Polysubstance Use Among Veterans in Intensive PTSD Programs: Association With Symptoms and Outcomes Following Treatment

Abstract

Objective: A distinct group of patients has recently been described who experience polysubstance use disorder characterized by use of multiple addictive substances. This study examines baseline characteristics and longitudinal outcomes of a group of such patients in specialized intensive Veterans Health Administration posttraumatic stress disorder (PTSD) programs and followed 4 months after discharge. Methods: Patients with diagnosed PTSD or subsyndromal PTSD and who used a single substance at baseline were compared to those who used two or three and more than three different addictive substances on measures of PTSD symptom severity and functioning. Comparisons were also adjusted for differences in total days of any substance use and other potentially confounding factors. Patients were reclassified according to the number of substances used at follow-up and again compared on symptoms and functioning. Results: Bivariate analysis of baseline data (N = 8,240) showed frequent polysubstance use (n = 3,695, 44.8% of the sample) and that use of greater numbers of substances was associated with more severe PTSD symptoms as well as more total days of substance use. At follow-up after treatment, 58.2% of the original sample (n = 4,797) was assessed. Polysubstance use was less frequent (n = 756, 15.8% of the follow-up sample), but showed a similar association with more severe symptoms, although differences were attenuated after adjusting for total days of substance use. Conclusions: Polysubstance use, conceptualized within the multimorbidity perspective, is associated with increased severity of PTSD symptoms among veterans with dual diagnoses requiring complex interventions, the evaluation of which will require innovative trial designs.

Keywords:

• Polysubstance use
• PTSD
• multimorbidity
• dual diagnosis
• psychiatric comorbidity

Acknowledgements

This article is the product of work with the Department of Veterans Affairs and the VA New England Mental Illness Research Education Clinical, Centers of Excellence, and the Yale School of Medicine Department of Psychiatry. IB would also like to acknowledge the UCLA National Clinician Scholars Program, the David Geffen School of Medicine at UCLA, and Cedars-Sinai Medical Center.

Disclosures

The authors declare no conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors report no financial relationships with commercial interests.

Additional information

Funding

This work did not have any specific funding and was completed as part of our employment with the VA Connecticut Healthcare System and Yale School of Medicine.