousal/partner physical abuse, and history of attempted suicide. PTSD was highly comorbid with other disorders among older adults. Distinct patterns of PTSD comorbidity exist among this cohort and these findings can aid clinicians and researchers in understanding and predicting maladaptive responses to trauma and associated psychopathology.
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Affiliation(s)
- Robert Fox
- Department of Psychology, Maynooth University, Kildare, Ireland.
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland.
| | - Joanna McHugh Power
- Department of Psychology, Maynooth University, Kildare, Ireland; UK CRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
| | - Andrew N Coogan
- Department of Psychology, Maynooth University, Kildare, Ireland.
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Weiss NH, Forkus SR, Raudales AM, Schick MR, Contractor AA. Alcohol misuse to down-regulate positive emotions: A cross-sectional multiple mediator analysis among US military veterans. Addict Behav 2020; 105:106322. [PMID: 32006684 PMCID: PMC7059215 DOI: 10.1016/j.addbeh.2020.106322] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol misuse presents a pervasive and clinically relevant concern among US military veterans. OBJECTIVE The current investigation sought to examine the role of positive emotion dysfunction in the relation between PTSD symptomatology and alcohol misuse. To do so, we examined the separate and sequential roles of positive emotional intensity and positive emotional avoidance in the relation between PTSD symptoms and alcohol misuse among US military veterans. METHOD Cross-sectional data were collected from 468 US military veterans (M age = 37.74, 70.5% male, 69.0% White) who responded to an online survey. RESULTS Findings suggest that positive emotional avoidance, separately, and positive emotional intensity and positive emotional avoidance, sequentially, mediated the relation between PTSD symptoms and alcohol misuse. CONCLUSIONS Findings advance theory on the role of positive emotions and related processes in the co-occurrence of PTSD and alcohol misuse, and highlight important avenues for future research and treatment focused on the PTSD-alcohol misuse co-occurrence.
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Rey CN, Badger GJ, Melbostad HS, Wachtel D, Sigmon SC, MacAfee LK, Dougherty AK, Heil SH. Perceptions of long-acting reversible contraception among women receiving medication for opioid use disorder in Vermont. Contraception 2020; 101:333-337. [PMID: 32014521 PMCID: PMC7510935 DOI: 10.1016/j.contraception.2020.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/23/2019] [Accepted: 01/20/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate perceptions of long-acting reversible contraceptives (LARC) among women receiving medication for opioid use disorder. STUDY DESIGN Cross-sectional survey of 200 women receiving medication for opioid use disorder in Vermont. RESULTS A considerable proportion of women receiving medication for opioid use disorder in Vermont reported previous use of an IUD (40%) and/or a subdermal contraceptive implant (16%); the majority of prior LARC users were satisfied with their IUD (68%) or their implant (74%). Of the 38% of participants who had never considered IUD use, 85% percent (64/75) said that they knew nothing or only a little about IUDs. Of the 61% of participants who had never considered an implant, 81% percent (98/121) said that they knew nothing or only a little about the contraceptive method. The most commonly reported reasons for a lack of interest in the IUD and/or implant were concerns about side effects and preference for a woman-controlled method. CONCLUSIONS Gaps in LARC knowledge are common among those who have not used LARCs and concerns about side effects and preferences for a woman-controlled method limit some women's interest in these contraceptives. Additionally, reasons for dissatisfaction among past users are generally similar for IUD and implant and include irregular bleeding and having a bad experience with the method. IMPLICATIONS Efforts to increase awareness of LARC methods among women receiving medication for opioid use disorder should address concerns about side effects and reproductive autonomy and encourage satisfied LARC users to share their experiences with their social networks.
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Affiliation(s)
- Catalina N Rey
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Gary J Badger
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Heidi S Melbostad
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Deborah Wachtel
- Department of Nursing, University of Vermont, Burlington, VT, USA
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA; Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Lauren K MacAfee
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Burlington, VT, USA
| | - Anne K Dougherty
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Burlington, VT, USA
| | - Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA; Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA.
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Abstract
BACKGROUND Depression and post-traumatic stress disorder (PTSD) are leading causes of disability and loss of life by suicide. Currently, there are less than satisfactory medical solutions to treat these mental disorders. Here, we explore recent preclinical and clinical studies demonstrating the potential of using buprenorphine to treat major depressive disorder, treatment-resistant depression, and PTSD. METHOD Bibliographic databases were searched to include preclinical and clinical studies demonstrating the therapeutic potential of buprenorphine and the involvement of the kappa opioid receptor (KOR) in mediating these effects. RESULTS Original clinical studies examining the effectiveness of buprenorphine to treat depression were mixed. The majority of participants in the PTSD studies were males and suffer from chronic pain and/or substance use disorders. Nonetheless, these recent studies and analyses established proof of concept warranting farther investigations. Additionally, KOR likely mediates the antidepressant and some of the anxiolytic effects of buprenorphine. Still, it appears that the full spectrum of buprenorphine's beneficial effects might be due to activity at other opioid receptors as well. CONCLUSIONS Pharmaceuticals' abilities to treat medical conditions directly relates to their ability to act upon the endogenous biological systems related to the conditions. Thus, these recent findings are likely a reflection of the central role that the endogenous opioid system has in these mental illnesses. Further studies are necessary to study the involvement of endogenous opioid systems, and specifically KOR, in mediating buprenorphine's beneficial effects and the ability to treat these medical conditions while minimizing risks for misuse and diversion.
