Do Treatment Improvements in PTSD Severity Affect Substance Use Outcomes? A Secondary Analysis From a Randomized Clinical Trial in NIDA's Clinical Trials Network

Hien, Denise A.; Jiang, Huiping; Campbell, Aimee N.C.; Hu, Mei‐Chen; Miele, Gloria M.; Cohen, Lisa R.; Brigham, Gregory S.; Capstick, Carrie; Kulaga, Agatha; Robinson, James A.; Suarez-Morales, Lourdes; Nunes, Edward V.

doi:10.1176/appi.ajp.2009.09091261

Cited by 277 publications

(235 citation statements)

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“…It is important to note, however, that studies examining the temporal sequencing of changes in PTSD and substance dependence symptoms have shown that improvements in PTSD symptoms are associated with subsequent improvements in substance dependence, but the reciprocal relationship is not observed. 31,32 These findings highlight the importance of treating PTSD to improve substance dependence outcomes for individuals with this comorbidity.…”

Section: Commentmentioning

confidence: 94%

Integrated Exposure-Based Therapy for Co-occurring Posttraumatic Stress Disorder and Substance Dependence

Mills

Teesson

Back

et al. 2012

JAMA

282

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Context There is concern that exposure therapy, an evidence-based cognitivebehavioral treatment for posttraumatic stress disorder (PTSD), may be inappropriate because of risk of relapse for patients with co-occurring substance dependence.Objective To determine whether an integrated treatment for PTSD and substance dependence, Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE), can achieve greater reductions in PTSD and substance dependence symptom severity compared with usual treatment for substance dependence.Design, Setting, and Participants Randomized controlled trial enrolling 103 participants who met DSM-IV-TR criteria for both PTSD and substance dependence. Participants were recruited from 2007-2009 in Sydney, Australia; outcomes were assessed at 9 months postbaseline, with interim measures collected at 6 weeks and 3 months postbaseline.Interventions Participants were randomized to receive COPE plus usual treatment (n=55) or usual treatment alone (control) (n=48). COPE consists of 13 individual 90minute sessions (ie, 19.5 hours) with a clinical psychologist. Main Outcome MeasuresChange in PTSD symptom severity as measured by the Clinician-Administered PTSD Scale (CAPS; scale range, 0-240) and change in severity of substance dependence as measured by the number of dependence criteria met according to the Composite International Diagnostic Interview version 3.0 (CIDI; range, 0-7), from baseline to 9-month follow-up. A change of 15 points on the CAPS scale and 1 dependence criterion on the CIDI were considered clinically significant. ResultsFrom baseline to 9-month follow-up, significant reductions in PTSD symptom severity were found for both the treatment group (mean difference, −38.24 [95% CI, −47.93 to −28.54]) and the control group (mean difference, −22.14 [95% CI, −30.33 to −13.95]); however,thetreatmentgroupdemonstratedasignificantlygreaterreductioninPTSDsymptom severity (mean difference, −16.09 [95% CI, −29.00 to −3.19]). No significant between-group difference was found in relation to improvement in severity of substance dependence (0.43 vs 0.52; incidence rate ratio, 0.85 [95% CI, 0.60 to 1.21), nor were there any significant between-group differences in relation to changes in substance use, depression, or anxiety. ConclusionAmong patients with PTSD and substance dependence, the combined use of COPE plus usual treatment, compared with usual treatment alone, resulted in improvement in PTSD symptom severity without an increase in severity of substance dependence.

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Section: Commentmentioning

confidence: 94%

Integrated Exposure-Based Therapy for Co-occurring Posttraumatic Stress Disorder and Substance Dependence

Mills

Teesson

Back

et al. 2012

JAMA

282

288

View full text Add to dashboard Cite

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“…Interestingly, the elevated risk of developing secondary psychiatric diagnoses disappears with the remission of PTSD symptoms [13]. In addition, in patients with PTSD and comorbid substance abuse, the treatment of PTSD improves symptoms of substance abuse, but treatment directed toward substance abuse does not appear to ameliorate PTSD symptoms [15]. …”

Section: Introductionmentioning

confidence: 99%

Posttraumatic Stress Disorder: Neurocircuitry and Implications for Potential Deep Brain Stimulation

Taghva

Oluigbo

Corrigan

et al. 2013

Stereotact Funct Neurosurg

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Posttraumatic stress disorder (PTSD) is a prevalent and highly disabling psychiatric disorder that is notoriously difficult to treat. At some point in their lifetimes, 5-8% of men, 10-14% of women, and up to a quarter of combat veterans carry this diagnosis. Despite pharmacological and behavioral therapies, up to 30% of patients are still symptomatic 10 years after initial diagnosis. Recent advances in imaging have implicated changes in the limbic and autonomic corticostriatopallidothalamocortical (CSPTC) circuitry in the pathogenesis of this disease. Deep brain stimulation modulates CSPTC circuits in movement and other neuropsychiatric disorders. In this review, we discuss the salient clinical features and neurocircuitry of PTSD and propose a neuromodulation strategy for the disorder.

