Treatment outcomes for veterans with PTSD and substance use: Impact of specific substances and achievement of abstinence

Drug Alcohol Depend. 2015 Nov 1:156:70-77. doi: 10.1016/j.drugalcdep.2015.08.036. Epub 2015 Sep 25.

Abstract

Background: Scant longitudinal data exists about the interplay between specific substances of abuse, the achievement of abstinence, and clinical outcomes in the treatment of dually diagnosed Veterans with post-traumatic stress disorder (PTSD).

Methods: As part of a national program evaluation, Veterans admitted from the community to specialized intensive PTSD programs were assessed at intake and 4 months after discharge. Seven mutually exclusive groups were identified from admission self-report data (N=22,948): no substance use, exclusive use of alcohol, opiates, sedatives, cocaine, marijuana, and use of three or more substances. Analysis of covariance, adjusting for potentially confounding baseline variables was used to compare change among these seven groups in non-substance use outcomes (PTSD symptoms, violent behavior, suicidality, medical problems, and employment). The effect of abstinence on specific groups was evaluated as the interaction of group membership by abstinence.

Results: All outcome measures except for employment showed significant improvement, with few differences between the groups. Although rate of abstinence differed markedly between the groups, abstinence achievement was associated with greater improvement on all the outcomes except employment in every group. No significant differences in the effect of abstinence across the substance abuse groups were observed.

Conclusion: The specific type of substance used prior to entry into treatment among dually diagnosed PTSD patients seems to have limited effect on treatment outcomes. However, attainment of abstinence at 4 months after treatment, irrespective of the substances abused, was strongly associated with improvement in PTSD symptoms, violence, suicidality and medical problems.

Keywords: Dual diagnosis; Post-traumatic; Psychotherapy; Stress disorders; Substance use disorders; Treatment outcome.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Diagnosis, Dual (Psychiatry)
  • Employment / statistics & numerical data
  • Ethnicity
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Socioeconomic Factors
  • Stress Disorders, Post-Traumatic / rehabilitation*
  • Substance-Related Disorders / rehabilitation*
  • Suicidal Ideation
  • Treatment Outcome
  • United States
  • Veterans / psychology*
  • Violence / psychology