Trafton JA (Center for Health Care Evaluation)
Minkel J (Center for Health Care Evaluation)
Humphreys K (Center for Heatlh Care Evaluation)
Objectives: In psychosocial treatments, posttraumatic stress disorder (PTSD) patients usually have more severe substance use disorder (SUD) symptoms at intake and worse SUD outcomes following treatment. Whether PTSD impairs SUD recovery in pharmacotherapy for addiction is unknown. This study examines this issue in the context of the VA Multisite Opioid Substitution Treatment (MOST) study.
Methods: Opioid dependent patients (N=255) entering one of eight participating VA OST clinics were interviewed about their substance use, mental health and health status at treatment entry, and 6 and 12 months following. PTSD diagnosis, urinanalysis results and methadone/LAAM dosing patterns were determined by medical record review. Treatment utilization data was downloaded from VA national databases. Repeated measures ANOVAs compared differences between PTSD positive and negative patients on substance use, mental health and treatment utilization outcomes.
Results: PTSD positive (27%) and negative patients entered treatment with similar substance use patterns, including nearly daily use of heroin and high rates of cocaine and alcohol use. Both PTSD positive and negative patients significantly and equivalently decreased self-reported heroin, cocaine and alcohol use during the year after treatment initiation. PTSD patients had lower rates of opioid positive urinalysis tests in the first 3 months of treatment, and similar rates of opioid positive urines for the duration of the year. Yet, patients with PTSD had more severe psychological problems at treatment entry and during the course of treatment. PTSD positive patients were more engaged in treatment, remaining in treatment longer and attending a greater number of individual and group psychotherapy sessions over the year. They also received higher doses of methadone.
Conclusions: PTSD patients show marked SUD recovery in OST. Relative to veterans without PTSD, they are more likely to stay in treatment and make use of available SUD therapies. Nevertheless, psychological problems remain unmanaged in PTSD patients in OST.
Impact: OST is an effective treatment for opioid dependence in patients with PTSD. Providing such addiction treatments to patients with PTSD will lead to increased rates of long-term abstinence from substance use for the approximately 1/3 of SUD patients with this disorder.