title: Treatment outcomes for veterans with PTSD and substance use: Impact of specific substances and achievement of abstinence.
abstract: BACKGROUND
  Scant longitudinal data exists about the interplay between specific substances of abuse, the achievement of abstinence, and clinical outcomes in the treatment of dually diagnosed Veterans with post-traumatic stress disorder (PTSD).
  
  
  METHODS
  As part of a national program evaluation, Veterans admitted from the community to specialized intensive PTSD programs were assessed at intake and 4 months after discharge. Seven mutually exclusive groups were identified from admission self-report data (N=22,948): no substance use, exclusive use of alcohol, opiates, sedatives, cocaine, marijuana, and use of three or more substances. Analysis of covariance, adjusting for potentially confounding baseline variables was used to compare change among these seven groups in non-substance use outcomes (PTSD symptoms, violent behavior, suicidality, medical problems, and employment). The effect of abstinence on specific groups was evaluated as the interaction of group membership by abstinence.
  
  
  RESULTS
  All outcome measures except for employment showed significant improvement, with few differences between the groups. Although rate of abstinence differed markedly between the groups, abstinence achievement was associated with greater improvement on all the outcomes except employment in every group. No significant differences in the effect of abstinence across the substance abuse groups were observed.
  
  
  CONCLUSIONS
  The specific type of substance used prior to entry into treatment among dually diagnosed PTSD patients seems to have limited effect on treatment outcomes. However, attainment of abstinence at 4 months after treatment, irrespective of the substances abused, was strongly associated with improvement in PTSD symptoms, violence, suicidality and medical problems.
authors.affiliation: VA New England Mental Illness Research and Education Center, West Haven, CT, United States; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States. Electronic address: ajay.manhapra@yale.edu.
authors.forename: Ajay
authors.initials: A
authors.lastname: Manhapra
authors.affiliation: VA New England Mental Illness Research and Education Center, West Haven, CT, United States; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.
authors.forename: Elina
authors.initials: E
authors.lastname: Stefanovics
authors.affiliation: VA New England Mental Illness Research and Education Center, West Haven, CT, United States; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenheck
mesh_terms: D000328:Adult; D000368:Aged; D017831:Diagnosis, Dual (Psychiatry); D004651:Employment / Q000706:statistics & numerical data; D005006:Ethnicity; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000534:rehabilitation*; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D059020:Suicidal Ideation; D016896:Treatment Outcome; D014481:United States; D014728:Veterans / Q000523:psychology*; D014754:Violence / Q000523:psychology
keywords: Dual diagnosis; Post-traumatic; Psychotherapy; Stress disorders; Substance use disorders; Treatment outcome