Introduction to the special section on substance use disorder and posttraumatic stress disorder comorbidity.

A body of 2 complementary, albeit independent, research literatures has emerged that documents a strong relationship between substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) in both community and clinical samples. Research on the concomitants and consequences of PTSD has found that substance abuse is a frequent comorbid problem among individuals diagnosed with PTSD. Researchers from the substance abuse field are now investigating the interrelationship between PTSD and SUDs and finding that PTSD has a notable effect on SUD course and treatment response. Here, a brief summary of the prevalence of SUD-PTSD comorbidity is provided and the 5 articles of the special section are introduced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A different kind of comorbidity: Understanding posttraumatic stress disorder and chronic pain.

Many traumatic events leave lingering physical injuries and chronic pain in their wake, in addition to trauma-related psychopathology. In this review, we provide an overview of developments in the recent literature on comorbid posttraumatic stress disorder (PTSD) and chronic pain. Starting with the conceptual models presented by Sharp and Harvey (2001) and Asmundson, Coons, Taylor, and Klatz (2002), this review summarizes newer studies that examine prevalence of these comorbid conditions. Additionally, we present an updated synthesis of research on factors that may maintain both chronic physical pain and PTSD in trauma survivors. Consideration of the impact of this comorbidity on psychosocial assessment and treatment also is discussed, with particular attention to issues that warrant additional research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cannabis use among military veterans after residential treatment for posttraumatic stress disorder.

The present investigation prospectively evaluated whether treatment changes in PTSD symptom severity, among military Veterans in residential PTSD treatment, were related to cannabis use 4 months after discharge from residential rehabilitation. The sample was comprised of 432 male military Veteran patients (Mage = 51.06 years, SD = 4.17), who had a primary diagnosis of PTSD and were admitted to a VA residential rehabilitation program for PTSD. Results demonstrated that lower levels of change in PCL-M scores between treatment intake and discharge were significantly predictive of greater frequency of cannabis use at 4-month follow-up (p     

Screening for posttraumatic stress disorder in a general psychiatric outpatient setting.

Posttraumatic stress disorder (PTSD) may affect survivors of a number of accidents and illnesses, in addition to violence victims and combat veterans. Prior research suggests that PTSD may be underdiagnosed when trauma is not the presenting problem. Thus, a PTSD screening scale might have utility in routine clinical settings. The authors evaluated the screening performance of the Posttraumatic Diagnostic Scale (PDS) in a general psychiatric setting. Results indicated that the PDS performed as well in this setting as it did in the original trauma-focused validation studies, independent of PTSD status as a primary, versus secondary, reason for presenting. A simple cutoff score was adequate for case identification. There were no gender effects, and the scale performed equally well among patients with, versus without, a depressive diagnosis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exposure therapy for posttraumatic stress disorder in a residential substance use treatment facility.

Clinical lore abounds when discussing the issue of treating trauma-related symptoms in substance-dependent clients. Historically, clinicians have wondered whether they should wait until the client has gained substantial abstinence from abused substances before initiating trauma treatment or if trauma treatment should be conducted during substance use treatment. Furthermore, questions arise with regard to exactly how trauma-related symptoms should be addressed and how trauma treatment should be incorporated into the recovery process. In this article, the growing literature suggesting that posttraumatic stress disorder (PTSD) can be treated concurrently with substance use disorders is reviewed. In addition, the unique challenges of implementing treatment for PTSD with substance-dependent clients seeking treatment in a residential treatment facility are discussed. Specifically, we provide concrete suggestions about how to utilize prolonged exposure, a very effective treatment for PTSD, with clients in a residential substance use treatment facility, including use of the internet to facilitate exposure therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma exposure and posttraumatic stress disorder predictors of mental health treatment use in college students.