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“…These changes include reinstatement to drug-related cues and a persistent drugseeking response following cue-induced reinstatement. Clinical studies have shown that trauma-focused treatments are significantly more effective at improving SUDs in individuals with a comorbid PTSD diagnosis (Hien et al 2010), suggesting that our preclinical approach could be used in situations that may better model the clinical condition (Hariri and Holmes 2015). Because this model involves measurable behavioral responses in the stress-associated context (freezing) and the drug-associated context (drug-seeking), it can serve as a tool for understanding the relation between learned fears and substance abuse, as well as the potential to test novel therapeutic agents designed to weaken fear and attenuate reinstatement in the comorbid condition.…”

Section: Discussionmentioning

confidence: 99%

Persistent effects of acute stress on fear and drug-seeking in a novel model of the comorbidity between post-traumatic stress disorder and addiction

2017

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Even following long periods of abstinence, individuals with anxiety disorders have high rates of relapse to drugs of abuse. Although many current models of relapse demonstrate effects of acute stress on drug-seeking, most of these studies examine stressful experiences that occur in close temporal and physical proximity to the reinstatement test. Here, we assess the effects of a stressful experience in one context on fear and drug-seeking in a different context. We adapt the stress-enhanced fear learning procedure to examine impacts on drug-seeking long after the stressful experience occurred. We find massive footshock in a distinct environment produced an acute increase in corticosterone, long-term hyper-responsivity to a single shock in different contexts with extensive histories of drug-seeking behaviors, enhancements in cocaineinduced conditioned place preference in mice, and persistent enhancements in cue-induced reinstatement of methamphetamine-seeking behavior in rats. Together, these experiments demonstrate that an acute trauma causes persistent changes in responsivity to mild stressors and drug-seeking behavior in other contexts, which mirrors aspects of the comorbidity between post-traumatic stress disorder and substance use disorders. These behavioral approaches provide novel procedures for investigating basic mechanisms underlying this comorbidity and they provide powerful tools for testing preclinical pharmacological and behavioral interventions. [Supplemental material is available for this article.]Compared with the general population, individuals diagnosed with post-traumatic stress disorder (PTSD) have higher rates of substance use disorders (SUDs) (Stewart 1996;McFarlane 1998;Ouimette et al. 1998;Back et al. 2000;Sonne et al. 2003;McCauley et al. 2012;Tipps et al. 2014;Roberts et al. 2015) and are twice as likely to use methamphetamine (METH) than are individuals with trauma exposure that does not lead to PTSD (Smith et al. 2010). Individuals with PTSD are also more likely to relapse to drugs of abuse when cues associated with drug-seeking are encountered, even long after periods of acute stress have ended (Bradizza et al. 2006), suggesting stressors that are temporally and contextually dissociated from drug-seeking may induce longterm changes that contribute to an increased risk for relapse.It has long been observed that stress is a potent inducer of reinstatement (an animal model of relapse) in rodents (e.g., Shaham et al. 2000;Erb et al. 2001;Sanchez and Sorg 2001;Boutrel et al. 2005;Redila and Chavkin 2008;Schindler et al. 2010). Although the ability of stress to induce reinstatement has been well established in the literature, most studies have focused on effects when the organism is tested in a state of acute stress within the drug-seeking context; few studies have evaluated the persistent effects of an acute stressor long after the stress has ended. Individuals with PTSD have traumatic experiences long before relapse and are unlikely to use drugs in the trauma-associated context; avoiding ...

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Do Treatment Improvements in PTSD Severity Affect Substance Use Outcomes? A Secondary Analysis From a Randomized Clinical Trial in NIDA's Clinical Trials Network

Cited by 277 publications

References 20 publications

Integrated Exposure-Based Therapy for Co-occurring Posttraumatic Stress Disorder and Substance Dependence

Integrated Exposure-Based Therapy for Co-occurring Posttraumatic Stress Disorder and Substance Dependence

Posttraumatic Stress Disorder: Neurocircuitry and Implications for Potential Deep Brain Stimulation

Persistent effects of acute stress on fear and drug-seeking in a novel model of the comorbidity between post-traumatic stress disorder and addiction

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