Characterization of comorbid PTSD in treatment-seeking alcohol dependent inpatients: Severity and personality trait differences

Sells, Joanna R.; Waters, Andrew J.; Schwandt, Melanie L.; Kwako, Laura E.; Heilig, Markus; George, David T.; Ramchandani, Vijay A.

doi:10.1016/j.drugalcdep.2016.03.016

Cited by 22 publications

(18 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, only male rats with a history of alcohol consumption showed stress-induced increases in startle reactivity after bobcat urine exposure. In agreement with these findings, previous studies have reported that individuals with comorbid PTSD and alcohol misuse exhibit more severe PTSD symptoms [54,55]. Startle reactivity was tested 6 days after the last drinking session (i.e., not during intoxication).…”

Section: Discussionsupporting

confidence: 75%

Sex differences in traumatic stress reactivity of rats with a history of alcohol drinking

Albrechet‐Souza

Schratz

Gilpin

2019

Preprint

View full text Add to dashboard Cite

Background: Alcohol misuse and post-traumatic stress disorder (PTSD) are highly comorbid and treatment outcomes are worse in individuals with both conditions. Although more men report experiencing traumatic events than women, the lifetime prevalence of PTSD is twice as high in females. Despite these data trends in humans, preclinical studies of traumatic stress reactivity have been performed almost exclusively in male animals. Methods:This study was designed to examine sex differences in traumatic stress reactivity in alcohol-naïve rats and rats given intermittent access to 20% ethanol in a 2-bottle choice paradigm for 5 weeks. Rats were exposed to predator odor (bobcat urine) and tested for avoidance of the odor-paired context 24 hours later; unstressed Controls were never exposed to odor. Two days after stress, we measured physiological arousal using the acoustic startle response (ASR) test. We also measured anxiety-like behavior using the elevated plus-maze (EPM) and circulating corticosterone levels before and immediately after odor exposure. Results:Male and female rats exposed to predator odor displayed blunted weight gain 24 hours post-stress, but only a subset of stressed animals exhibited avoidance behavior. Chronic intermittent alcohol drinking increased the proportion of Avoiders in males and predator odor exposure increased ASR in these animals. Predator odor stress reduced ASR in females relative to unstressed females and stressed males, regardless of alcohol drinking history. Bobcat urine exposure did not promote persistent anxiety-like behavior, but alcohol-experienced males exhibited reduced activity in the EPM in comparison to alcohol-experienced females.3 Furthermore, predator odor increased circulating corticosterone levels in females relative to males and baseline. Conclusions:We report robust sex differences in behavioral and endocrine responses to bobcat urine exposure in adult Wistar rats. Also, chronic moderate alcohol drinking increased traumatic stress reactivity in males but not females. Our findings emphasize the importance of considering sex as a biological variable in the investigation of traumatic stress effects on physiology and behavior. BackgroundPost-traumatic stress disorder (PTSD) is a chronic psychiatric disease that is seen in some but not all individuals after experiencing a life-threatening traumatic event. Major diagnostic criteria for PTSD include re-experiencing the traumatic event, negative affective state, exaggerated startle responses and persistent avoidance of trauma-related cues [1]. Women are twice as likely to develop PTSD after trauma [2, 3] and women with trauma exposure and/or PTSD exhibit more sensitivity to and less tolerance of negative emotions [4,5].Alcohol use disorder (AUD) is one of the most common co-occurring conditions among individuals diagnosed with PTSD [6,7]. Approximately one-third of individuals with lifetime PTSD also meet criteria for AUD [8]. Some populations, such as military personnel, are at high risk for AUD and PTSD comorbidities. For...

show abstract

Section: Discussionsupporting

confidence: 75%

Sex differences in traumatic stress reactivity of rats with a history of alcohol drinking

Albrechet‐Souza

Schratz

Gilpin

2019

Preprint

View full text Add to dashboard Cite

show abstract

“…There is substantial research demonstrating that people with post‐traumatic stress disorder (PTSD) frequently have co‐occurring substance use disorders (SUD) and that they typically evidence greater impairment than individuals with either one or the other disorder . However, these investigations have taken different approaches when populating the groups, making comparisons across studies challenging.…”

Section: Introductionmentioning

confidence: 99%

“…We anticipated more individuals with life‐time PTSD/DUD would meet past‐year diagnostic criteria for one or more of the disorders comprising the comorbidity and would also evidence greater social and clinical impairment than those with life‐time PTSD/AUD . We also anticipated that the comorbid groups would evidence greater social and psychiatric impairment than their single disorder comparators .…”

