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Treatment of Comorbid PTSD & Alcohol or Other Drug Use Disorders

Comorbid posttraumatic stress disorder (PTSD) and substance-use disorders should be managed using a combination approach, including alcohol-targeted pharmacotherapies and trauma-focused behavioral therapies that lead to early and sustained improvements, according to findings of a meta-analysis of 36 studies of 4,046 participants. The authors conclude, “Further treatment development is indicated for combining behavioral and pharmacological treatments for synergized impact and understanding the mechanisms of action and conditions under which each treatment type is optimized.”

In the meta-analysis, treatments were evaluated using moderated nonlinear factor analysis, propensity score weight–adjusted multilevel models, and model-predicted effect sizes. Based on primary outcomes of severity scores for PTSD, alcohol use, and drug use, the results showed the following: “Compared with treatment as usual, combining trauma-focused therapy and pharmacotherapy for substance use disorders showed the largest comparative effect sizes for PTSD severity (d = −0.92, 95% CI = −1.57, −0.30) and alcohol use severity (d = −1.10, 95% CI = −1.54, −0.68) at end of treatment. Other treatments with large comparative effect sizes included pharmacotherapies for alcohol or other drug use disorders, trauma-focused integrated therapies, and trauma-focused nonintegrated therapies. Reductions in outcomes for PTSD symptoms and alcohol use were observed for nearly all treatments.”

Source: American Journal of Psychiatry