To reduce or abstain? Substance use goals in the treatment of veterans with substance use disorders and comorbid PTSD

Lozano, Brian E.; Teer, Drew; Back, Sudie E.

doi:10.1016/j.drugalcdep.2014.09.425

Cited by 1 publication

(2 citation statements)

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“…Many persons with comorbid SUD/PTSD may be reluctant to pursue abstinence or may otherwise experience increased difficulty reducing substance use, particularly if substances are used to self‐medicate PTSD symptoms 22 . Examination of substance use goal choice in the context of an integrated treatment for SUD and co‐occurring PTSD yielded findings consistent with those on goal choice in the SUD literature 23 . Specifically, among treatment‐seeking veterans with SUD/PTSD, approximately half endorsed a treatment goal other than abstinence (eg, reduced use) and these individuals were significantly younger, more likely to be employed, and endorsed significantly fewer symptoms of alcohol dependence, compared to those with an abstinence goal.…”

Section: Introductionmentioning

confidence: 59%

“…Exclusion criteria included: (a) current psychotic disorder or other condition that may require a higher level of care; (b) current suicidal or homicidal ideation and intent; (c) participation in other ongoing PTSD or SUD treatment; and (d) significant cognitive impairment. The decision to only include persons with alcohol dependence and not alcohol abuse was based on the majority of participants in the RCT 24 being diagnosed as alcohol‐dependent 80% (65/81) vs alcohol abuse 8% (7/81), and efforts to minimize confounding based on differential levels of dependence as the severity of alcohol dependence has been shown to predict goal choice (ie, abstinence vs reduced use) 23 …”

Section: Methodsmentioning

confidence: 99%

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Treatment Goals and Alcohol Use Outcomes in Veterans With Comorbid Alcohol Dependence and Posttraumatic Stress Disorder

et al. 2020

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Background and Objectives Previous research demonstrates the utility of goals in attaining improved drinking outcomes. Considerably less is known about the association between substance use goals and outcomes among persons with comorbid substance use disorder (SUD) and posttraumatic stress disorder (PTSD). This secondary analysis examined the association between alcohol use outcomes and participants’ treatment entry substance use goals to either abstain or reduce substance use in the context of treatment for comorbid SUD/PTSD. Methods Participants (N = 39) were treatment‐seeking veterans with current alcohol dependence and PTSD. Participants completed self‐report and clinician‐rated measures of substance use and PTSD as part of a larger randomized controlled trial. Results Participants in both goal groups (abstain; reduce) achieved significant reductions in the likelihood of drinking and the likelihood of exceeding low‐risk drinking levels. The primary analysis did not identify significant differences in outcome between goal groups; however, the exploratory analysis revealed that participants with reduced use goals were more likely to drink and more likely to exceed low‐risk drinking levels. Conclusion and Scientific Significance The findings suggest a moderately strong association between substance use goal and drinking outcome in the current study. Although the findings did not unequivocally support abstinence as a superior treatment goal, they offer a preliminary indication that abstinence may be an overall lower‐risk option. These findings expand consideration of the utility of substance use goals and suggest that clinicians should invite consideration of abstinence but may need not limit integrated treatment for SUD/PTSD based on strict adherence to abstinence, particularly if low‐risk use goals are targeted. (Am J Addict 2021;30:131–137)

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Section: Introductionmentioning

confidence: 59%

Section: Methodsmentioning

confidence: 99%