Reduced PTSD Symptoms Lead to Reduced Substance Abuse, but Not the Other Way Around | Print |  E-mail
Monday, 01 March 2010
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A new study from researchers at C.C.N.Y. (City College of New York) examined the connection between improvements in posttraumatic stress and improvement in substance abuse over the course of time in 353 women diagnosed with both conditions.

Participants were randomly assigned to 12 sessions of either trauma-focused treatment or health education.  Assessments were made on the PTS and the substance use during treatment at 1 week and posttreatment after 3, 6, and 12 months.

Subjects showing no improvement, an improvement in the substance use only, or a total, global improvement early on, tended to maintain their original diagnosis over time; but subjects initially exhibiting improvement in their PTSD symptoms were significantly more likely to transition into a global response over time, indicating that they maintained their PTSD improvement, and that it was associated with subsequent improvements in substance use.
 

Additionally, trauma-focused treatment was significantly more effective than the health education method in achieving substance use improvement, but only among those who were heavy substance users at baseline and had achieved significant PTSD reductions.
 
This study concludes that reductions in PTSD severity were more likely to be associated with substance use improvement, but that it did not work the other way around:  reductions in substance abuse did not lead to improved PTSD symptoms. These results support the self-medication model of coping with PTSD symptoms, and an empirical basis for integrated interventions for improved substance use outcomes in patients with severe symptoms.

Citation:  Hien DA, Jiang H, Campbell AN, Hu MC, Miele GM, Cohen LR, Brigham GS, Capstick C, Kulaga A, Robinson J, Suarez-Morales L, Nunes EV. Do treatment improvements in PTSD severity affect substance use outcomes? A secondary analysis from a randomized clinical trial in NIDA's Clinical Trials Network. American Journal of Psychiatry. 2010 Jan; 167(1):95-101. Epub 2009 Nov 16. dah26@columbia.edu



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Comments (4)Add Comment
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written by AWGI, March 07, 2010
Well, this one has been filled with those Rilke questions this past week. Makes sense in context of my own personal experience--I'm a lousy drinker...grew up surrounded by alcoholism in family of origin, et al and Al-anon member myself since I was in college. But the physical pain of the pts was so acute (and I'm not a pain wimp) I thought 'what the heck'---the etoh didn't help, but then neither did the clonazepam or the lexapro (without the etoh)---they made me feel as tho' I was wrapped in gauze and all the instincts I count on to keep me safe & alive were dulled and mostly unavailable....no way could I live like that. So the question that remains for me is why? why exactly did the pts stuff finally take me down?
And tbrfgi...thank belleruth for guided imagery!
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written by ypay4badmedadvice? I'mfree., April 28, 2010
Having little of these and lack of access to local ptsd care too-
I would imagine the ability to find a safe, stable, accessible, affordable environment and basic food clothing housing utils med care needs are what is fundamental in determining the successful PTSD/anxiety treatment.

I have grave concern for those who are prescribed anti depressants that might tranquilize and dull outward response but not effect ,or worse increase, anxiety over all.
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written by SUSAN WEUNT, April 28, 2010
sO...IS THE MESSAGE THAT IS BEING SENT.... THAT IN ACTUALITY THE PTSD IS THE

SYMPTON TO TREAT FIRST...THAN THE ALCOHOLISM HAS A BETTER CHANCE OF BEING

TREATED WITH SUCCESS? BECAUSE THAT IS HOW I PRESENTED THE PROBLEM MY HUSBAND

HAD BACK IN THE 1980'S TO HIS DOCTOR'S AT THE vETERANS HOSPITAL. tHEY TOLD ME

I WAS IN DENIAL. DOES ANYONE HAVE AN ANSWER TO MY QUESTION.

THANKS
SUSAN
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written by Gene, October 11, 2012
In treating veterans presenting with diagnosed symptoms of ptsd/sud the VA favors an intergrated approach to treatment, and have evidenced results equal to that of a sequensial approach.

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