随机对照试验
酒精使用障碍
退伍军人事务部
医学
暴露疗法
精神科
共病
心理干预
认知加工疗法
认知行为疗法
酒
内科学
焦虑
生物化学
化学
作者
Sonya B. Norman,Ryan S. Trim,Moira Haller,Brittany Davis,Ursula S. Myers,Peter J. Colvonen,Erika Blanes,Robert Lyons,Emma Siegel,Abigail C. Angkaw,Gregory J. Norman,Tina L. Mayes
出处
期刊:JAMA Psychiatry
[American Medical Association]
日期:2019-04-24
卷期号:76 (8): 791-791
被引量:103
标识
DOI:10.1001/jamapsychiatry.2019.0638
摘要
Importance
Co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is common and associated with psychiatric and functional problems. Understanding whether exposure therapy is tolerable and efficacious for treating PTSD and AUD is critical to ensure that best practice treatments are available. Objective
To compare the efficacy of integrated (ie, targeting both PTSD and alcohol use) prolonged exposure (I-PE) therapy with present-centered integrated coping skills (I-CS) therapy, a more commonly available treatment, in reducing PTSD symptoms and alcohol use. Design, Setting, and Participants
This prospective randomized clinical trial with masked assessments considered 186 veterans seeking Veterans Affairs mental health services. A total of 119 veterans with PTSD and AUD were randomized. Data were collected from February 1, 2013, to May 31, 2017, before treatment, after treatment, and at 3- and 6-month follow-ups. Intention-to-treat analyses were performed. Interventions
Veterans underwent I-PE (Concurrent Treatment of PTSD and Substance Use Disorder Using Prolonged Exposure) or I-CS (Seeking Safety) therapy. Main Outcomes and Measures
A priori planned outcomes were PTSD symptoms (Clinician Administered PTSD Scale forDSM-5) and percentage of heavy drinking days (Timeline Follow-Back) before treatment, after treatment, and at 3- and 6-month follow-ups. Results
A total of 119 veterans (mean [SD] age, 41.6 [12.6] years; 107 [89.9%] male) were randomized. Linear mixture models found that PTSD symptoms decreased in both conditions, with a significantly greater decrease for I-PE treatment compared with I-CS treatment (treatment × time interaction, −2.83;F3,233.1 = 4.92; Cohend = 0.41;P = .002). The percentage of heavy drinking days improved in both conditions but was not statistically different between I-PE and I-CS treatment (treatment × time interaction, 1.8%;F3,209.9 = 0.18; Cohend = 0.04;P = .91). Conclusions and Relevance
The I-PE arm had a greater reduction in PTSD symptoms than the I-CS arm and comparable drinking decreases. The study provides evidence that exposure therapy is more efficacious in treating PTSD than a more commonly available integrated treatment without exposure for comorbid PTSD and AUD. Trial Registration
ClinicalTrials.gov identifier:NCT01601067
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