Psychological therapies for post-traumatic stress disorder and comorbid substance use disorder

Roberts, Neil P.; Roberts, Pamela A.; Jones, Neil P.; Bisson, Jonathan I.

doi:10.1002/14651858.cd010204.pub2

Cited by 83 publications

(110 citation statements)

References 138 publications

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“…Another study of veterans who had had repeated hospitalizations found that only 12% of the patients remained in outpatient treatment two years after being hospitalized (Bowersox, Saunders, & Berger, 2013). Furthermore, most trauma treatment studies exclude patients with complex and severe presentations including those with suicidality (Roberts, Roberts, Jones, & Bisson, 2016), although the present study did not exclude any patients based on symptomatology or chronicity (Brand et al, 2009). Attrition is higher in patients who have low incomes, receive government subsidies, and who struggle with substance abuse and/or serious psychiatric illnesses (Mancino et al, 2010), characteristics that were common in this sample (Brand et al, 2009).…”

Section: Discussionmentioning

confidence: 93%

Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates

Myrick

Webermann

Langeland

et al. 2017

European Journal of Psychotraumatology

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Background: Interpersonal trauma and trauma-related disorders cost society billions of dollars each year. Because of chronic and severe trauma histories, dissociative disorder (DD) patients spend many years in the mental health system, yet there is limited knowledge about the economic burden associated with DDs. Objective: The current study sought to determine how receiving specialized treatment would relate to estimated costs of inpatient and outpatient mental health services. Method: Patients’ and individual therapists’ reports of inpatient hospitalization days and outpatient treatment sessions were converted into US dollars. DD patients and their clinicians reported on use of inpatient and outpatient services four times over 30 months as part of a larger, naturalistic, international DD treatment study. The baseline sample included 292 clinicians and 280 patients; at the 30-month follow-up, 135 clinicians and 111 patients. Missing data were replaced in analyses to maintain adequate statistical power. The substantial attrition rate (>50%) should be considered in interpreting findings. Results: Longitudinal and cross-sectional analyses of cost estimates based on patient reported inpatient hospitalization significantly decreased over time. Longitudinal cost estimates based on clinician-reported outpatient services also significantly decreased over time. Cross-sectional cost estimates based on patient and clinician reported inpatient hospitalization were significantly lower for patients in later stages of treatment compared to those struggling with safety and stabilization. Cross-sectional cost estimates based on clinician-reported outpatient services were significantly lower for patients in later stages of treatment compared to those in early stages. Conclusions: This pattern of longitudinal and cross-sectional reductions in inpatient and outpatient costs, as reported by both patients and therapists, suggests that DD treatment may be associated with reduced inpatient and outpatient costs over time. Although these preliminary results show decreased mental health care utilization and associated estimated costs, it is not clear whether it was treatment that caused these important changes.

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Section: Discussionmentioning

confidence: 93%

Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates

Myrick

Webermann

Langeland

et al. 2017

European Journal of Psychotraumatology

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“…Although there is evidence for the effectiveness of disorder-specific treatments to reduce symptom severity of PTSD [45] in individuals with co-occurring substance use disorders, our finding is in line with a Cochrane review by Hunt et al [17], indicating that there is no compelling evidence for any psychosocial intervention to reduce substance use or improve mental state in patients with substance use disorders and severe mental illness [12]. Although there is evidence for the effectiveness of disorder-specific treatments to reduce symptom severity of PTSD [45] in individuals with co-occurring substance use disorders, our finding is in line with a Cochrane review by Hunt et al [17], indicating that there is no compelling evidence for any psychosocial intervention to reduce substance use or improve mental state in patients with substance use disorders and severe mental illness [12].…”

Section: Discussionmentioning

confidence: 99%

“…No between-group differences were found regarding alcohol and drug use problems and psychiatric symptom severity between CAU and CAU + SOS training. Although there is evidence for the effectiveness of disorder-specific treatments to reduce symptom severity of PTSD [45] in individuals with co-occurring substance use disorders, our finding is in line with a Cochrane review by Hunt et al [17], indicating that there is no compelling evidence for any psychosocial intervention to reduce substance use or improve mental state in patients with substance use disorders and severe mental illness [12]. Victimization has been linked to substance use and psychiatric symptom severity in both patients with severe mental illness [5,46] and Table 3 Observed percentage of participants with treatment response at 14-month follow-up and results of the logistic regression analyses for primary outcome treatment response for total victimization and secondary outcomes treatment response for violent victimization and treatment response for property victimization.…”

Section: Discussionmentioning

confidence: 99%

“…However, we would like to emphasize that SOS training is by no means a substitute for trauma treatment, and that patients suffering from post-traumatic stress disorder should always receive evidence-based psychotherapeutic interventions [45]. However, we would like to emphasize that SOS training is by no means a substitute for trauma treatment, and that patients suffering from post-traumatic stress disorder should always receive evidence-based psychotherapeutic interventions [45].…”