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Affiliation(s)
- Caitlin A Madison
- Behavioral and Cellular Neuroscience, Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX77843, USA
| | - Shoshana Eitan
- Behavioral and Cellular Neuroscience, Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX77843, USA
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Thome J, Terpou BA, McKinnon MC, Lanius RA. The neural correlates of trauma-related autobiographical memory in posttraumatic stress disorder: A meta-analysis. Depress Anxiety 2020; 37:321-345. [PMID: 31815346 DOI: 10.1002/da.22977] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/02/2019] [Accepted: 11/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Autobiographical memory (AM) refers to memories of events that are personally relevant and are remembered from one's own past. The AM network is a distributed brain network comprised largely by prefrontal medial and posteromedial cortical brain regions, which together facilitate AM. Autobiographical memories with high arousal and negatively valenced emotional states are thought to be retrieved more readily and re-experienced more vividly. This is critical in the case of trauma-related AMs, which are related to altered phenomenological experiences as well as aberrations to the underlying neural systems in posttraumatic stress disorder (PTSD). Critically, these alterations to the AM network have not been explored recently and have never been analyzed with consideration to the different processes of AM, them being retrieval and re-experiencing. METHODS We conducted a series of effect-size signed differential mapping meta-analyses across twenty-eight studies investigating the neural correlates of trauma-related AMs in participants with PTSD as compared with controls. Studies included either trauma-related scripts or trauma-related materials (i.e., sounds, images, pictures) implemented to evoke the recollection of a trauma-related memory. RESULTS The meta-analyses revealed that control and PTSD participants displayed greater common brain activation of prefrontal medial and posteromedial cortices, respectively. Whereby the prefrontal medial cortices are suggested to facilitate retrieval monitoring, the posteromedial cortices are thought to enable the visual imagery processes of AM. CONCLUSIONS Taken together, reduced common activation of prefrontal cortices may be interpreted as a bias toward greater re-experiencing, where the more salient elements of the traumatic memory are relived as opposed to retrieved in a controlled manner in PTSD.
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Affiliation(s)
- Janine Thome
- Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Theoretical Neuroscience, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Braeden A Terpou
- Department of Neuroscience, Western University, London, Ontario, Canada
| | - Margaret C McKinnon
- Mood Disorders Program, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
| | - Ruth A Lanius
- Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Neuroscience, Western University, London, Ontario, Canada
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Contractor AA, Weiss NH, Schick MR, Natesan P, Forkus S, Sharma R. Comparison of latent typologies of posttraumatic stress disorder and depression symptoms across military personnel from India and the US. J Anxiety Disord 2020; 70:102195. [PMID: 32035292 PMCID: PMC7074844 DOI: 10.1016/j.janxdis.2020.102195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/20/2020] [Accepted: 01/25/2020] [Indexed: 11/29/2022]
Abstract
Research has identified heterogeneous subgroups of individuals based on posttraumatic stress disorder (PTSD) and depression symptoms. Using data collected from military personnel in India (N = 146) and U.S. (N = 194), we examined (1) the best-fitting latent class solution; (2) multi-group invariance of the class solution; and (3) construct validity of optimal class solution. Results indicated that the optimal 4-class solution differed in severity and severity/type in the India and U.S. samples respectively. With similarity in the optimal number of classes across cultural samples, the meaning/nature of classes differed. In the India sample, anxiety severity predicted the Low Severity Class vs. all other classes, and the Moderately High Severity/High Severity Classes vs. the Moderately Low Severity Class; number of traumas predicted the High Severity Class vs. other classes; and resilience predicted the Moderately Low Severity Class vs. the Moderately High Severity Class. In the U.S. sample, alcohol use predicted the High Severity Class vs. all other classes, and the High Depression-Low PTSD Class vs. the Low Severity Class; rumination significantly predicted the High Severity and High Depression-Low PTSD Classes vs. each of the High PTSD-Low Depression and Low Severity Classes. Thus, meaning and nature of PTSD-depression subgroups may vary culturally; hence, culturally-sensitive interventions need to account for this heterogeneity.
