RESEARCH ARTICLE

The Effects of Prolonged Exposure on Substance Use in Patients With Posttraumatic Stress Disorder and Substance Use Disorders

Corresponding Author

Jessica M. Peirce

jmpeirce@jhmi.edu

orcid.org/0000-0002-1192-3965

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Correspondence concerning this article should be addressed to Jessica Peirce, Mason F. Lord, 6 East, 5200 Eastern Avenue, Baltimore, MD 21224; E-mail: jmpeirce@jhmi.edu.

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Rebecca L. Schacht,

Rebecca L. Schacht

orcid.org/0000-0002-2122-8384

Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA

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Robert K. Brooner,

Robert K. Brooner

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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Jessica M. Peirce,

Corresponding Author

Jessica M. Peirce

jmpeirce@jhmi.edu

orcid.org/0000-0002-1192-3965

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Correspondence concerning this article should be addressed to Jessica Peirce, Mason F. Lord, 6 East, 5200 Eastern Avenue, Baltimore, MD 21224; E-mail: jmpeirce@jhmi.edu.

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Rebecca L. Schacht,

Rebecca L. Schacht

orcid.org/0000-0002-2122-8384

Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA

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Robert K. Brooner,

Robert K. Brooner

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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First published: 29 June 2020

https://doi.org/10.1002/jts.22546

Citations: 12

This research was supported by a grant to the first author from the National Institutes on Drug Abuse (R34DA032689).

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Abstract

Despite research demonstrating the benefit of exposure-based therapy for posttraumatic stress disorder (PTSD) in patients with co-occurring substance use disorders, there remains a strong clinical expectation that this treatment will exacerbate substance use or other psychiatric symptoms. The present study evaluated within-session and session-to-session changes in (a) craving and use of substances for a range of drug classes and (b) symptoms of PTSD and other psychiatric distress in a sample of 44 SUD patients who received prolonged exposure (PE) therapy for PTSD. Visual analog scales showed no within-session increases in craving, except for cocaine, within Session 8. Across sessions, craving scores dropped for heroin, methadone, benzodiazepines, and cocaine; no increases in craving were found. Past-week substance use reported at each session did not differ. The severity of PTSD symptoms and self-reported serious emotional problems decreased from Session 1 to subsequent sessions, with no increases or decreases in other psychiatric, social, or medical problems. Finally, PTSD severity was unrelated to substance use reported 1 or 2 weeks later. Substance use during the past week was associated with higher PTSD severity scores at the next session, B = 6.86 (SE = 2.87), p = .018, but was not associated 2 weeks later. These findings indicate that the concern that exposure therapy for PTSD will increase SUD patients’ substance use or other psychiatric symptoms may be unwarranted, and, thus, SUD patients, including those who are actively using, should have access to effective treatments for PTSD, like PE.

Resumen

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET)

Efectos de la exposición prolongada para TEPT en el uso de sustancias en pacientes con trastornos de uso de sustancias

EFECTOS DE LA EXPOSICIÓN PROLONGADA SOBRE EL USO DE SUSTANCIAS

A pesar de que la investigación demuestra el beneficio de la terapia basada en la exposición para el trastorno de estrés postraumático (TEPT) en pacientes con co-ocurrencia de trastornos por uso de sustancias (TUS), sigue habiendo una fuerte expectativa clínica de que este tratamiento exacerbará el uso de sustancias u otros síntomas psiquiátricos. El presente estudio evaluó los cambios dentro de una sesión y de una sesión a otra en (a) el ansia de consumo y uso de sustancias para una variedad de clases de drogas y (b) los síntomas de TEPT y otros problemas psiquiátricos en una muestra de 44 pacientes TUS que recibieron terapia de exposición prolongada (EP) para el TEPT. Las escalas analógicas visuales no mostraron aumentos dentro de la sesión del ansia de consumo, excepto para la cocaína, dentro de la Sesión 8. A través de las sesiones, los puntajes de ansia de consumo para heroína, metadona, benzodiazepinas y cocaína cayeron; no se encontraron aumentos en el ansia de consumo. El consumo de sustancias durante la semana anterior informado en cada sesión no difirió. La gravedad de los síntomas de TEPT y los problemas emocionales graves autoreportados disminuyeron de la Sesión 1 a las sesiones posteriores, sin aumentos o disminuciones en otros problemas psiquiátricos, sociales o médicos. Finalmente, la gravedad del TEPT no se relacionó al consumo de sustancias informado 1 o 2 semanas después. El uso de sustancias durante la semana anterior se asoció con puntuaciones más altas de gravedad del TEPT en la siguiente sesión, B = 6.86 (DE = 2.87), p = 0.018, pero no se asoció 2 semanas después. Estos hallazgos indican que la preocupación de que la terapia de exposición para el TEPT aumentará el uso de sustancias u otros síntomas psiquiátricos de los pacientes con TUS pueden ser injustificada y, por lo tanto, los pacientes TUS, incluidos los que usan activamente, deben tener acceso a tratamientos efectivos para el TEPT, como la EP.

