Clinical presentations, social functioning, and treatment receipt among individuals with comorbid life‐time PTSD and alcohol use disorders versus drug use disorders: findings from NESARC‐III

Abstract

Aims To compare individuals with comorbid life-time post-traumatic stress disorder (PTSD) and alcohol use disorders [AUD; i.e. no drug use disorders (DUD)] with those with comorbid PTSD and DUD on past-year prevalence of these disorders, social functioning, life-time psychiatric comorbidities, and treatment receipt. The comorbid groups were also compared with their single diagnosis counterparts. Design and Setting Cross-sectional cohort study using data from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC-III). Participants The total sample size was 36 309. Six groups were established: PTSD/AUD, PTSD/DUD, AUD, DUD, PTSD, and neither PTSD nor AUD/DUD. Life-time prevalence of AUD among those with PTSD/DUD was 80.2% and among those with DUD was 73.8%. Measurements The Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 version assessed lifetime and past-year psychiatric disorders and treatment receipt. Demographics and social stability indicators were queried. Group characteristics were summarized using weighted means. Prevalences and estimates for adjusted differences in means and adjusted odds ratios (aORs) were derived from multiple linear regression and logistic regression models, respectively. Analyses were conducted in R and accounted for the NESARC-III’s complex survey design, clustering, and non-response. Findings Compared with those with life-time PTSD/AUD, those with life-time PTSD/DUD were significantly less likely to have neither disorder in the past year (PTSD/AUD = 16.1%; PTSD/DUD = 8.5%; aOR = 0.54), and were more likely to report worse social and psychiatric functioning, and to have received both addiction and mental health treatment (PTSD/AUD = 18.4%; PTSD/DUD = 43.2%; aOR = 3.88). Compared with their single disorder counterparts, those with PTSD/DUD reported greater impairment than both groups, whereas the comorbid PTSD/AUD group differed more from the AUD than the PTSD group. Conclusions People with comorbid PTSD and drug use disorder have greater social and psychiatric impairment and may require different types and intensity of intervention than people with comorbid post-traumatic stress disorder and alcohol use disorder.

Comparison of social and sociodemographic characteristics and treatment goals of persons with alcohol versus drug use disorders: Result from a national census of inpatients in specialized treatment for substance use

“…For example, one study based on a large sample representative of the US population reported that compared with those with primary AUD, people with a lifetime diagnostic status of illicit drug use disorder were younger and more likely to have a lower socioeconomic status (e.g. no college education, currently unemployed) and to be homeless ( Simpson, Rise, Browne, Lehavot, & Kaysen, 2019 ). However, when it comes to the total harmful effects of a given substance to the individual user and others, studies have suggested that alcohol is causing the greatest overall harm ( Bonomo et al, 2019 , Nutt et al, 2010 , Van Amsterdam et al, 2010 ).…”

N-acetylcysteine for the treatment of comorbid alcohol use disorder and posttraumatic stress disorder: Design and methodology of a randomized clinical trial

“…Data from national epidemiological studies indicate that the lifetime prevalence rates of AUD and PTSD are 29.1% and 7.8%, respectively [21,28,29]. Moreover, AUD and PTSD frequently co-occur [60,71]. Among individuals seeking treatment for substance use disorders, 30%-59% meet criteria for PTSD [4,19,39,49,71].…”

“…Among individuals seeking treatment for substance use disorders, 30%-59% meet criteria for PTSD [4,19,39,49,71]. This is of considerable clinical importance, as comorbid substance use disorder and PTSD is associated with a more severe presentation and worse treatment outcomes as compared to either disorder alone [40,60,71].…”

Comparison of cannabidiol to citalopram in targeting fear memory in female mice

“…Leading clinical therapies for PTSD include cognitive behavioral therapy, eye movement desensitization therapy, and reprocessing therapy. However, these approaches are minimally effective and consequently are often used in combination with pharmacotherapeutics (Gallagher 2017 ; Simpson et al 2019 ; Garcia et al 2019 ). This prominently includes the use of selective serotonin reuptake inhibitors (SSRIs) which were originally developed for depression.…”