Review of biological mechanisms and pharmacological treatments of comorbid PTSD and substance use disorder

Abstract

Posttraumatic stress disorder (PTSD) and alcohol/substance use disorder (A/SUD) are frequently comorbid. Comorbidity is associated with poorer psychological, functional, and treatment outcomes than either disorder alone. This review outlines biological mechanisms that are potentially involved in the development and maintenance of comorbid PTSD and A/SUD including neurotransmitter and hypothalamic-pituitary-adrenal dysregulation, structural differences in the brain, and shared genetic risk factors. The literature regarding pharmacological treatments that have been investigated for comorbid PTSD and A/SUD is also reviewed. Empirical data for each proposed mechanism and pharmacological approach is reviewed with the goal of making recommendations for future research.

Integrated treatment programs for individuals with concurrent substance use disorders and trauma experiences: A systematic review and meta-analysis

“…Only a few studies have examined the efficacy of specific pharmaceuticals as a stand-alone treatment for concurrent PTSD and SUD, and not one has examined the efficacy of medication in supporting psychotherapeutic interventions. In a recent review of the literature, Norman et al (2011) concluded that medications targeting the serotonin or dopamine system warrant further attention in well-conducted studies with large samples and rigorous scientific methods. Finally, it may also be useful to explore the integration of SUD treatment with intensive, longer term therapy programs such as dialectical behavior therapy.…”

Substance use and misuse in burn patients: Testing the classical hypotheses of the interaction between post-traumatic symptomatology and substance use

“…The high risk hypothesis receives evidence from epidemiological 16 and family genetic studies 17 , and the susceptibility hypothesis mainly from neurobiological and genetic studies 18,19 . The self-medication hypothesis has received support mainly from clinical 20 and epidemiological studies 21--23 .…”

Consumer Information and Treatment Resources for Posttraumatic Stress Disorder

“…In several reviews, authors included one or two RCTs in their analyses, and drew most of their conclusions from longitudinal, observational, openlabel, or case studies. 45,51,52 Other reviews included calls for methodological homogeneity and addressed a lack of research on whether different treatments might be more or less effective depending upon etiology, comorbidities, or other patient characteristics. 23,31,32,44,[53][54][55][56] And though individualized treatment is an attractive goal, "To date, no published study has examined the potential for matching treatment protocol based on symptom profile."…”