抽象

Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS)

簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯

Effects of Prolonged Exposure for PTSD on substance use in patients with substance use disorders

Traditional Chinese

標題: PTSD延長暴露療法用於治療藥物濫用失常患者的功效

撮要: 過往已有研究顯示, 暴露為本的療法對患創傷後壓力症(PTSD)及藥物濫用失常(SUD)共病的患者的療效。然而, 目前的臨床治療仍預期這種療法會加劇患者的濫用藥物情況及其他精神症狀。本研究評估樣本在節段期間以及節段跟節段之間:(a) 對一系列藥物類別的藥癮及使用, 及(b) 其PTSD症狀及其他精神悲痛症狀。樣本為44名SUD患者, 他們接受了針對PTSD的延長暴露療法(PE)。視覺類比量尺反映, 樣本除了在第八節段期間對可卡因的藥癮提升外, 其他藥癮在節段期間並無上升。在節段之間, 樣本對海洛英、美沙酮、苯二氮䓬類藥物、可卡因的藥癮分數均下降, 亦無藥癮提升。樣本在每次節段報告的過去一星期濫用藥物情況並無改變。樣本的PTSD症狀嚴重度及自評的嚴重情緒問題, 從第一個節段開始至往後的節段都有所下降, 其他精神、社會或藥物問題則無上升或下降。最後, PTSD嚴重度跟樣本報告一或兩星期後的濫用藥物情況無關。過去一星期的濫用藥物情況, 跟在下一節段PTSD嚴重度分數較高相關)B = 6.86 (SE = 2.87), p = .018(, 但在兩星期後就無此關連。這些結果反映, 憂慮針對PTSD的暴露療法將加劇SUD患者的濫用藥物或其他精神症狀問題, 可能並無根據。因此, SUD患者)包括正活躍地濫用藥物的患者(應有機會接受像PE那樣有效的PTSD治療。

Simplified Chinese

标题: PTSD延长暴露疗法用于治疗药物滥用失常患者的功效

撮要: 过往已有研究显示, 暴露为本的疗法对患创伤后压力症(PTSD)及药物滥用失常(SUD)共病的患者的疗效。然而, 目前的临床治疗仍预期这种疗法会加剧患者的滥用药物情况及其他精神症状。本研究评估样本在节段期间以及节段跟节段之间:(a) 对一系列药物类别的药瘾及使用, 及(b) 其PTSD症状及其他精神悲痛症状。样本为44名SUD患者, 他们接受了针对PTSD的延长暴露疗法(PE)。视觉模拟量尺反映, 样本除了在第八节段期间对可卡因的药瘾提升外, 其他药瘾在节段期间并无上升。在节段之间, 样本对海洛英、美沙酮、苯二氮䓬类药物、可卡因的药瘾分数均下降, 亦无药瘾提升。样本在每次节段报告的过去一星期滥用药物情况并无改变。样本的PTSD症状严重度及自评的严重情绪问题, 从第一个节段开始至往后的节段都有所下降, 其他精神、社会或药物问题则无上升或下降。最后, PTSD严重度跟样本报告一或两星期后的滥用药物情况无关。过去一星期的滥用药物情况, 跟在下一节段PTSD严重度分数较高相关)B = 6.86 (SE = 2.87), p = .018(, 但在两星期后就无此关连。这些结果反映, 忧虑针对PTSD的暴露疗法将加剧SUD患者的滥用药物或其他精神症状问题, 可能并无根据。因此, SUD患者)包括正活跃地滥用药物的患者(应有机会接受像PE那样有效的PTSD治疗。

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Volume33, Issue4

August 2020

Pages 465-476

The Effects of Prolonged Exposure on Substance Use in Patients With Posttraumatic Stress Disorder and Substance Use Disorders

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The Effects of Prolonged Exposure on Substance Use in Patients With Posttraumatic Stress Disorder and Substance Use Disorders

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