Treatment receipt patterns among individuals with co-occurring posttraumatic stress disorder (PTSD) and substance use disorders.

Abstract

Objective: To determine latent classes of treatment receipt among people with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) and describe each class by demographics, disease characteristics, and psychiatric diagnoses. Method: Participants were National Epidemiologic Survey on Alcohol and Related Conditions-III respondents with lifetime PTSD and SUD (n ϭ 1,349; mean age 40.3; 62.5% female; 30.9% non-White or Hispanic-White). Cross-sectional data were collected using the DSM-5 Alcohol Use Disorder and Associated Disabilities Interview Schedule. Latent class analysis was used to identify subgroups of participants with different patterns of treatment receipt. Results: Of the patients, 36% received at least 1 SUD treatment while 84% received at least 1 mental health (MH) treatment. Six latent classes were identified: no treatment (17.3%), outpatient MH (34.0%), outpatient ϩ inpatient MH (17.9%), SUD (7.3%), SUD ϩ outpatient MH (15.7%), and SUD ϩ outpatient MH ϩ inpatient MH (7.7%). The SUD treatment classes evidenced greater social instability, had higher alcohol use disorder symptom severity, and used more drug types than the non-SUD classes. Classes receiving inpatient MH treatment had a greater incidence of additional comorbid conditions and suicidal behaviors. Across all 6 classes, most respondents met diagnostic criteria for chronic PTSD (overall: 68.9%) while fewer met diagnostic criteria for chronic SUD (overall: 38.7%). Conclusions: Most people with lifetime PTSD and SUD have sought either SUD or MH treatment or both, with substantially greater receipt of MH treatment. This comorbid group has complex clinical presentations that differ depending

Efficacy and acceptability of interventions for co-occurring PTSD and SUD: A meta-analysis

“…Studies conducted in SUD clinical sites showed substantially larger effects in five within-group models ( g s = 0.48–1.01) and three between-group models ( g s = 0.55–1.11), with six of the eight significant outcomes pertaining to SUD. It is possible that patients enrolled through SUD treatment clinics participated in additional SUD programming that was helpful to them and/or they had more severe substance use profiles (see Simpson et al, 2020 ) and thus had more room for improvement. Additionally, clinicians at SUD treatment clinics likely have more experience treating individuals with SUD (with or without PTSD) than those in university or laboratory settings where community-based recruiting was the norm.…”

“…These studies were excluded from the primary between-group analyses but were included in sensitivity analyses in the trauma-focused vs. all comparators models. To isolate the effects of trauma-focused treatments involving empirically supported PTSD treatment components (CPT: Simpson et al, 2020 ; Vujanovic personal communication; PE 4 : Back et al, 2019 ; Foa et al, 2014 ; Ruglass et al, 2017 ) relative to the most rigorous comparators (manualized SUD), a set of sensitivity analyses involving only those studies were conducted.…”

“…Given the level of disease burden and deleterious effects on functioning associated with co-occurring PTSD/SUD, it is not surprising that these individuals are likely to access treatment. A recent nationally representative study estimated that approximately 36% of people with comorbid PTSD/SUD have sought SUD-specific care while 84% have sought care in mental health settings ( Simpson et al, 2020 ; see also Hawn, Cusack, & Amstadter, 2020 ). However, despite these high rates of treatment engagement, persistence of PTSD is common with over two-thirds of individuals with comorbid PTSD/SUD meeting criteria for a chronic PTSD diagnosis and nearly 40% for a chronic SUD (i.e., positive diagnosis both prior to the past year and in the past year; Simpson et al, 2020 ).…”

“…Given the modest number of studies available for several comparisons tested by Roberts et al ( k s ranged from 1 to 4 studies), which likely impacted statistical power ( Valentine, Pigott, & Rothstein, 2010 ), the increase in available studies suggests that it is an opportune time for an updated examination. In addition, Roberts et al did not evaluate potential moderators of treatment response, such as participant drug use involvement or recruitment setting (i.e., SUD treatment clinics vs. community-based recruitment), factors that may be markers of disease severity ( Moss, Goldstein, Chen, & Yi, 2015 ; Simpson et al, 2020 ). Thus, we undertook an updated meta-analysis of behavioral treatments for adults with co-occurring PTSD/SUD in RCTs involving outcomes pertaining to PTSD severity, substance use, and treatment retention.…”

“…1 Second, in light of findings suggesting that those with co-occurring PTSD/DUD are at elevated risk of worse social functioning (e.g., greater risk of unemployment and lifetime incarceration; lower educational attainment), greater SUD severity, and greater suicide risk than those with PTSD/AUD-only ( Simpson et al, 2019 ), we evaluated whether the proportion of the samples with reported drug use moderated treatment effects. Third, we explored whether the setting in which the RCTs took place (e.g., SUD treatment clinics vs. community recruitment by university-based investigators) moderated outcomes given epidemiologic evidence that those with PTSD/SUD who receive SUD treatment have markedly more severe SUDs and are more likely to have chronic SUDs than those reporting no treatment or mental health treatment only ( Simpson et al, 2020 ). Fourth, we evaluated whether differential assessment attrition moderated outcomes because study outcomes could be biased if, for example, less severe, more stable study participants are more likely to attend post-treatment assessments than more severe, less stable participants.…”