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Affiliation(s)
| | | | | | | | | | - Rachita Sharma
- Department of Rehabilitation and Health Services, University of North Texas
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37
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María-Ríos CE, Morrow JD. Mechanisms of Shared Vulnerability to Post-traumatic Stress Disorder and Substance Use Disorders. Front Behav Neurosci 2020; 14:6. [PMID: 32082127 PMCID: PMC7006033 DOI: 10.3389/fnbeh.2020.00006] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/13/2020] [Indexed: 12/11/2022] Open
Abstract
Psychoactive substance use is a nearly universal human behavior, but a significant minority of people who use addictive substances will go on to develop an addictive disorder. Similarly, though ~90% of people experience traumatic events in their lifetime, only ~10% ever develop post-traumatic stress disorder (PTSD). Substance use disorders (SUD) and PTSD are highly comorbid, occurring in the same individual far more often than would be predicted by chance given the respective prevalence of each disorder. Some possible reasons that have been proposed for the relationship between PTSD and SUD are self-medication of anxiety with drugs or alcohol, increased exposure to traumatic events due to activities involved in acquiring illegal substances, or addictive substances altering the brain's stress response systems to make users more vulnerable to PTSD. Yet another possibility is that some people have an intrinsic vulnerability that predisposes them to both PTSD and SUD. In this review, we integrate clinical and animal data to explore these possible etiological links between SUD and PTSD, with an emphasis on interactions between dopaminergic, adrenocorticotropic, GABAergic, and glutamatergic neurobehavioral mechanisms that underlie different emotional learning styles.
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Affiliation(s)
| | - Jonathan D. Morrow
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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38
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Basedow LA, Kuitunen-Paul S, Roessner V, Golub Y. Traumatic Events and Substance Use Disorders in Adolescents. Front Psychiatry 2020; 11:559. [PMID: 32625122 PMCID: PMC7314975 DOI: 10.3389/fpsyt.2020.00559] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 06/01/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Adolescents with substance use disorders (SUD) frequently report traumatic events (TEs) and symptoms of post-traumatic stress disorder (PTSD). This study aimed to assess whether lifetime prevalence rates of TEs and PTSD are related to SUD severity in adolescent psychiatric patients. METHODS We analyzed N = 114 self-reports of treatment-seeking German adolescents aged 12 to 18 years, who visited a specialized SUD outpatient unit. Standardized questionnaires were applied to assess SUD severity, the number of TEs and DSM-IV PTSD criteria. RESULTS Patients fulfilling PTSD criteria (28% of the total sample) had a higher Drug Use Disorders Identification Test (DUDIT) score compared to non-PTSD patients with TEs (p <.001), and compared to adolescents without TEs or PTSD (p = .003). Additionally, SUD severity was positively associated with the number of TEs and the number of intrusion, hyperarousal, and avoidance symptoms (all r = .33 to.48, all p <.01). DISCUSSION Adolescent patients with SUD reported 3-times higher rates of TEs, and a 5-time higher prevalence of PTSD following TEs, than the general adolescent population. Adolescent SUD patients with PTSD reported more severe substance use problems than patients without PTSD-regardless of previous TEs. Longitudinal studies are needed in order to investigate the temporal relationship between TEs, PTSD and SUD.
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Affiliation(s)
- Lukas A Basedow
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Sören Kuitunen-Paul
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Yulia Golub
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
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39
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MacAfee LK, Harfmann RF, Cannon LM, Minadeo L, Kolenic G, Kusunoki Y, Dalton VK. Substance Use Treatment Patient and Provider Perspectives on Accessing Sexual and Reproductive Health Services: Barriers, Facilitators, and the Need for Integration of Care. Subst Use Misuse 2020; 55:95-107. [PMID: 31455128 DOI: 10.1080/10826084.2019.1656255] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Women with substance use disorders have high rates of adverse sexual and reproductive health (SRH) outcomes, including unintended pregnancy, sexually transmitted infections, and contraceptive nonuse. Little research has explored barriers and facilitators to accessing SRH services experienced by women with substance use disorders. Objectives: To investigate barriers and facilitators to accessing SRH services experienced by women with substance use disorders. To assess perspectives on integration of SRH services into substance use treatment. Methods: Twenty-nine semi-structured interviews were conducted with female patients (N = 17) and providers (N = 12) at four substance use treatment facilities in Michigan between October 2015 and January 2016. Respondents were asked about experiences accessing SRH services and perspectives on integration of SRH services into substance use treatment. Data were analyzed using the constant comparative method. Results: Patients and providers discussed barriers to accessing SRH services, including competing priorities, structural barriers, lack of knowledge on SRH services and substance use, fear of Child Protective Services and law enforcement, and stigma. Facilitators included reprioritization of SRH, accessible transportation, insurance coverage and funding for SRH services, and education and training on SRH. Finally, participants expressed support for integration of SRH services into substance use treatment. Conclusions/Importance: Understanding the barriers to accessing SRH services is essential to reducing the adverse SRH outcomes experienced by women with substance use disorders. Substance use treatment is a critical time to offer SRH services. Integration of care is a potential model for improving the SRH of women with substance use disorders.