The authors examined trauma exposure and posttraumatic stress disorder (PTSD) associations with previous mental health (MH) treatment use in college students while statistically controlling for gender and treatment attitudes. A total of 300 students were recruited for an Internet survey and were administered a modified version of the demographic survey, the Stressful Life Events Screening Questionnaire (L. Goodman, C. Corcoran, K. Turner, N. Yuan, & B. L. Green, 1998), PTSD Symptom Scale-Self-Report (PSS; E. B. Foa, D. S. Riggs, C. V. Dancu, & B. O. Rothbaum, 1993), Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH; E. H. Fischer & A. Farina, 1995), and a MH treatment use survey. Univariate analyses demonstrated that previous MH treatment use was associated with violent crime and noncrime trauma frequency, and treatment attitudes. Controlling for gender and MH treatment attitudes, regression analyses including violent and noncrime trauma and PTSD significantly predicted previous MH service use and recent visit counts; only noncrime trauma and treatment attitudes were significant for service use, and only treatment attitudes was significant for visit counts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral treatment for severe anger in posttraumatic stress disorder.

With a randomized group design, a 12-session anger treatment was evaluated with severely angry Vietnam War veterans suffering combat-related posttraumatic stress disorder (PTSD). Eight participants in anger treatment and 7 in a routine clinical care control condition completed multiple measures of anger control, anger reaction, and anger disposition, as well as measures of anxiety, depression, and PTSD at pre- and posttreatment. Controlling for pretreatment scores, significant effects were found on anger reaction and anger control measures but not on anger disposition or physiological measures. Eighteen-month follow-up (for both completers and dropouts) supported the posttreatment anger control findings. The challenges of treatment research with this refractory population are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Imaginal flooding in the treatment of a posttraumatic stress disorder.

A 36-yr-old Vietnam veteran was treated for the anxiety-related symptoms of a posttraumatic stress disorder during a 22-day inpatient hospitalization. Primary treatment was the exposure technique of imaginal flooding using the intrusive thoughts (nightmares and flashbacks) associated with the traumatic events. Self-monitored data, the State-Trait Anxiety Inventory, and physiological responding during scene presentation provided evidence for treatment efficacy. 12-mo follow-up indicated improved adjustment as supported by employment status, residential stability, emotional involvement, and self-report of anxiety, nightmares, and flashbacks. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examining comorbidity and posttraumatic stress disorder in a Vietnam veteran population using the MMPI-2

Examined the discriminant validity of the MMPI-2 in assessing comorbidity in a posttraumatic stress disorder (PTSD) Vietnam veteran population. The Structured Clinical Interview for the DSM-III-R (SCID) was used to diagnose veterans and to classify them into four groups: PTSD Only, PTSD with mood disorders, PTSD with other anxiety disorders, and PTSD with mood and anxiety disorders. All groups had clinical elevations on scales F, 1, 2, 3, 4, 6, 7, 8, 0, PK, and PS, with peak elevations on scales 8, 7, and 2. The PTSD Only group's MMPI-2 scores were not significantly lower than other groups' scores. The PTSD+Mood/Anxiety group was significantly more elevated on scales 2 and 7 than the PTSD Only and PTSD+Anxiety group but did not otherwise show significantly higher scale elevations than others groups. No significant differences existed between groups on scales F, L, K, PK, and PS. Implications of these results for PTSD and the current diagnostic system are explored.     

Substance abuse patients with posttraumatic stress disorder (PTSD): Identifying specific triggers of substance use and their associations with PTSD symptoms.

Although individuals with comorbid posttraumatic stress disorder (PTSD) and substance use diagnoses are at heightened risk for relapse after substance abuse treatment, little is known about the specific situations in which these individuals are likely to relapse. The present study was designed to test whether a PTSD diagnosis related to substance use in specific situations in which PTSD symptoms were likely to be present. Data were gathered from inpatients (n?=?86) in a substance-abuse treatment program, and relationships between PTSD diagnosis and frequency of substance use in high-risk situations were examined. As predicted, PTSD diagnosis was related to substance use in situations involving unpleasant emotions, physical discomfort, and interpersonal conflict, but not to substance use in other situations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment and treatment response among adults in inpatient treatment for posttraumatic stress disorder.

