How changes in posttraumatic stress disorder (PTSD) severity mediate substance use disorder (SUD) severity during and after treatment for co-occurring PTSD and SUD: Results from Project Harmony.

IF 5.3 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2025-07-10 DOI:10.1111/add.70126

Denise A Hien, Jordan A Gette, Shannon M Blakey, Marilyn L Piccirillo, Sudie E Back, Alexandria G Bauer, Chantel T Ebrahimi, Robyn A Ellis, Therese K Killeen, Elizabeth A Lehinger, Teresa López-Castro, Sonya B Norman, Lesia M Ruglass, Tanya C Saraiya, Lissette M Saavedra, Antonio A Morgan-López

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Abstract

Background and aims: Posttraumatic stress disorder (PTSD) commonly co-occurs with substance use disorders (SUD). Comorbid PTSD and SUD (PTSD+SUD) is associated with greater severity and impairment and poorer treatment outcomes. Several interventions exist to treat PTSD, SUD and PTSD+SUD; however, research has yet to elucidate the indirect pathways underlying treatment for PTSD+SUD. The present study examined how changes in PTSD severity relate to changes in SUD severity across treatment types during and post-treatment.

Methods: Observational study using data collected as part of Project Harmony, a virtual clinical trial employing integrative data analysis to compare treatment effectiveness of PTSD+SUD interventions from 36 randomized controlled trials for PTSD+SUD (n = 4046). Multilevel mediated linear growth modeling was used to examine potential outcomes mediation. Each of the eight active treatments was compared to treatment as usual (TAU) for both alcohol and drug use outcomes.

Results: Alcohol use severity outcomes were fully or partially mediated by changes in PTSD severity for trauma-focused psychotherapy + AUD medication [ab = -0.16 (95% confidence interval = -0.30 to -0.04)]; other treatments with mediation effects included trauma-focused integrated psychotherapy, AUD medications and PTSD medications. Drug use severity outcomes were fully or partially mediated by changes in PTSD severity for trauma-focused psychotherapy + AUD medication [ab = -0.08 (-0.18 to -0.001)]; other treatments with mediation effects on drug use severity included trauma-focused integrated psychotherapy, AUD medications, PTSD medications and placebo medications.

Conclusions: Among people with co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD), reductions in alcohol and drug use severity appear to be mediated by reductions in PTSD during treatment. For those with drug use disorders, PTSD reductions appear to mediate further SUD reductions after treatment.

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创伤后应激障碍（PTSD）严重程度的变化如何介导物质使用障碍（SUD）严重程度在治疗期间和治疗后：和谐项目的结果

背景与目的：创伤后应激障碍（PTSD）通常与物质使用障碍（SUD）共同发生。PTSD和SUD共病（PTSD+SUD）与更严重的损害和更差的治疗结果相关。目前已有几种干预措施治疗PTSD、PTSD和PTSD+SUD；然而，研究尚未阐明创伤后应激障碍+SUD治疗的间接途径。本研究考察了PTSD严重程度的变化与治疗期间和治疗后不同治疗类型的SUD严重程度的变化之间的关系。方法：观察性研究使用作为Project Harmony的一部分收集的数据，这是一项虚拟临床试验，采用综合数据分析比较36项随机对照试验（n = 4046） PTSD+SUD干预措施的治疗效果。采用多水平中介线性增长模型检验潜在结果中介。八种积极治疗方法中的每一种都与常规治疗（TAU）进行了酒精和药物使用结果的比较。结果：以创伤为中心的心理治疗+ AUD药物治疗的PTSD严重程度变化完全或部分介导了酒精使用严重程度结局[ab = -0.16(95%可信区间= -0.30至-0.04)]；其他具有调解作用的治疗包括以创伤为中心的综合心理治疗、AUD药物和PTSD药物。以创伤为中心的心理治疗+ AUD药物治疗的PTSD严重程度变化完全或部分介导了药物使用严重程度结局[ab = -0.08(-0.18至-0.001)]；其他对药物使用严重程度有中介作用的治疗包括以创伤为重点的综合心理治疗、AUD药物、PTSD药物和安慰剂药物。结论：在同时发生创伤后应激障碍（PTSD）和物质使用障碍（SUD）的人群中，治疗期间PTSD的减少似乎介导了酒精和药物使用严重程度的降低。对于那些有药物使用障碍的人，PTSD的减少似乎介导了治疗后SUD的进一步减少。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.