Treatment outcome in substance use disorder patients with and without comorbid posttraumatic stress disorder: A systematic review

Abstract

We investigated the role of comorbid posttraumatic stress disorder (CO-PTSD) in substance use disorder (DSM-IV/ICD-10 substance abuse or dependence, SUD) treatment. We conducted a systematic review of treatment outcome studies in SUD patients with and without CO-PTSD from 2000 to 2011. The N = 22 studies found differed clearly with regard to methodology and the sufficiency of provided study information, limiting their comparability. Remarkably, no consistent indication of a negative effect of CO-PTSD on the reported SUD treatment outcome was found. In addition to CO-PTSD, we point out possible further effect modifiers which need to be better understood. Finally, we emphasize the requirements for future research such as methodological standardization and a focus on long-term studies.

Abstract

We investigated the role of comorbid posttraumatic stress disorder (CO-PTSD) in substance use disorder (DSM-IV/ICD-10 substance abuse or dependence, SUD) treatment. We conducted a systematic review of treatment outcome studies in SUD patients with and without CO-PTSD from 2000 to 2011. The N = 22 studies found differed clearly with regard to methodology and the sufficiency of provided study information, limiting their comparability. Remarkably, no consistent indication of a negative effect of CO-PTSD on the reported SUD treatment outcome was found. In addition to CO-PTSD, we point out possible further effect modifiers which need to be better understood. Finally, we emphasize the requirements for future research such as methodological standardization and a focus on long-term studies.

Zusammenfassung:

Wir untersuchten die Rolle von komorbiden Posttraumatischen-Belastungs-Störungen (CO-PTSD) in der Behandlung von Suchterkrankungen (DSM-IV/ICD-10 Substanzmissbrauch oder -abhängigkeit, SUD). Wir haben ein systematisches Review erstellt über Ergebnisstudien mit SUD Patienten mit und ohne CO-PTSD der Jahre 2000-2011. Die N = 22 Studien unterschieden sich klar im Hinblick auf die Methodik und der Hinlänglichkeit der gegebenen Studieninformationen, was ihre Vergleichbarkeit limitiert. Bemerkenswerterweise wurde keine konsistente Indikation von negativen Effekten der CO-PTBS auf die berichteten SUD Behandlungsergebnisse gefunden. Zusätzlich zu CO-PTBS weisen wir auf weitere mögliche Effekt Modifikatoren hin, die noch besser verstanden werden müssen. Schließlich betonen wir die Voraussetzungen für weitere zukünftige Forschung, wie methodische Standardisierungen und den Fokus auf Langzeit Studien.

Este estudo investigou o papel da perturbação de stress pós-traumático em comorbilidade (PSPT-CO) com o tratamento da perturbação de uso de substâncias (DSM-IV / ICD10 abuso ou dependência de substância, ADS). Foi realizada uma revisão sistemática de estudos sobre resultados de tratamentos em pacientes ADS, com e sem PSPT-CO, de 2000 a 2011. Os estudos encontrados (N = 22) diferiram claramente no respeitante à metodologia e à suficiência das informações fornecidas acerca do estudo, limitando a sua comparação. Notavelmente, não foi encontrada qualquer indicação consistente de um efeito negativo da PSPT-CO no resultado do tratamento relatado para o ADS. Além da PSPT-CO, este estudo destacou ainda possíveis novos modificadores de efeito, os quais requerem melhor compreensão. Finalmente, enfatizaram-se recomendações para futuras investigações, tais como a padronização metodológica e o foco em estudos de longa duração.

本文探討共病創傷後壓力疾患(CO-PTSD) 在物質使用疾患(DSM-IV/ICD-10 中的物質濫用或依賴，SUD)治療上的角色，我們對2000年到2011年SUD病人中，有無CO-PTSD者的治療效果進行系統性回顧。由於二十二項研究在方法學上有明顯差別，並且未提供足夠的研究訊息，因此在相互比較上有困難。探討結果發現，顯然未有一致的證據顯示CO-PTSD在SUD之治療效果上有負面影響。除了CO-PTSD，我們也指出可能對療效有影響，尚待進一步了解的調節因子。最後，我們強調未來研究的要件，例如方法上應標準化，並應以長期研究為重點。

Keywords:

• outcome research
• substance abuse
• trauma
• comorbidity
• substance use disorder

Acknowledgments

The authors have declared that no competing interests exist. Funds were provided from the institutions of the authors. We wish to thank Dr. Monika Ludwig and Simone Eichmann for their helpful comments on earlier versions of the manuscript and Dr. Stephen Clive Crawcour for his helpful language editing.

Notes

¹ Studies with a lifetime CO-PTSD diagnosis were included for the sake of completeness and were highlighted or considered separately. They were excluded from the box-score analysis.

² Trafton et al. (2006) included a three-year period for the diagnosis of PTSD. Although not explicitly stated by the original authors, this time span was defined as “current” for this review.