In this study, the authors investigated changes in attachment orientation after treatment in an inpatient program for adults with posttraumatic stress disorder. The authors also examined the association between these changes and symptom reduction. Results indicated that secure attachment increased significantly over treatment in comparison to a wait list group, and this change was maintained over the 6 months after discharge. Positive changes were also noted in the underlying attachment dimensions of anxiety and avoidance. Furthermore, positive changes in attachment were found to be associated with symptom reduction during treatment and maintenance of these reductions after discharge. These results have potential implications for the goals of psychotherapeutic intervention in general and for the utility of specialized inpatient trauma treatment specifically. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributional style and combat-related posttraumatic stress disorder.

This study examined the relations of attributions for good and bad events on the one hand and combat-related posttraumatic stress disorder (PTSD) on the other. The sample consisted of 262 Israeli soldiers who suffered a combat stress reaction episode during the 1982 Lebanon War and were followed 2 and 3 years after their participation in combat. Cross-sectional analyses revealed significant relations between attributions and PTSD at the two points of assessment. Changes in PTSD from Time 1 to Time 2 were also associated with changes in attribution. Theoretical and clinical implications of the findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current and lifetime psychiatric disorders among veterans with war zone-related posttraumatic stress disorder

Previous research has found high rates of psychiatric disorders among veterans with war zone-related posttraumatic stress disorder (PTSD). However, many studies in this area are methodologically limited in ways that preclude unambiguous interpretation of their results. The purpose of this study was to address some of these limitations to clarify the relationship between war zone-related PTSD and other disorders. Participants were 311 male Vietnam theater veterans assessed at the National Center for PTSD at the Boston Veterans Affairs Medical Center. The Clinician-Administered PTSD Scale and the Structured Clinical Interview for DSM-III-R were used to derive current and lifetime diagnoses of PTSD, other axis I disorders (mood, anxiety, substance use, psychotic, and somatoform disorders), and two axis II disorders (borderline and antisocial personality disorders only). Participants also completed several self-report measures of PTSD and general psychopathology. Relative to veterans without PTSD, veterans with PTSD had significantly higher rates of current major depression, bipolar disorder, panic disorder, and social phobia, as well as significantly higher rates of lifetime major depression, panic disorder, social phobia, and obsessive-compulsive disorder. In addition, veterans with PTSD scored significantly higher on all self-report measures of PTSD and general psychopathology. These results provide further evidence that PTSD is associated with high rates of additional psychiatric disorders, particularly mood disorders and other anxiety disorders. The implications of these findings and suggestions about the direction of future research in this area are discussed.     

Gender differences in posttraumatic stress disorder.

One of the most consistent findings in the epidemiology of posttraumatic stress disorder (PTSD) is the higher risk of this disorder in women. Explanations reviewed within a psychobiological model of PTSD suggest that women's higher PTSD risk may be due to the type of trauma they experience, their younger age at the time of trauma exposure, their stronger perceptions of threat and loss of control, higher levels of peritraumatic dissociation, insufficient social support resources, and greater use of alcohol to manage trauma-related symptoms like intrusive memories and dissociation, as well as gender-specific acute psychobiological reactions to trauma. This review demonstrates the need for additional research of the gender differences in posttraumatic stress. Recommendations are made for clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional processing in posttraumatic stress disorder.

The emotional deficits associated with posttraumatic stress disorder (PTSD) are the least understood and the most understudied aspect of the syndrome. In this study, the connection was evaluated between trauma-context reactivity and subsequent emotional deficits in PTSD. Combat veterans with PTSD and well-adjusted veteran control participants were exposed to reminders of combat, after which their emotional behavior was assessed in response to a series of emotionally evocative images. Under the neutral condition, both groups exhibited emotional behavior modulated by stimulus valence. Partially consistent with the conceptual model described by B. Litz (1992), the PTSD group exhibited suppressed expressive-motor responses to positively valenced images, in comparison with the control group, only after being exposed to a trauma-related prime. Contrary to expectations, the PTSD group showed no augmentation of emotional response to negatively valenced cues after being exposed to trauma reminders. However, the PTSD group responded to all images, in both prime conditions, with higher heart rate reactivity, suggesting an automatic preparation for demand or threat in any uncertain emotional context. Possible causes and consequences of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of anticonvulsants in posttraumatic stress disorder: case study and overview

A case of posttraumatic stress disorder is described in which a favorable response to the anticonvulsants carbemazepine and sodium valproate occurred. The literature on the use of anticonvulsants in this disorder is reviewed.     

