Concurrent Treatment of Substance Use and PTSD

Abstract

Substance use disorders (SUD) and posttraumatic stress disorder (PTSD) are chronic, debilitating conditions that frequently co-occur. Individuals with co-occurring SUD and PTSD suffer a more complicated course of treatment and less favorable treatment outcomes compared to individuals with either disorder alone. The development of effective psychosocial and pharmacological interventions for co-occurring SUD and PTSD is an active and critically important area of investigation. Several integrated psychosocial treatments for co-occurring SUD and PTSD have demonstrated promising outcomes. While recent studies examining medications to treat co-occurring SUD and PTSD have yielded encouraging findings, there remain substantial gaps in the evidence base regarding the treatment of co-occurring SUD and PTSD. This review will summarize the findings from clinical trials targeting a reduction in SUD and PTSD symptoms simultaneously. These results may improve our knowledge base and subsequently enhance our ability to develop effective interventions for this complex comorbid condition.

Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE): A Pilot Study in Alcohol-dependent Women

“…Randomized controlled trials (RCTs) will be needed to conclusively establish efficacy and effectiveness. More research is warranted based on the present findings and the current literature on PTSD and comorbid SUD, highlighting the need for welldesigned studies and replication of those already conducted (van Dam et al, 2012; Ralevski et al, 2014; Roberts et al, 2015; Flanagan et al, 2016). Based on the data reported here, an RCT is underway.…”

“…These observations are in agreement with previously published findings (Killeen et al, 2011; Mills et al, 2012). Together with a recent review (Flanagan et al, 2016), these data should allay concerns that trauma-focused psychological treatment with exposure for PTSD promotes substance use and relapse (Riggs et al, 2003; Becker et al, 2004). Thus, these observations pave theway for research on, and implementation of, integrated exposurebased treatment for comorbid PTSD and SUD.…”

“…When it comes to psychological treatment, there is very little evidence to support the use of nontrauma-focused psychological interventions for PTSD and comorbid SUD (van Dam et al, 2012; Roberts et al, 2015). Reviews have found trauma-focused psychological treatment, with exposure-based interventions the most promising (Berenz and Coffey, 2012; van Dam et al, 2012), and integrated psychosocial treatments and combined psychosocial and pharmacological approaches encouraging (Flanagan et al, 2016). A recent meta-analysis found that traumafocused psychological treatment given alongside interventions for SUD reduced both PTSD symptom severity and substance use at 5 to 7 months of follow-up (Roberts et al, 2015).…”

Complex Comorbidity of Substance Use Disorders with Anxiety Disorders: Diagnosis and Treatment

“…In the cerebrospinal luid of individuals with PTSD, levels of corticotropin releasing factor (CRF) and norepinephrine were detected higher than normal levels. Considering the role of CRF and norepinephrine as a mediator of the relationship between stress and substance seeking behaviour, future research about these might explain "self-medication of PTSD symptoms using substances" theory in some individuals [70].…”

Salud mental y consumo de sustancias psicoactivas en adolescentes colombianos

“…Así mismo, los factores de riesgo individuales, incluyen las particularidades de la primera infancia, como: problemas de conducta disruptiva temprana (ej. comportamiento agresivo), rendimiento académico y fracaso escolar, que se correlaciona con actitudes favorables en el consumo de sustancias psicoactivas (Flanagan, Korte, Killeen, & Back, 2016;García, Luque, Ruiz, & Tabernero, 2017 (Gomez, Alfonso et al, 2013). Por este incremento en el consumo se requiere de atención en salud pública.…”