Posttraumatic stress disorder's role in integrated substance dependence and depression treatment outcomes

Norman, Sonya B.; Tate, Susan R.; Wilkins, Kendall C.; Cummins, Kevin; Brown, Sandra A.

doi:10.1016/j.jsat.2010.01.013

« Previous Next »Journal of Substance Abuse Treatment
Volume 38, Issue 4 , Pages 346-355, June 2010

Posttraumatic stress disorder's role in integrated substance dependence and depression treatment outcomes

Sonya B. Norman, Ph.D.
- VA San Diego Healthcare System and University of California, San Diego, San Diego, CA 92161, USA
- Psychiatry Department, University of California, San Diego School of Medicine, San Diego, CA 92037, USA
- VA Center of Excellence in Stress and Mental Health, San Diego, CA 92037, USA
Susan R. Tate, Ph.D.
- VA San Diego Healthcare System and University of California, San Diego, San Diego, CA 92161, USA
- Psychiatry Department, University of California, San Diego School of Medicine, San Diego, CA 92037, USA
Kendall C. Wilkins, B.A.
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA
Kevin Cummins, M.S.
- Psychology Department, University of California San Diego, San Diego, CA 92037, USA
Sandra A. Brown, Ph.D.
- VA San Diego Healthcare System and University of California, San Diego, San Diego, CA 92161, USA
- Psychiatry Department, University of California, San Diego School of Medicine, San Diego, CA 92037, USA
- Psychology Department, University of California San Diego, San Diego, CA 92037, USA
- Corresponding author. VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA. Tel.: +1 858 822 1887.

Received 4 August 2009; received in revised form 11 January 2010; accepted 22 January 2010. published online 05 April 2010.

Abstract

Posttraumatic stress disorder (PTSD) frequently co-occurs with depression and substance use disorder (SUD). This study investigates the impact of PTSD diagnosis on treatment outcomes of 178 veterans treated for depression and SUD, with Integrated Cognitive–Behavioral Therapy (ICBT) or 12-Step Facilitation Therapy (TSF). Percentage days abstinent (PDA) and Hamilton Depression Rating Scale total score (HDRS total) trajectories were created. PDA was similar through initial follow-up; however, by 18 months, ICBT participants without PTSD had better PDA (M = 91%) than those without PTSD in TSF (M = 76%) and those with PTSD in either group (M = 75%–77%). Across time, participants with PTSD had higher depression levels than those without PTSD but benefited similarly from treatment (main effect, p < .004). Both conditions demonstrated reductions in average HDRS at 18 months (M = 17%–29%). Findings highlight the need to assess for PTSD and to investigate how to treat concomitant SUD, depression, and PTSD.

Keywords: PTSD, Depression, Substance use, Treatment