PTSD and Substance Use Disorder Among Veterans: Characteristics, Service Utilization and Pharmacotherapy

Bowe, Adina; Rosenheck, Robert A.

doi:10.1080/15504263.2014.989653

Cited by 66 publications

(32 citation statements)

References 64 publications

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“…There were 38.3 % who had an unknown severity of TBI. Psychiatric comorbidity was similar to other populations of veterans with complex issues (Bowe and Rosenheck 2015 ). With respect to the veteran demographics by service, 41 % were Army, 17 % were Marines, 19 % were Air Force, and 23 % were Navy.…”

Section: Methodssupporting

confidence: 72%

Functional neuroimaging with default mode network regions distinguishes PTSD from TBI in a military veteran population

Raji

Willeumier

Taylor

et al. 2015

Brain Imaging and Behavior

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PTSD and TBI are two common conditions in veteran populations that can be difficult to distinguish clinically. The default mode network (DMN) is abnormal in a multitude of neurological and psychiatric disorders. We hypothesize that brain perfusion SPECT can be applied to diagnostically separate PTSD from TBI reliably in a veteran cohort using DMN regions. A group of 196 veterans (36 with PTSD, 115 with TBI, 45 with PTSD/TBI) were selected from a large multi-site population cohort of individuals with psychiatric disease. Inclusion criteria were peacetime or wartime veterans regardless of branch of service and included those for whom the traumatic brain injury was not service related. SPECT imaging was performed on this group both at rest and during a concentration task. These measures, as well as the baseline-concentration difference, were then inputted from DMN regions into separate binary logistic regression models controlling for age, gender, race, clinic site, co-morbid psychiatric diseases, TBI severity, whether or not the TBI was service related, and branch of armed service. Predicted probabilities were then inputted into a receiver operating characteristic analysis to compute sensitivity, specificity, and accuracy. Compared to PSTD, persons with TBI were older, male, and had higher rates of bipolar and major depressive disorder (p < 0.05). Baseline quantitative regions with SPECT separated PTSD from TBI in the veterans with 92 % sensitivity, 85 % specificity, and 94 % accuracy. With concentration scans, there was 85 % sensitivity, 83 % specificity and 89 % accuracy. Baseline-concentration (the difference metric between the two scans) scans were 85 % sensitivity, 80 % specificity, and 87 % accuracy. In separating TBI from PTSD/TBI visual readings of baseline scans had 85 % sensitivity, 81 % specificity, and 83 % accuracy. Concentration scans had 80 % sensitivity, 65 % specificity, and 79 % accuracy. Baseline-concentration scans had 82 % sensitivity, 69 % specificity, and 81 % accuracy. For separating PTSD from PTSD/TBI baseline scans had 87 % sensitivity, 83 % specificity, and 92 % accuracy. Concentration scans had 91 % sensitivity, 76 % specificity, and 88 % accuracy. Baseline-concentration scans had 84 % sensitivity, 64 % specificity, and 85 % accuracy. This study demonstrates the ability to separate PTSD and TBI from each other in a veteran population using functional neuroimaging.

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Section: Methodssupporting

confidence: 72%

Functional neuroimaging with default mode network regions distinguishes PTSD from TBI in a military veteran population

Raji

Willeumier

Taylor

et al. 2015

Brain Imaging and Behavior

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show abstract

“…Although substance use may result in short-term relief of symptoms, the long-term consequences of addiction can be severe. For instance, veterans diagnosed with PTSD and comorbid SUD tend to display higher rates of homelessness and are more likely to receive VA disability than individuals with PTSD alone (Bowe & Rosenheck, 2015). Veterans with PTSD and SUD also tend to display greater levels of intolerance for uncertainty, lower tolerance for distress (Banducci et al, 2016) and have poorer treatment outcomes (Norman, Tate, Anderson, & Brown, 2007).…”

Section: Introductionmentioning

confidence: 99%

Integrated, exposure-based treatment for PTSD and comorbid substance use disorders: Predictors of treatment dropout

Szafranski

Snead

Grös

et al. 2017

Addictive Behaviors

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High rates of comorbid posttraumatic stress disorder (PTSD) and substance use disorders (SUD) have been noted in veteran populations. Fortunately, there are a number of evidence-based psychotherapies designed to address comorbid PTSD and SUD. However, treatments targeting PTSD and SUD simultaneously often report high dropout rates. To date, only one study has examined predictors of dropout from PTSD/SUD treatment. To address this gap in the literature, this study aimed to 1) examine when in the course of treatment dropout occurred, and 2) identify predictors of dropout from a concurrent treatment for PTSD and SUD. Participants were 51 male and female veterans diagnosed with current PTSD and SUD. All participants completed at least one session of a cognitive-behavioral treatment (COPE) designed to simultaneously address PTSD and SUD symptoms. Of the 51 participants, 22 (43.1%) dropped out of treatment prior to completing the full 12 session COPE protocol. Results indicated that the majority of dropout (55%) occurred after session 6, with the largest amount of dropout occurring between sessions 9 and 10. Results also indicated a marginally significant relationship between greater baseline PTSD symptom severity and premature dropout. These findings highlight inconsistencies related to timing and predictors of dropout, as well as the dearth of information noted about treatment dropout within PTSD and SUD literature. Suggestions for procedural changes, such as implementing continual symptom assessments during treatment and increasing dialog between provider and patient about dropout were made with the hopes of increasing consistency of findings and eventually reducing treatment dropout.

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“…Individuals with co-occurring SUD and PTSD incur heightened risk for other psychiatric problems (e.g., depression, anxiety), suicidality, neuropsychological impairment, increased morbidity and mortality, unemployment, and social impairment [2, 5, 7, 8]. This complex comorbidity also places a tremendous economic burden on the healthcare system, as it results in poorer treatment outcomes, longer duration of substance use, and more treatment episodes [9–12]. …”

Section: Introductionmentioning

confidence: 99%

Concurrent Treatment of Substance Use and PTSD

Flanagan

Korte

Killeen

et al. 2016

Curr Psychiatry Rep

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Substance use disorders (SUD) and posttraumatic stress disorder (PTSD) are chronic, debilitating conditions that frequently co-occur. Individuals with co-occurring SUD and PTSD suffer a more complicated course of treatment and less favorable treatment outcomes compared to individuals with either disorder alone. The development of effective psychosocial and pharmacological interventions for co-occurring SUD and PTSD is an active and critically important area of investigation. Several integrated psychosocial treatments for co-occurring SUD and PTSD have demonstrated promising outcomes. While recent studies examining medications to treat co-occurring SUD and PTSD have yielded encouraging findings, there remain substantial gaps in the evidence base regarding the treatment of co-occurring SUD and PTSD. This review will summarize the findings from clinical trials targeting a reduction in SUD and PTSD symptoms simultaneously. These results may improve our knowledge base and subsequently enhance our ability to develop effective interventions for this complex comorbid condition.

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PTSD and Substance Use Disorder Among Veterans: Characteristics, Service Utilization and Pharmacotherapy

Cited by 66 publications

References 64 publications

Functional neuroimaging with default mode network regions distinguishes PTSD from TBI in a military veteran population

Functional neuroimaging with default mode network regions distinguishes PTSD from TBI in a military veteran population

Integrated, exposure-based treatment for PTSD and comorbid substance use disorders: Predictors of treatment dropout

Concurrent Treatment of Substance Use and PTSD

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