Section: Introductionmentioning

confidence: 99%

Clinical presentations, social functioning, and treatment receipt among individuals with comorbid life‐time PTSD and alcohol use disorders versus drug use disorders: findings from NESARC‐III

et al. 2019

View full text Add to dashboard Cite

Aims To compare individuals with comorbid life-time post-traumatic stress disorder (PTSD) and alcohol use disorders [AUD; i.e. no drug use disorders (DUD)] with those with comorbid PTSD and DUD on past-year prevalence of these disorders, social functioning, life-time psychiatric comorbidities, and treatment receipt. The comorbid groups were also compared with their single diagnosis counterparts. Design and Setting Cross-sectional cohort study using data from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC-III). Participants The total sample size was 36 309. Six groups were established: PTSD/AUD, PTSD/DUD, AUD, DUD, PTSD, and neither PTSD nor AUD/DUD. Life-time prevalence of AUD among those with PTSD/DUD was 80.2% and among those with DUD was 73.8%. Measurements The Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 version assessed lifetime and past-year psychiatric disorders and treatment receipt. Demographics and social stability indicators were queried. Group characteristics were summarized using weighted means. Prevalences and estimates for adjusted differences in means and adjusted odds ratios (aORs) were derived from multiple linear regression and logistic regression models, respectively. Analyses were conducted in R and accounted for the NESARC-III’s complex survey design, clustering, and non-response. Findings Compared with those with life-time PTSD/AUD, those with life-time PTSD/DUD were significantly less likely to have neither disorder in the past year (PTSD/AUD = 16.1%; PTSD/DUD = 8.5%; aOR = 0.54), and were more likely to report worse social and psychiatric functioning, and to have received both addiction and mental health treatment (PTSD/AUD = 18.4%; PTSD/DUD = 43.2%; aOR = 3.88). Compared with their single disorder counterparts, those with PTSD/DUD reported greater impairment than both groups, whereas the comorbid PTSD/AUD group differed more from the AUD than the PTSD group. Conclusions People with comorbid PTSD and drug use disorder have greater social and psychiatric impairment and may require different types and intensity of intervention than people with comorbid post-traumatic stress disorder and alcohol use disorder.

show abstract

“…Co‐occurring PTSD and AUD (PTSD–AUD) can have additive, interacting effects on mental and physical health and quality of life (QoL). Indeed, PTSD–AUD is associated with more severe symptoms, greater functional impairment, increased suicide risk, and greater treatment utilization than either disorder alone (Rojas, Bujarski, Babson, Dutton, & Feldner, ; Sells et al., ). Because PTSD and AUD share common mechanisms, particularly in terms of maintenance, integrated treatment is recommended (VA/DoD, 2010).…”

mentioning

confidence: 99%

Acceptance and Commitment Therapy for Co‐Occurring Posttraumatic Stress Disorder and Alcohol Use Disorders in Veterans: Pilot Treatment Outcomes

Meyer

Walser

Hermann

et al. 2018

Journal of Traumatic Stress

View full text Add to dashboard Cite

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co‐occur and are associated with worse outcomes together than either disorder alone. A lack of consensus regarding recommendations for treating PTSD–AUD exists, and treatment dropout is a persistent problem. Acceptance and Commitment Therapy (ACT), a transdiagnostic, mindfulness‐ and acceptance‐based form of behavior therapy, has potential as a treatment option for PTSD–AUD. In this uncontrolled pilot study, we examined ACT for PTSD–AUD in 43 veterans; 29 (67%) completed the outpatient individual therapy protocol (i.e., ≥ 10 of 12 sessions). Clinician‐assessed and self‐reported PTSD symptoms were reduced at posttreatment, ds = 0.79 and 0.96, respectively. Self‐reported symptoms of PTSD remained lower at 3‐month follow‐up, d = 0.88. There were reductions on all alcohol‐related outcomes (clinician‐assessed and self‐reported symptoms, total drinks, and heavy drinking days) at posttreatment and 3‐month follow‐up, dmean = 0.91 (d range: 0.65–1.30). Quality of life increased at posttreatment and follow‐up, ds = 0.55–0.56. Functional disability improved marginally at posttreatment, d = 0.35; this effect became significant by follow‐up, d = 0.52. Fewer depressive symptoms were reported at posttreatment, d = 0.50, and follow‐up, d = 0.44. Individuals experiencing suicidal ideation reported significant reductions by follow‐up. Consistent with the ACT theoretical model, these improvements were associated with more between‐session mindfulness practice and reductions in experiential avoidance and psychological inflexibility. Recommendations for adapting ACT to address PTSD–AUD include assigning frequent between‐session mindfulness practice and initiating values clarification work and values‐based behavior assignments early in treatment.

show abstract

Characterization of comorbid PTSD in treatment-seeking alcohol dependent inpatients: Severity and personality trait differences

Cited by 22 publications

References 39 publications

Sex differences in traumatic stress reactivity of rats with a history of alcohol drinking

Sex differences in traumatic stress reactivity of rats with a history of alcohol drinking

Clinical presentations, social functioning, and treatment receipt among individuals with comorbid life‐time PTSD and alcohol use disorders versus drug use disorders: findings from NESARC‐III

Acceptance and Commitment Therapy for Co‐Occurring Posttraumatic Stress Disorder and Alcohol Use Disorders in Veterans: Pilot Treatment Outcomes

Contact Info

Product

Resources

About