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Affiliation(s)
- Lauren K MacAfee
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Roxanne F Harfmann
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Lindsay M Cannon
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Leah Minadeo
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Giselle Kolenic
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Yasamin Kusunoki
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Vanessa K Dalton
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan, USA
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Kahl J, Holl J, Grundmann J, Lotzin A, Hiller P, Schroeder K, Schulte B, Barnow S, Schäfer I. Emotion Regulation as a Mediator between Childhood Abuse and Neglect and Posttraumatic Stress Disorder in Women with Substance Use Disorders. Subst Use Misuse 2020; 55:2184-2193. [PMID: 32835585 DOI: 10.1080/10826084.2020.1797805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A history of childhood abuse and neglect (CAN) is significantly associated with psychopathologies in adulthood, including comorbid posttraumatic stress disorder (PTSD) and substance use disorders (SUD). Difficulties in emotion regulation (ER) might influence the association between CAN and PTSD. The aim of this study was to examine the relationship between CAN and PTSD symptom severity in women with SUD and to investigate the mediating role of general difficulties in ER and its specific dimensions. Method: We examined 320 women, with a current diagnosis of at least subsyndromal PTSD and SUD, using self-report measures of CAN, PTSD symptom severity, and ER difficulties. We conducted both simple and multiple bootstrapping-enhanced mediation analysis to investigate whether general difficulties in ER and its specific dimensions mediate the relationship between CAN and PTSD symptom severity. Results: General difficulties in ER mediated the association between CAN and PTSD symptom severity. CAN significantly predicted adult PTSD symptom severity, directly and indirectly, through ER difficulties. Difficulties engaging in goal directed behavior when distressed was the only ER dimension, which mediated the effect of CAN on PTSD symptoms. Conclusions: Our results suggest that difficulties in ER and specifically difficulties engaging in goal directed behavior when distressed might constitute an influential factor in the relationship between CAN and PTSD symptom severity in a sample of SUD patients, and highlight the importance of targeting ER as a potential treatment focus for patients with comorbid PTSD and SUD.
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Affiliation(s)
- Johanna Kahl
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Holl
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
| | - Johanna Grundmann
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annett Lotzin
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Hiller
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Schroeder
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Schulte
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Barnow
- Clinical Psychology and Psychotherapy, Institute of Psychology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Ingo Schäfer
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Luderer M, Reinhard I, Richter A, Kiefer F, Weber T. ADHD Is Associated with a Higher Risk for Traumatic Events, Self-Reported PTSD, and a Higher Severity of PTSD Symptoms in Alcohol-Dependent Patients. Eur Addict Res 2020; 26:245-253. [PMID: 32653887 DOI: 10.1159/000508918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/25/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Alcohol dependence (AD) is frequently associated with attention-deficit/hyperactivity disorder (ADHD) as well as with posttraumatic stress disorder (PTSD). OBJECTIVE Aim of this study was to investigate whether in patients with AD, ADHD is associated with an increased rate of exposure to potentially traumatic events (PTEs) and PTSD, with increased PTSD severity and higher impact on daily functioning. METHODS Patients with AD were thoroughly assessed for ADHD during long-term residential treatment. Participants also completed the Posttraumatic Diagnostic Scale (PDS). The PDS is a 49-item self-report instrument that assesses exposure to different PTEs, DSM-IV criteria for PTSD, severity of PTSD, and related functional impairment. RESULTS Of 341 patients with AD, 66 were diagnosed with ADHD (19%). ADHD was associated with a more frequent exposure to PTEs (88 vs. 65%, p < 0.001). In patients with PTEs (n = 237), odds for PTSD were higher in ADHD versus no-ADHD patients (OR 8.9, 95% CI 3.9-20.5). Furthermore, PTSD severity and functional impairment were increased in ADHD patients. CONCLUSIONS ADHD in patients with AD is associated with a higher frequency of PTEs and PTSD with more severe and more impairing PTSD symptoms. In alcohol-dependent patients with ADHD, regular screening for PTSD should be considered.
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Affiliation(s)
- Mathias Luderer
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany, .,Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany,
| | - Iris Reinhard
- Department of Biostatistics, Central Institute of Mental Health, Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany
| | | | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany.,Feuerlein Center of Translational Addiction Medicine, Heidelberg, Germany
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The role of gender in the associations among posttraumatic stress disorder symptom, severity, difficulties regulating emotions, and alcohol misuse. Addict Behav 2019; 99:106086. [PMID: 31445483 DOI: 10.1016/j.addbeh.2019.106086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/11/2019] [Accepted: 08/09/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol misuse is highly prevalent and clinically significant. Delineating mediators (i.e., emotion regulation) and moderators (i.e., gender) of this co-occurrence is critical to understanding underlying mechanisms of such comorbidity and intervention development/refinement. METHOD The present study examined the potential mediating role of difficulties regulating negative and positive emotions in this association as well as the moderating role of gender using a moderated mediation analysis. Participants were 475 trauma-exposed community adults recruited from Amazon's Mechanical Turk (MTurk) platform (Mage = 35.62, 55.4% women, 77.0% White). RESULTS Difficulties regulating positive (but not negative) emotions significantly mediated the relation between PTSD symptom severity and alcohol misuse. Further, gender was found to significantly moderate each of the paths in this mediation model. CONCLUSIONS Results highlight gender-specific intervention targets for reducing alcohol misuse among trauma-exposed individuals who experience PTSD symptoms.