Recent-onset ecstasy use: Association with deviant behaviors and psychiatric comorbidity.

Background: Despite increases in ecstasy (MDMA) use in the United States, little is known about characteristics linked with recent-onset ecstasy use, especially psychiatric symptoms and deviant behaviors. Aims: To test whether individuals with high levels of other drug use are more likely to be recent-onset ecstasy users; to test whether psychiatric symptoms in adults are associated with recent-onset ecstasy use; to explore the association between recent-onset ecstasy use and concomitant deviant behaviors in adolescents and adults. Methods: Data from the 2001 National Survey on Drug Use and Health. Findings: Recent-onset ecstasy use was significantly more likely to occur among adolescents and adults (18-34 years old) who engaged in deviant behaviors during the past year as compared with those who did not engage in deviant behaviors during the past year. Higher levels of deviancy indicated a higher likelihood of being a recent-onset ecstasy user, and associations were strongest with nonviolent deviant behaviors such as selling illegal drugs and stealing. Associations between deviant behaviors and recent-onset ecstasy use were similar in strength to associations between deviant behaviors and recent-onset cocaine and marijuana use, respectively. Adults who had past-year psychiatric symptoms (both depressive and panic symptoms) were twice as likely to be recent-onset ecstasy users as compared with those without past-year psychiatric symptoms. Greater levels of drug involvement increased the odds of being a recent-onset ecstasy user. Conclusion: Recent-onset ecstasy use seems to be associated with a range of other behavioral problems and may reflect one aspect of a larger problem behavior syndrome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sertraline treatment of comorbid posttraumatic stress disorder and alcohol dependence

BACKGROUND: Posttraumatic stress disorder (PTSD) often co-occurs with alcohol dependence, yet little is known about treatment of this comorbidity. The serotonin selective reuptake inhibitors have been shown preliminarily to be effective in decreasing symptoms of PTSD but have not been studied in individuals with comorbid alcohol dependence. This is of particular interest as the SSRIs also have a modest effect in decreasing alcohol consumption. METHOD: In this preliminary trial, nine subjects with comorbid PTSD and alcohol dependence were treated in an open-label trial with sertraline for a 12-week period. Symptoms of PTSD and depression were monitored monthly with the Impact of Event Scale and the Hamilton Rating Scale for Depression (HAM-D). Alcohol consumption was monitored by a self-report instrument (Time-Line Follow-Back). RESULTS: There were significant decreases in all three symptom clusters of PTSD measured by overall PTSD symptom scores (p < or = .001) and in HAM-D scores (p < or = .001) during the follow-up period. Days of abstinence increased and average number of drinks decreased during the follow-up period. Four subjects claimed total abstinence during the follow-up period. CONCLUSION: While limited by small sample size and the open-label, nonblinded study design, this study suggests that sertraline may be useful in the treatment of PTSD complicated by alcoholism. The medication was well tolerated and subjects showed improvement in PTSD symptoms as well as decreased alcohol consumption. A controlled trial of sertraline in this population would be of interest.     

Mindfulness in the treatment of posttraumatic stress disorder among military veterans.

How might a practice that has its roots in contemplative traditions, seeking heightened awareness through meditation, apply to trauma-related mental health struggles among military veterans? In recent years, clinicians and researchers have observed the increasing presence of mindfulness in Western mental health treatment programs. Mindfulness is about bringing an attitude of curiosity and compassion to present experience. This review addresses the above question in a detailed manner with an emphasis on the treatment of military veterans suffering from posttraumatic stress disorder (PTSD) and related psychopathology. In addition, the integration of mindfulness with current empirically supported treatments for PTSD is discussed with specific attention to directions for future research in this area. (PsycINFO Database Record (c) 2011 APA, all rights reserved)