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Impact of hazardous alcohol use on intensive PTSD treatment outcomes among veterans
European Journal of Psychotraumatology ( IF 5.783 ) Pub Date : 2021-06-14 , DOI: 10.1080/20008198.2021.1888541
Philip Held 1 , Victoria L Steigerwald 1 , Dale L Smith 2 , Debra Kaysen 3 , Rebecca Van Horn 1 , Niranjan S Karnik 1
Affiliation  

ABSTRACT

Background: Intensive treatment programmes (ITPs) for posttraumatic stress disorder (PTSD) produce large symptom reductions and have generally higher completion rates compared to traditional weekly care. Although ITPs do not appear to increase substance use, it has yet to be determined whether their effectiveness differs for veterans with and without hazardous alcohol use (HAU).

Objective: This study examined the effectiveness of a 3-week Cognitive Processing Therapy-based ITP for 538 veterans with PTSD (66.0% male; mean age = 41.22 years) and with (n = 193) or without HAU (n = 343) for reducing PTSD and depression symptoms.

Method: Veterans’ PTSD (PCL-5) and depression (PHQ-9) symptoms were assessed at pre-treatment, during treatment, and at post-treatment. HAU (AUDIT-C total score ≥4 for males; ≥3 for females) was measured at intake.

Results: Treatment completion rates were high for both individuals who endorsed HAU (92.68%) and those who did not (93.37%), likely due to veterans being housed near the treatment facility. Mixed effects regression models revealed a significant time by alcohol use interaction when predicting both PCL-5 (p < .001) and PHQ-9 (p = .003), suggesting time-trends over the course of the ITP differed based on alcohol use. Veterans who endorsed HAU improved to a statistically significantly lesser extent. However, endpoint differences between groups for both outcomes were small (Cohen’s ds between 0.15 and 0.20).

Conclusions: Veterans with and without HAU reported significant reductions in PTSD and depression symptoms and completed the ITP at comparably high rates. Findings support the effectiveness of intensive PTSD treatment programmes for individuals with PTSD and HAU. Future studies should utilize controlled designs to evaluate whether intensive PTSD treatment can reduce HAU.



中文翻译:

危险酒精使用对退伍军人强化 PTSD 治疗结果的影响

摘要

背景:与传统的每周护理相比,针对创伤后应激障碍 (PTSD) 的强化治疗计划 (ITP) 可大幅减轻症状,并且通常具有更高的完成率。尽管 ITP 似乎并未增加物质使用,但尚未确定它们对使用和不使用危险酒精 (HAU) 的退伍军人的有效性是否不同。

目标: 本研究检查了基于认知加工疗法的 3 周 ITP 对 538 名患有 PTSD 的退伍军人(66.0% 为男性;平均年龄 = 41.22 岁)和有 (n = 193) 或没有 HAU (n = 343 )有效性减少创伤后应激障碍和抑郁症状。

方法:在治疗前、治疗期间和治疗后评估退伍军人的 PTSD (PCL-5) 和抑郁症 (PHQ-9) 症状。HAU(男性的 AUDIT-C 总分≥4;女性≥3)在摄入时测量。

结果:支持 HAU 的人 (92.68%) 和不支持 HAU 的人 (93.37%) 的治疗完成率都很高,这可能是因为退伍军人被安置在治疗设施附近。混合效应回归模型显示,在预测 PCL-5 ( p < .001) 和 PHQ-9 ( p = .003)时,饮酒相互作用的显着时间,表明 ITP 过程中的时间趋势因饮酒而异. 认可 HAU 的退伍军人在统计学上的改善程度明显较小。然而,两种结果的组间终点差异很小(Cohen's d s 在 0.15 和 0.20 之间)。

结论:有和没有 HAU 的退伍军人报告 PTSD 和抑郁症状显着减少,并以相对较高的比率完成 ITP。研究结果支持强化 PTSD 治疗计划对 PTSD 和 HAU 患者的有效性。未来的研究应该利用对照设计来评估强化 PTSD 治疗是否可以减少 HAU。

更新日期:2021-06-14
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