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Castillo-Carniglia A, Keyes KM, Hasin DS, Cerdá M. Psychiatric comorbidities in alcohol use disorder. Lancet Psychiatry 2019; 6:1068-1080. [PMID: 31630984 PMCID: PMC7006178 DOI: 10.1016/s2215-0366(19)30222-6] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/13/2019] [Accepted: 05/30/2019] [Indexed: 01/10/2023]
Abstract
Alcohol use disorder is a major contributor to the morbidity and mortality burden worldwide. It often coexists with other psychiatric disorders; however, the nature of this comorbidity is still a matter of debate. In this Series paper, we examine the main psychiatric disorders associated with alcohol use disorder, including the prevalence of co-occurring disorders, the temporal nature of the relationship, and mechanisms that might explain comorbidity across the lifespan. Overall, this disorder co-occurs with a wide range of other psychiatric disorders, especially those disorders involving substance use and violent or aggressive behaviour. The causal pathways between alcohol use disorder and other psychiatric disorders are heterogeneous. Hypotheses explaining these relationships include reciprocal direct causal associations, shared genetic and environmental causes, and shared psychopathological characteristics of broader diagnostic entities (eg, externalising disorders). Efforts to untangle the associations between alcohol use disorder and other disorders across the lifespan remain a crucial avenue of research.
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Affiliation(s)
- Alvaro Castillo-Carniglia
- Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile; Department of Population Health, New York University School of Medicine, New York, NY, USA.
| | - Katherine M Keyes
- Department of Epidemiology, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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44
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van Hagen LJ, de Waal MM, Christ C, Dekker JJM, Goudriaan AE. Patient Characteristics Predicting Abstinence in Substance Use Disorder Patients With Comorbid Mental Disorders. J Dual Diagn 2019; 15:312-323. [PMID: 31566115 DOI: 10.1080/15504263.2019.1667043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Patients with both a substance use disorder and comorbid mental disorder, or dual diagnosis, form a heterogeneous group with complex treatment needs. Dual diagnosis patients have worse treatment outcomes compared to patients with substance use disorders alone. There is a lack of research focusing on predictors of treatment outcome in dual diagnosis patients. The aim of this study was to identify patient characteristics associated with abstinence in dual diagnosis patients. Methods: In a cohort design, we examined associations between baseline demographic and clinical patient characteristics and abstinence at 14-month follow-up in 102 dual diagnosis patients undergoing treatment in an addiction-psychiatry service in Amsterdam. Immigration, employment, housing, age, emotion regulation, psychiatric symptoms, and frequency and nature of substance abuse were examined as possible predictors of abstinence. Patients were considered abstinent if they had refrained from any substance use in the 30 days prior to the follow-up assessment, as measured with the Timeline Follow Back method. Results: In a multiple logistic regression analysis corrected for treatment utilization, being a first- or second-generation immigrant was associated with lower odds of abstinence (OR = 5.13; 95% CI [1.63, 18.18]), as well as higher levels of depressive and anxiety symptoms at baseline (OR = 0.90; 95% CI [0.81, 0.99]). Gender, age, housing, employment, emotion regulation, frequency and nature of substance abuse, and the psychiatric symptoms positive symptoms, negative symptoms, and manic excitement and disorganization did not show a significant relationship with abstinence. Conclusions: The results indicate that being a first- or second-generation immigrant and experiencing more symptoms of depression and anxiety are predictive of non-abstinence. Attention for linguistic and cultural congruence of dual diagnosis treatments may enhance abstinence in immigrants. Additionally, addressing symptoms of depression and anxiety in dual diagnosis treatment may be beneficial for the maintenance of abstinence. More research is needed on factors influencing treatment success in dual diagnosis patients.
