PTSD/Substance Use Disorder Comorbidity: Treatment Options and Public Health Needs
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Substance Use Disorders (FG Moeller, Section Editor)
PTSD/Substance Use Disorder Comorbidity: Treatment Options and Public Health Needs Lisa M. Najavits, PhD1,* H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM2 Carlo C. DiClemente3 Marc N. Potenza, MD, PhD4 Howard J. Shaffer, PhD5 James L. Sorensen, PhD6 Matthew T. Tull, PhD7 Allen Zweben, PhD8 Joan E. Zweben, PhD9 Address *,1 University of Massachusetts Medical School, Worcester, MA, USA Email: [email protected] 2 Santa Clara University, Santa Clara, CA, USA 3 University of Maryland, Baltimore County, MD, USA 4 Departments of Psychiatry, Child Study and Neuroscience, Yale University School of Medicine, New Haven, CT, USA 5 Division on Addiction, Harvard Medical School, Boston, MA, USA 6 Department of Psychiatry and Behavioral Sciences, University of California at San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA 7 University of Toledo, Toledo, OH, USA 8 Columbia University School of Social Work, New York, NY, USA 9 University of California, Veterans Affairs Medical Center, San Francisco, CA, USA
* Springer Nature Switzerland AG 2020
This article is part of the Topical Collection on Substance Use Disorders Keywords PTSD I Substance abuse I Therapy I Addiction I Trauma I Review
Abstract Purpose of review Posttraumatic stress disorder (PTSD) commonly co-occurs with substance use disorder (SUD) and is challenging to treat. We review all behavioral therapy models
Substance Use Disorders (FG Moeller, Section Editor) with at least one randomized controlled trial in a current PTSD/SUD population. We identify factors in selecting a model for clinical use, emphasizing a public health framework that balances the need for evidence with the need for feasibility in frontline settings. Recent findings Seven published models and 6 unpublished models are reviewed. Public health considerations for choosing a model include the following: whether it has been studied across a broad range of SUDs and in complex SUD patients; whether it can be conducted in group modality; its appeal to patients and providers; its cost; workforce requirements; and its ability to reduce substance use in addition to PTSD. Summary There are two broad types of models: those that originated in the PTSD field versus the SUD field. Overall, the latter are stronger on public health factors and more feasible in SUD settings. Published models in this category include Relapse Prevention, BRENDA, and Seeking Safety. PTSD/SUD research is at an early stage and there is a need for methodology that quantifies “level of burden” (patients’ socioeconomic disadvantages) across trials.
Introduction It is well established that posttraumatic stress disorder (PTSD) commonly co-occurs with substance use disorder (SUD) and predicts a worse course than either disorder alone [1]. What is less established, however, is how to treat the comorbidity. This review addresses
behavioral therapies for PTSD/SUD, which is the primary treatment modality for this population. We focus on a p
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