Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2010 Jan;167(1):95-101.
doi: 10.1176/appi.ajp.2009.09091261. Epub 2009 Nov 16.

Do treatment improvements in PTSD severity affect substance use outcomes? A secondary analysis from a randomized clinical trial in NIDA's Clinical Trials Network

Denise A Hien  1 , Huiping Jiang, Aimee N C Campbell, Mei-Chen Hu, Gloria M Miele, Lisa R Cohen, Gregory S Brigham, Carrie Capstick, Agatha Kulaga, James Robinson, Lourdes Suarez-Morales, Edward V Nunes
Affiliations
Randomized Controlled Trial

Do treatment improvements in PTSD severity affect substance use outcomes? A secondary analysis from a randomized clinical trial in NIDA's Clinical Trials Network

Denise A Hien et al. Am J Psychiatry. 2010 Jan.

Abstract

Objective: The purpose of the analysis was to examine the temporal course of improvement in symptoms of posttraumatic stress disorder (PTSD) and substance use disorder among women in outpatient substance abuse treatment.

Method: Participants were 353 women randomly assigned to 12 sessions of either trauma-focused or health education group treatment. PTSD and substance use assessments were conducted during treatment and posttreatment at 1 week and after 3, 6, and 12 months. A continuous Markov model was fit on four defined response categories (nonresponse, substance use response, PTSD response, or global response [improvement in both PTSD and substance use]) to investigate the temporal association between improvement in PTSD and substance use symptom severity during the study's treatment phase. A generalized linear model was applied to test this relationship over the follow-up period.

Results: Subjects exhibiting nonresponse, substance use response, or global response tended to maintain original classification; subjects exhibiting PTSD response were significantly more likely to transition to global response over time, indicating maintained PTSD improvement was associated with subsequent substance use improvement. Trauma-focused treatment was significantly more effective than health education in achieving substance use improvement, but only among those who were heavy substance users at baseline and had achieved significant PTSD reductions.

Conclusions: PTSD severity reductions were more likely to be associated with substance use improvement, with minimal evidence of substance use symptom reduction improving PTSD symptoms. Results support the self-medication model of coping with PTSD symptoms and an empirical basis for integrated interventions for improved substance use outcomes in patients with severe symptoms.

Trial registration: ClinicalTrials.gov NCT00078156.

PubMed Disclaimer

Comment in

References

    1. Chilcoat HD, Menard C. In: Epidemiological investigations: comorbidity of posttraumatic stress disorder and substance use disorder, in Trauma and substance abuse: causes, consequences and treatment of comorbid disorders. Ouimette PC, Brown PJ, editors. Washington, DC: American Psychological Association; 2003. pp. 9–28.
    1. Khantzian EJ. Treating Addiction as a Human Process. London: Aronson; 1999.
    1. Khantzian EJ. The ego, the self, and opiate addiction: theoretical and treatment considerations. Int J Psychoanal. 1977;5:189–199. - PubMed
    1. Chilcoat HD, Breslau N. Investigations of casual pathways between PTSD and drug use disorders. Addict Behav. 1998;23:827–840. - PubMed
    1. Dixon L, Haas G, Weiden PJ. Drug abuse in schizophrenia patients: clinical correlates and reasons for use. Am J Psychiatry. 1991;148:224–230. - PubMed

Publication types

MeSH terms

Associated data