Integrated Treatment of PTSD and Substance Use Disorders: The Mediating Role of PTSD Improvement in the Reduction of Depression

Abstract

Posttraumatic stress disorder (PTSD) represents one of the most common mental health disorders, particularly among veterans, and is associated with significant distress and impairment. This highly debilitating disorder is further complicated by common comorbid psychiatric disorders, such as substance use disorders (SUD). Individuals with PTSD and co-occurring SUD also commonly present with secondary symptoms, such as elevated depression. Little is known, however, about how these secondary symptoms are related to treatment outcome. The aim of the present study, therefore, was to examine (1) the effects of treatment of comorbid PTSD/SUD on depressive symptoms; and (2) whether this effect was mediated by changes in PTSD severity or changes in SUD severity. Participants were 81 U.S. military veterans (90.1% male) with PTSD and SUD enrolled in a randomized controlled trial examining the efficacy of an integrated, exposure-based treatment (Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure; n = 54) versus relapse prevention (n = 27). Results revealed significantly lower depressive symptoms at post-treatment in the COPE group, as compared to the relapse prevention group. Examination of the mechanisms associated with change in depression revealed that reduction in PTSD severity, but not substance use severity, mediated the association between the treatment group and post-treatment depression. The findings underscore the importance of treating PTSD symptoms in order to help reduce co-occurring symptoms of depression in individuals with PTSD/SUD. Clinical implications and avenues for future research are discussed.

Psychiatric comorbidity for veterans with posttraumatic stress disorder (PTSD): A latent profile analysis and implications for treatment.

“…Further improvements may be seen if programs develop tailored components to address the unique comorbidity profiles of individual veterans. Moving to more tailored interventions should be a continued focus in PTSD treatments and build on evidence suggesting that such approaches are effective and potentially suitable for diverse comorbid issues including substance use, pain, and anxiety (Dibaj, Øveraas Halvorsen, Edward Ottesen Kennair, & Inge Stenmark, 2017; Falsetti, Resnick, Davis, & Gallagher, 2001; Korte et al, 2017).…”

Predictors of PTSD Treatment Retention and Response: A Systematic Review

“…Eight studies (Bray et al, 2016;Currier, Holland, and Drescher, 2014;Jeffreys et al, 2014;Korte et al, 2017;López et al, 2017;Tiet et al, 2015;Tuerk et al, 2011;Walter et al, 2014) included race/ethnicity as a variable in multivariate models. Five found race significantly associated with response to PTSD treatment.…”

Post-traumatic stress disorder among persons with HIV who engage in heavy alcohol consumption in southwestern Uganda

“…Among PLWH, probable PTSD may negatively affect HIV treatment outcomes [ 11 , 12 ], adherence [ 13 , 14 ], and retention in HIV care [ 15 ]. In addition, probable PTSD is further complicated by other common comorbid mental health disorders such as depression, as well as substance and alcohol use disorders [ 16 ]; among PLWH, probable PTSD commonly co-occurs with depression and alcohol use [ 17 , 18 ]. Alcohol use is highly prevalent among PLWH [ 19 ] and may act as a coping mechanism for HIV-related stress [ 20 , 21 ] and possibly probable PTSD.…”