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Affiliation(s)
- Lisanne J van Hagen
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Marleen M de Waal
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam Institute for Addiction Research, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Carolien Christ
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jack J M Dekker
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands.,Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anna E Goudriaan
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam Institute for Addiction Research, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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45
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Lee WK, Hayashi K, DeBeck K, Milloy MJS, Grant C, Wood E, Kerr T. Association between posttraumatic stress disorder and nonfatal drug overdose. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2019; 12:373-380. [PMID: 31524428 DOI: 10.1037/tra0000511] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE North America is in the midst of a growing drug overdose crisis. While prescription opioid misuse and synthetic opioids such as fentanyl have been implicated in the overdose crisis, less attention has been given to the role that posttraumatic stress disorder (PTSD) may play in this crisis. As such, this study sought to examine the relationship between PTSD and risk of nonfatal overdose among people who use drugs (PWUD). METHOD Data were derived from three prospective cohorts of PWUD in Vancouver, Canada. For each participant, PTSD was assessed using the PTSD Checklist for the DSM-5. Multivariate logistic regression analysis was used to estimate the relationship between PTSD and nonfatal overdose, adjusting for potential confounders. RESULTS Between 2016 and 2018 among 1,059 PWUD, including 363 (34%) nonmale participants, 171 (16%) experienced a nonfatal drug overdose in the past 6 months, and 414 (39%) met criteria for a provisional PTSD diagnosis. In multivariate analysis, PTSD (adjusted odds ratio = 1.98, 95% confidence interval [1.4, 2.79]) remained independently associated with nonfatal overdose after adjustment for a range of confounders. CONCLUSIONS Among participants in these community-recruited cohorts of PWUD, having a provisional PTSD diagnosis nearly doubled the risk of nonfatal overdose. The findings from this study support the need to incorporate a trauma-informed approach within the current overdose prevention framework. Education and training relating to trauma and PTSD should be prioritized for health care professionals who work with and treat PWUD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Evan Wood
- British Columbia Centre on Substance Use
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46
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Weiss NH, Schick MR, Contractor AA, Dixon-Gordon KL. Posttraumatic stress disorder and substance use: Identifying the underlying role of difficulties regulating positive emotions. Addict Behav 2019; 96:119-126. [PMID: 31075729 DOI: 10.1016/j.addbeh.2019.04.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 04/22/2019] [Accepted: 04/26/2019] [Indexed: 12/22/2022]
Abstract
The co-occurrence of posttraumatic stress disorder (PTSD) and substance use is clinically-relevant. Emotion dysregulation is one factor that has been shown to underlie this association. However, literature in this area has been limited in its exclusive focus on emotion dysregulation stemming from negative emotions. The goal of the current study was to extend prior research by exploring the role of difficulties regulating positive emotions in the associations between PTSD symptom severity and both alcohol use and problems from drug use. Participants were 463 trauma-exposed individuals recruited from Amazon's MTurk (M age = 35.66 years; 55.7% female; 76.6% White). PTSD symptom severity, difficulties regulating positive emotions, alcohol use, and problems from drug use demonstrated significant positive zero-order correlations. Further, difficulties regulating positive emotions were found to account for the associations between PTSD symptom severity and both alcohol use and problems from drug use. Our results suggest the potential utility of addressing difficulties regulating positive emotions in interventions aimed at reducing substance use and abuse among individuals with PTSD.
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47
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Norman SB, Trim R, Haller M, Davis BC, Myers US, Colvonen PJ, Blanes E, Lyons R, Siegel EY, Angkaw AC, Norman GJ, Mayes T. Efficacy of Integrated Exposure Therapy vs Integrated Coping Skills Therapy for Comorbid Posttraumatic Stress Disorder and Alcohol Use Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2019; 76:791-799. [PMID: 31017639 PMCID: PMC6487906 DOI: 10.1001/jamapsychiatry.2019.0638] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is common and associated with psychiatric and functional problems. Understanding whether exposure therapy is tolerable and efficacious for treating PTSD and AUD is critical to ensure that best practice treatments are available. OBJECTIVE To compare the efficacy of integrated (ie, targeting both PTSD and alcohol use) prolonged exposure (I-PE) therapy with present-centered integrated coping skills (I-CS) therapy, a more commonly available treatment, in reducing PTSD symptoms and alcohol use. DESIGN, SETTING, AND PARTICIPANTS This prospective randomized clinical trial with masked assessments considered 186 veterans seeking Veterans Affairs mental health services. A total of 119 veterans with PTSD and AUD were randomized. Data were collected from February 1, 2013, to May 31, 2017, before treatment, after treatment, and at 3- and 6-month follow-ups. Intention-to-treat analyses were performed. INTERVENTIONS Veterans underwent I-PE (Concurrent Treatment of PTSD and Substance Use Disorder Using Prolonged Exposure) or I-CS (Seeking Safety) therapy. MAIN OUTCOMES AND MEASURES A priori planned outcomes were PTSD symptoms (Clinician Administered PTSD Scale for DSM-5) and percentage of heavy drinking days (Timeline Follow-Back) before treatment, after treatment, and at 3- and 6-month follow-ups. RESULTS A total of 119 veterans (mean [SD] age, 41.6 [12.6] years; 107 [89.9%] male) were randomized. Linear mixture models found that PTSD symptoms decreased in both conditions, with a significantly greater decrease for I-PE treatment compared with I-CS treatment (treatment × time interaction, -2.83; F3,233.1 = 4.92; Cohen d = 0.41; P = .002). The percentage of heavy drinking days improved in both conditions but was not statistically different between I-PE and I-CS treatment (treatment × time interaction, 1.8%; F3,209.9 = 0.18; Cohen d = 0.04; P = .91). CONCLUSIONS AND RELEVANCE The I-PE arm had a greater reduction in PTSD symptoms than the I-CS arm and comparable drinking decreases. The study provides evidence that exposure therapy is more efficacious in treating PTSD than a more commonly available integrated treatment without exposure for comorbid PTSD and AUD. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01601067.
