Clinical Challenges in the Treatment of Patients With Posttraumatic Stress Disorder and Substance Abuse

Ingo Schäfer; Lisa M. Najavits


Curr Opin Psychiatry. 2007;20(6):614-618. 

In This Article

Pharmacological Treatment

Only a few studies to date have examined pharmacological treatments in PTSD/SUD patients. In one study, Trafton et al.[57] assessed the effects of opioid substitution therapy among 255 opioid-dependent veterans. In this prospective observational trial, substitution therapy was as effective at reducing substance use in patients with comorbid PTSD as it was in patients without the disorder. One year after treatment both groups showed similar reductions in substance use, but patients with PTSD received higher doses of opiate medication and attended more psychosocial treatment sessions. In another study, Brady et al.[58] examined the effects of sertraline in 94 alcohol-dependent patients with PTSD in a randomized, double-blind, placebo-controlled trial. Patients in active treatment received a fixed dose (150 mg/day) of sertraline over a 12-week period. Examination of average alcohol consumption during the treatment period revealed no significant differences in the sertraline and placebo groups. Furthermore, no significant difference in response was found for symptoms of PTSD. However, in a post-hoc cluster analysis,[58] a significant improvement became apparent in sertraline-treated participants with less-severe alcohol dependence and early-onset PTSD. Finally, a recent trial compared the effects of disulfiram and naltrexone with placebo in male veterans with alcohol dependence and different comorbid psychiatric disorders.[59*] Patients received either disulfiram or no disulfiram and were in addition randomized to naltrexone or placebo, resulting in four different study groups. Of the 93 patients with PTSD and comorbid alcohol dependence, individuals receiving naltrexone, disulfiram or both medications had better outcomes after 12 weeks of treatment than the placebo group in terms of drinking days per week and consecutive days of abstinence. In addition, favorable effects on PTSD symptoms were observed in patients with disulfiram compared with those on naltrexone. However, as the authors point out, several limitations make the interpretation of these results difficult, including the potentially confounding effect of abstinence and the open administration of disulfiram. Nevertheless, the findings of this study suggest that both medications are safe and effective for alcohol-dependent patients with PTSD and should be considered for clinical management.


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