Changes in PTSD symptomatology during acute and protracted alcohol and cocaine abstinence

Abstract

Previous research with substance users has demonstrated, across a variety of psychiatric disorders, significant decreases in psychological symptoms during early substance abstinence. To build on this literature, the current study prospectively assessed trauma symptomatology over 28 days during acute and protracted cocaine and alcohol abstinence. Participants were 162 male and female cocaine and/or alcohol dependent outpatients who reported a history of trauma. Trauma-related symptoms and substance use were assessed at 2, 5, 10, 14, 21, and 28 days following last substance use. For participants who were known to relapse, assessments began again after the last day of substance use. Latent growth modeling was employed to estimate changes in posttraumatic stress disorder (PTSD) symptoms. Consistent with studies of other psychiatric syndromes, PTSD symptoms declined across the 28-day study period regardless of withdrawal substance (i.e., cocaine or alcohol). The majority of change in trauma symptoms occurred within 2 weeks of last substance use. Moreover, while trauma symptoms for the PTSD participants were more severe than those reported by the non-PTSD participants, trauma symptoms declined across the study period at the same rate irrespective of PTSD status.

Figure 1

Expected and observed percent change in PTSD symptoms, as measured by the Modified PTSD Symptom Scale – Self Report (MPSS) total score, during 28 days of cocaine and/or alcohol abstinence.

Figure 2

Representation of a latent growth model with mean structure estimation examining change in PTSD symptoms as assessed with the Modified PTSD Symptom Scale – Self Report (MPSS) during 28 days of cocaine and/or alcohol abstinence as a function of withdrawal substance (cocaine, alcohol, or cocaine and alcohol) and baseline PTSD diagnostic status. T1 = MPSS score at day 2; T2 = MPSS score at day 5; T3 = MPSS score at day 10; T4 = MPSS score at day 14; T5 = MPSS score at day 21; T6 = MPSS score at day 28; Cocaine = dummy coded variable (withdrawing from cocaine only = 1; withdrawing from alcohol or alcohol and cocaine = 0); Alcohol = dummy coded variable (withdrawing from alcohol only = 1; withdrawing from cocaine or alcohol and cocaine = 0); Baseline PTSD diagnosis = dichotomous variable (1 = yes; 0 = no); Intercept = latent variable representing baseline MPSS score; Growth Factor = latent variable representing change in MPSS scores over time; E₁ − E₆ = error variance on T1 − T6 MPSS scores; D_I and D_G = disturbance terms on latent Intercept and Growth Factor variables.