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Affiliation(s)
- Sonya B. Norman
- VA San Diego Healthcare System, San Diego, California,National Center for PTSD, White River Junction, Vermont,VA Center of Excellence for Stress and Mental Health, San Diego, California,Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla
| | - Ryan Trim
- VA San Diego Healthcare System, San Diego, California,Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla
| | - Moira Haller
- VA San Diego Healthcare System, San Diego, California,Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla
| | - Brittany C. Davis
- VA San Diego Healthcare System, San Diego, California,James A. Haley Veterans’ Hospital, Tampa, Florida
| | - Ursula S. Myers
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Peter J. Colvonen
- VA San Diego Healthcare System, San Diego, California,VA Center of Excellence for Stress and Mental Health, San Diego, California,Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla
| | - Erika Blanes
- VA San Diego Healthcare System, San Diego, California
| | - Robert Lyons
- VA San Diego Healthcare System, San Diego, California,San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
| | | | - Abigail C. Angkaw
- VA San Diego Healthcare System, San Diego, California,National Center for PTSD, White River Junction, Vermont,Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla,San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
| | - Gregory J. Norman
- Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla
| | - Tina Mayes
- VA San Diego Healthcare System, San Diego, California,Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla
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48
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Schumm JA, O'Farrell TJ, Murphy MM, Muchowski P. Efficacy of Behavioral Couples Therapy Versus Individual Recovery Counseling for Addressing Posttraumatic Stress Disorder Among Women With Drug Use Disorders. J Trauma Stress 2019; 32:595-605. [PMID: 31356702 DOI: 10.1002/jts.22415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 01/15/2019] [Accepted: 01/21/2019] [Indexed: 02/04/2023]
Abstract
Behavioral couples therapy (BCT) for substance use disorder shares similar intervention strategies with empirically supported couples therapies for posttraumatic stress disorder (PTSD). Like couples-based PTSD therapies, BCT includes interventions that may help to improve PTSD, such as increasing positive behavioral exchanges and improving communication. Studies have yet to examine whether BCT, which has demonstrated efficacy for improving substance-related outcomes, is efficacious for reducing PTSD. We conducted a secondary analysis of a randomized clinical trial comparing individually based treatment (IBT) to BCT plus IBT (BCT+IBT) for women with drug use disorders. Women in both conditions received 26 therapy sessions over 13 weeks. Women completed the PTSD Diagnostic Scale at baseline, posttreatment, and quarterly during the 1-year follow-up. Of the 61 women who were randomized to treatment, 51 (83.6%) reported a lifetime traumatic event. Of the 50 women who endorsed a "worst traumatic event," 25 (50.0%) had a baseline PTSD diagnosis. The treatments did not differ on baseline PTSD severity or diagnosis. Women who received BCT+IBT had significant reductions in PTSD severity from baseline to each of four posttreatment follow-ups, ds = 0.34-0.80; there were no changes in the IBT group. Generalized estimating equation results showed that women who received BCT+IBT had significantly lower PTSD severity during follow-up versus those who received IBT, d = 0.35. There were no differences in the proportion of participants diagnosed with PTSD following treatment. This was the first study to show that BCT+IBT is efficacious for reducing PTSD among women with drug use disorders.
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Affiliation(s)
- Jeremiah A Schumm
- School of Professional Psychology, Wright State University, Dayton, Ohio, USA
| | | | - Marie M Murphy
- VA Boston Healthcare System, Brockton, Massachusetts, USA
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49
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Flanagan JC, Mitchell JM. Augmenting Treatment for Posttraumatic Stress Disorder and Co-Occurring Conditions with Oxytocin. ACTA ACUST UNITED AC 2019; 6:132-142. [PMID: 31763133 DOI: 10.1007/s40501-019-00171-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose of review The goal of this manuscript is to review the extant literature examining the neurobiological and behavioral mechanisms underlying the potential utility of intranasal oxytocin as a novel pharmacologic intervention for the treatment of posttraumatic stress disorder (PTSD), and for the treatment of co-morbid PTSD and alcohol and substance use disorders. Recent findings Research indicates that intranasal oxytocin is a low-cost and easily accessible medication with an excellent safety profile. Oxytocin holds promise for facilitating more effective PTSD treatment, particularly when used in combination with evidence-supported psychotherapy interventions. There is still a significant need to identify the mechanisms of action underlying oxytocin treatment of PTSD, and to maximize methods of nasal spray delivery, examine dose-response outcomes, and clarify the characteristics of individuals and populations that are most likely to benefit from adjunctive oxytocin treatment. Summary Collectively, preclinical and human laboratory research suggest that oxytocin may be an effective mechanism by which treatment outcomes for PTSD and common comorbidities can be enhanced. Adequately powered randomized controlled trials are needed to address efficacy, identify predictors of treatment outcome, and to assess the use of intranasal oxytocin within appropriate PTSD populations.
