title: Correlates of improvement in substance abuse among dually diagnosed veterans with post-traumatic stress disorder in specialized intensive VA treatment.
abstract: Substantial rates of substance use comorbidity have been observed among veterans with Post-Traumatic Stress Disorder (PTSD), highlighting the need to identify patient and program characteristics associated with improved outcomes for substance abuse. Data were drawn from 12,270 dually diagnosed veterans who sought treatment from specialized intensive Veterans Health Administration PTSD programs between 1993 and 2011. The magnitude of the improvement in Addiction Severity Index (ASI) alcohol and drug use composite scores from baseline was moderate, with effect sizes (ES) of -.269 and -.287, respectively. Multivariate analyses revealed that treatment in longer-term programs, being prescribed psychiatric medication, and planned participation in reunions were all associated with slightly improved outcomes. Reductions in substance use measures were associated with robust improvements in PTSD symptoms and violent behavior. These findings suggest not only synergistic treatment effects linking improvement in PTSD symptoms with substance use disorders among dually diagnosed veterans with PTSD, but also to reductions in violent behavior. Furthermore, the findings indicate that proper discharge planning in addition to intensity and duration of treatment for dually diagnosed veterans with severe PTSD may result in better outcomes. Further dissemination of evidence-based substance abuse treatment may benefit this population.
authors.affiliation: Yale University School of Medicine, Forensic Drug Diversion Program.
authors.forename: Kendell L
authors.initials: KL
authors.lastname: Coker
authors.affiliation: A New England Mental Illness, Research, Education, and Clinical Center.
authors.forename: Elina
authors.initials: E
authors.lastname: Stefanovics
authors.affiliation: VA New England Mental Illness, Research, Education, and Clinical Center (MIRECC), VA Connecticut Health Care Center.
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenheck
mesh_terms: D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D015999:Multivariate Analysis; D011569:Psychiatric Status Rating Scales; D011619:Psychotropic Drugs / Q000627:therapeutic use; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D019966:Substance-Related Disorders / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology; D014754:Violence
chemical_list: D011619:Psychotropic Drugs