Section: Cau + Sosmentioning

confidence: 99%

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Self‐wise, Other‐wise, Streetwise (SOS) training, an intervention to prevent victimization in dual‐diagnosis patients: results from a randomized clinical trial

et al. 2018

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Background and Aims Patients with co‐occurring substance use and other mental disorders are vulnerable to crime victimization, yet no evidence‐based preventive interventions exist. Our aim was to test the efficacy of a new intervention, Self‐wise, Other‐wise, Streetwise training (SOS training), to prevent victimization in these dual‐diagnosis patients as an add‐on to care as usual. Design Multi‐site single‐blind parallel randomized controlled trial. Setting Three sites within one psychiatric service in Amsterdam, the Netherlands. Participants Adult in‐patients and out‐patients with dual diagnosis (n = 250), who were predominantly male (70.4%), aged on average 42.1 years, and diagnosed with 3.7 DSM‐IV disorders. Intervention and comparator Care as usual, consisting of pharmacotherapy combined with individual psychotherapy, group psychotherapy and/or supportive counselling (n = 125) was compared with care as usual plus SOS training: a 6‐week, 12‐session manualized group training focused on enhancing emotion regulation skills, conflict resolution skills and street skills (n = 125). Measurements Victimization was assessed with the Safety Monitor, the Dutch equivalent of the International Crime Victims Survey, in a face‐to‐face assessment. The primary outcome measure was treatment response (yes/no), with ‘yes’ defined as reporting at least a 50% reduction in the number of past‐year victimization incidents at the 14‐month follow‐up compared with baseline. Analyses were performed according to the intention‐to‐treat principle. Findings The proportion of participants achieving treatment response for total victimization was 54.0% in the control group and 67.6% in the experimental group, a significant difference [odds ratio (OR) = 1.78, 95% confidence interval (CI) = 1.02–3.11, P = 0.042]. Treatment response for violent victimization was achieved by 68.7% of the control group and 79.3% of the experimental group (OR = 1.75, 95% CI = 0.91–3.34, P = 0.092). With a Bayes factor of 2.26, this result was inconclusive. Conclusions Among dual‐diagnosis patients, care as usual plus Self‐wise, Other‐wise, Streetwise training was more effective in preventing victimization than care as usual alone.

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“…PTSD is tenacious, debilitating, and treatment refractory in many cases (Breslau, Peterson, Poisson, Schultz, & Lucia, 2004; Hoskins et al, 2015; Institute of Medicine, 2014; Kessler, 2000; Roberts, Roberts, Jones, & Bisson, 2015, 2016; Schnyder et al, 2015; Sijbrandij, Kleiboer, Bisson, Barbui, & Cuijpers, 2015). Early interventions may reduce the prevalence of chronic PTSD among survivors at risk (Kearns, Ressler, Zatzick, & Rothbaum, 2012), but they are resource demanding and effective in only a subset of survivors.…”

Section: Introductionmentioning

confidence: 99%

Application of data pooling to longitudinal studies of early post-traumatic stress disorder (PTSD): the International Consortium to Predict PTSD (ICPP) project

Ratanatharathorn

Gevonden

et al. 2018

European Journal of Psychotraumatology

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Background: Understanding the development of post-traumatic stress disorder (PTSD) is a precondition for efficient risk assessment and prevention planning. Studies to date have been site and sample specific. Towards developing generalizable models of PTSD development and prediction, the International Consortium to Predict PTSD (ICPP) compiled data from 13 longitudinal, acute-care based PTSD studies performed in six different countries.Objective: The objectives of this study were to describe the ICPP’s approach to data pooling and harmonization, and present cross-study descriptive results informing the longitudinal course of PTSD after acute trauma.Methods: Item-level data from 13 longitudinal studies of adult civilian trauma survivors were collected. Constructs (e.g. PTSD, depression), measures (questions or scales), and time variables (days from trauma) were identified and harmonized, and those with inconsistent coding (e.g. education, lifetime trauma exposure) were recoded. Administered in 11 studies, the Clinician Administered PTSD Scale (CAPS) emerged as the main measure of PTSD diagnosis and severity.Results: The pooled data set included 6254 subjects (39.9% female). Studies’ average retention rate was 87.0% (range 49.1–93.5%). Participants’ baseline assessments took place within 2 months of trauma exposure. Follow-up durations ranged from 188 to 1110 days. Reflecting studies’ inclusion criteria, the prevalence of baseline PTSD differed significantly between studies (range 3.1–61.6%), and similar differences were observed in subsequent assessments (4.3–38.2% and 3.8–27.0% for second and third assessments, respectively).Conclusion: Pooling data from independently collected studies requires careful curation of individual data sets for extracting and optimizing informative commonalities. However, it is an important step towards developing robust and generalizable prediction models for PTSD and can exceed findings of single studies. The large differences in prevalence of PTSD longitudinally cautions against using any individual study to infer trauma outcome. The multiplicity of instruments used in individual studies emphasizes the need for common data elements in future studies.

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Psychological therapies for post-traumatic stress disorder and comorbid substance use disorder

Cited by 83 publications

References 138 publications

Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates

Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates

Self‐wise, Other‐wise, Streetwise (SOS) training, an intervention to prevent victimization in dual‐diagnosis patients: results from a randomized clinical trial

Application of data pooling to longitudinal studies of early post-traumatic stress disorder (PTSD): the International Consortium to Predict PTSD (ICPP) project

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