This paper describes the development of a comprehensive treatment program for combat veterans diagnosed with posttraumatic stress disorder (PTSD) and substance abuse (SA). Outcome data are presented on 46 male patients who completed treatment between 1996 and 1998. The treatment approach, defined by a detailed manual, integrates elements of cognitive-behavioral skills training, constructivist theory approaches, SA relapse prevention strategies, and peer social support into a group-focused program. The Clinician-Administered PTSD Scale (CAPS) and the Addiction Severity Index (ASI) were used to assess treatment effectiveness at discharge and 6- and 12-month follow-up. Significant symptom changes revealed on CAPS and ASI scores at discharge and follow-up are analyzed. Discussion focuses on hypotheses regarding treatment effectiveness, study limitations, and suggestions for further research.

This study assessed the predictive validity of combat factors and selected premilitary variables (i.e., childhood physical abuse, substance abuse in the family of origin, or being raised in a nonadaptive or noncohesive family) on posttraumatic stress disorder (PTSD) group membership. In addition, it assessed the correlation of combat exposure and selected premilitary variables with the severity of PTSD symptomology. Ninety-three male Vietnam combat veterans with PTSD were compared to 82 male Vietnam combat veterans without the disorder. The results of two hierarchical logit analyses identified combat exposure as the best predictor of PTSD group membership. However, physical punishment was also found to significantly predict group membership when entered first in the analyses. Furthermore, multiple regression analyses conducted with the PTSD group alone found that both combat exposure and physical abuse predicted greater PTSD symptomology. These findings suggest that childhood physical abuse as well as military trauma should be addressed in the assessment and treatment of chronic PTSD patients.

1 PTSD has been an under-diagnosed syndrome among World War II and Korean era veterans both because of clinical inattention and the way this generation of soldiers coped with traumatic memories throughout their lives. 2 There are psychological, developmental, and situational factors that may cause PTSD symptoms to resurface among older veterans in health care settings. 3 Nurses in health care settings who have frequent contact with the elderly are in a unique position to identify older veterans who might be at risk for resurfacing of PTSD symptoms and to provide limited assistance and referral for mental health treatment.

This study assessed the predictive validity of combat factors and selected premilitary variables (i.e., childhood physical abuse, substance abuse in the family of origin, or being raised in a nonadaptive or noncohesive family) on posttraumatic stress disorder (PTSD) group membership. In addition, it assessed the correlation of combat exposure and selected premilitary variables with the severity of PTSD symptomology. Ninety-three male Vietnam combat veterans with PTSD were compared to 82 male Vietnam combat veterans without the disorder. The results of two hierarchical logit analyses identified combat exposure as the best predictor of PTSD group membership. However, physical punishment was also found to significantly predict group membership when entered first in the analyses. Furthermore, multiple regression analyses conducted with the PTSD group alone found that both combat exposure and physical abuse predicted greater PTSD symptomology. These findings suggest that childhood physical abuse as well as military trauma should be addressed in the assessment and treatment of chronic PTSD patients.

The Nightmare Intervention & Treatment Evaluation (NITE) Scale is a self-report instrument developed to assess nightmare distress among those diagnosed with posttraumatic stress disorder. This article describes two studies that examine the psychometric properties of this scale. Male and female participants ranged in age from 23 to 84 years and were from diverse ethnic backgrounds. The first study (N = 129) evaluated factor structure and internal consistency. Fifty-three scale items were tested and reduced to a 32-item scale with 24 items