Examining the Temporal Relation between Posttraumatic Stress Symptoms and Heavy Drinking among Veterans Receiving Mental Health Treatment in Primary Care.

IF 1.5 4区医学 Q3 PSYCHIATRY

Journal of Dual Diagnosis Pub Date : 2024-01-01 Epub Date: 2024-02-01 DOI:10.1080/15504263.2023.2294985

Christina Balderrama-Durbin, Eileen P Barden, Melissa V Gates, Jessica Hill, Nadine R Mastroleo, Kyle Possemato, Paul R King, Sheila A M Rauch

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引用次数: 0

Abstract

Objective: Evidence for the use of integrated treatments targeting co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorders is steadily growing. However, limited work has evaluated the temporal association between posttraumatic stress symptoms (PTSS) and alcohol misuse over the course of integrated treatment, with no studies examining such interventions in primary care (PC). The current study examined temporal changes in PTSS and heavy drinking among individuals who received a brief treatment for co-occurring PTSD and alcohol misuse in PC (Primary Care Treatment Integrating Motivation and Exposure; PC-TIME) compared with those who received PC treatment as usual (PC-TAU).

Method: A total of 63 veterans (33 randomized to PC-TIME and 30 randomized to PC-TAU) presenting to PC with co-occurring PTSD and alcohol misuse were included in this study. PTSS and heavy drinking were examined at each treatment session for those in PC-TIME. Veterans in both conditions provided reports of PTSS and heavy drinking at baseline, 8-weeks (post-treatment), 14-weeks, and 20-week follow-ups.

Results: Session-by-session findings for PC-TIME demonstrated that PTSS at Session 1 predicted a greater decrease in heavy drinking from Session 1 to Session 2. Moreover, heavy drinking at baseline predicted greater decreases in PTSS at 8-weeks for those in PC-TIME, whereas the reverse association was found for those randomized to PC-TAU. Additionally, heavy drinking at 8-weeks predicted decreased PTSS at 14-weeks for those randomized to PC-TAU.

Conclusions: The current study evidenced mixed support for the temporal precedence of PTSS and alcohol misuse. Relations between PTSS and heavy drinking appeared to be linked to treatment targets within PC-TIME and varied between treatment condition (PC-TIME versus PC-TAU). Notably, those with greater than average heavy drinking at the initiation of integrated treatment appeared to have greater reductions in PTSS at post-treatment. Results suggest a mutual maintenance model may best characterize the association between co-occurring PTSS and heavy drinking among treatment-seeking individuals.

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研究在基层医疗机构接受心理健康治疗的退伍军人的创伤后应激症状与酗酒之间的时间关系。

目的：针对同时存在的创伤后应激障碍（PTSD）和酒精使用障碍采取综合治疗的证据正在稳步增加。然而，对综合治疗过程中创伤后应激障碍症状（PTSS）与酒精滥用之间的时间关联进行评估的工作十分有限，而且没有研究对初级保健（PC）中的此类干预措施进行审查。本研究考察了在初级保健中接受创伤后应激障碍和酒精滥用并发症简短治疗（初级保健动机和暴露整合治疗；PC-TIME）的患者与接受初级保健常规治疗（PC-TAU）的患者相比，创伤后应激障碍和酗酒的时间变化：共有 63 名退伍军人（33 人随机接受 PC-TIME 治疗，30 人随机接受 PC-TAU 治疗）因同时患有创伤后应激障碍和酒精滥用而接受 PC 治疗。参加 PC-TIME 的退伍军人在每次治疗过程中都会接受创伤后应激障碍和酗酒的检查。在基线、8 周（治疗后）、14 周和 20 周的随访中，两种情况下的退伍军人都提供了有关创伤后应激障碍和酗酒的报告：结果：PC-TIME 的逐期研究结果表明，PTSS 在第 1 期时预示着从第 1 期到第 2 期的酗酒率会有更大的下降。此外，基线时的大量饮酒预示着 PC-TIME 参与者 8 周后 PTSS 的下降幅度更大，而 PC-TAU 随机参与者的情况正好相反。此外，8周时大量饮酒预示着随机PC-TAU参与者14周时PTSS的下降：结论：本研究对 PTSS 和酒精滥用在时间上的先后顺序提供了不同的支持。PTSS 与大量饮酒之间的关系似乎与 PC-TIME 中的治疗目标有关，并且因治疗条件（PC-TIME 与 PC-TAU）而异。值得注意的是，那些在综合治疗开始时酗酒程度高于平均水平的人在治疗后的 PTSS 下降幅度似乎更大。研究结果表明，在寻求治疗的人群中，相互维持模型可能是共存的 PTSS 与酗酒之间关系的最佳表征。

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来源期刊

Journal of Dual Diagnosis Multiple-

CiteScore

4.90

自引率

13.60%

发文量

期刊介绍： Journal of Dual Diagnosis is a quarterly, international publication that focuses on the full spectrum of complexities regarding dual diagnosis. The co-occurrence of mental health and substance use disorders, or “dual diagnosis,” is one of the quintessential issues in behavioral health. Why do such high rates of co-occurrence exist? What does it tell us about risk profiles? How do these linked disorders affect people, their families, and the communities in which they live? What are the natural paths to recovery? What specific treatments are most helpful and how can new ones be developed? How can we enhance the implementation of evidence-based practices at clinical, administrative, and policy levels? How can we help clients to learn active recovery skills and adopt needed supports, clinicians to master new interventions, programs to implement effective services, and communities to foster healthy adjustment? The Journal addresses each of these perplexing challenges.