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Affiliation(s)
- Julianne C Flanagan
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC
| | - Jennifer M Mitchell
- Department of Neurology, University of California San Francisco, San Francisco, CA.,Department of Psychiatry, University of California San Francisco, San Francisco, CA
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50
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Valiente-Gómez A, Moreno-Alcázar A, Radua J, Hogg B, Blanco L, Lupo W, Pérez V, Robles-Martínez M, Torrens M, Amann BL. A Multicenter Phase II Rater-Blinded Randomized Controlled Trial to Compare the Effectiveness of Eye Movement Desensitization Reprocessing Therapy vs. Treatment as Usual in Patients With Substance Use Disorder and History of Psychological Trauma: A Study Design and Protocol. Front Psychiatry 2019; 10:108. [PMID: 30930801 PMCID: PMC6428746 DOI: 10.3389/fpsyt.2019.00108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/13/2019] [Indexed: 12/27/2022] Open
Abstract
Background: Psychological trauma has a strong negative impact on the onset, course and prognosis of substance use disorders (SUD). Few trauma-oriented treatment approaches have been trialed, but preliminary evidence exists of the efficacy of Eye Movement Desensitization and Reprocessing (EMDR) therapy in improving clinical symptoms in SUD patients. Objective: To assess if EMDR therapy leads to: (1) reduced substance consumption; (2) an improvement in psychopathological and in trauma-related symptoms; and (3) an improvement in overall functioning. Our hypothesis is that the EMDR group will improve in all variables when compared to the treatment as usual (TAU) group at 6 and 12-months visits. Method: In this multicenter phase II rater-blinded randomized controlled trial, 142 SUD patients with a history of psychological trauma will be randomly assigned to EMDR (n = 71) or to TAU (n = 71). Patients in the EMDR group will receive 20 psychotherapeutic sessions of 60 min over 6 months. Substance use will be measured using the Timeline Followback Questionnaire, the Dependence Severity Scale and the Visual Analog Scale. Traumatic events will be measured by The Holmes-Rahe Life Stress Inventory, the Childhood Trauma Questionnaire Scale, the Global Assessment of Posttraumatic Stress Questionnaire, the Impact of Event Scale-Revised and the Dissociative Experiences Scale. Clinical symptomatology will be evaluated using the Hamilton Depression Rating Scale, the Young Mania Rating Scale and the Brief Psychiatric Rating Scale. Functionality will be assessed with the Functioning Assessment Short Test. All variables will be measured at baseline, post-treatment and 12 months as follow-up. Primary outcome: to test the efficacy of EMDR therapy in reducing the severity of substance use. The secondary outcomes: to test the efficacy in reducing trauma-related psychological symptoms and psychopathological symptoms and in improving overall functioning in patients with comorbid SUD and a history of psychological trauma. Conclusion: This study will provide evidence of whether EMDR therapy is effective in reducing addiction-related, trauma and clinical symptoms and in improving functionality in patients with SUD and a history of trauma. Clinical Trial Registration: The trial is registered at ClinicalTrials.gov, identifier: NCT03517592.
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Affiliation(s)
- Alicia Valiente-Gómez
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
- Department of Psychiatry, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Moreno-Alcázar
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Bridget Hogg
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Laura Blanco
- Benito Menni Complex Assistencial en Salut Mental, Sant Boi de Llobregat, Spain
- Department of Personality, Evaluation and Psychological Treatments, University of Barcelona, Barcelona, Spain
| | - W. Lupo
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions, Barcelona, Spain
| | - Víctor Pérez
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
- Department of Psychiatry, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Robles-Martínez
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
- RETICS-Redes Temáticas de Investigación Cooperativa en Salud en Trastornos Adictivos, Barcelona, Spain
| | - Marta Torrens
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
- Department of Psychiatry, Universitat Autònoma de Barcelona, Barcelona, Spain
- RETICS-Redes Temáticas de Investigación Cooperativa en Salud en Trastornos Adictivos, Barcelona, Spain
| | - Benedikt L. Amann
- Centre Fòrum Research Unit, Institut de Neuropsiquiatria i Addiccions, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
- Department of Psychiatry, Universitat Autònoma de Barcelona, Barcelona, Spain
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