مواجهه درمانی در درمان اختلال PTSD در افراد وابسته به کوکائین: شرح روش
|کد مقاله||سال انتشار||تعداد صفحات مقاله انگلیسی||ترجمه فارسی|
|32289||2001||11 صفحه PDF||سفارش دهید|
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Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Journal of Substance Abuse Treatment, Volume 21, Issue 1, July 2001, Pages 35–45
An estimated 30% to 50% of cocaine-dependent individuals meet criteria for lifetime PTSD. This comorbidity has detrimental effects on clinical presentation, and treatment course and outcome. Cocaine dependence is associated with increased rates of exposure to trauma, more severe symptoms, higher rates of treatment attrition and retraumatization, and greater vulnerability to PTSD when compared to other substance use disorders. These associations underscore the need for effective treatments that address issues particular to PTSD in a manner tolerable to cocaine-dependent individuals. This article describes a manualized psychotherapy developed specifically for individuals with PTSD and cocaine dependence. Concurrent Treatment of PTSD and Cocaine Dependence (CTPCD) provides coping skills training, cognitive restructuring techniques, and relapse prevention strategies to reduce cocaine use. In-vivo and imaginal exposure therapy techniques are incorporated to reduce PTSD symptom severity. Primary treatment goals include psychoeducation specific to the interrelationship between PTSD and cocaine dependence, and clinically meaningful reductions in cocaine use and PTSD symptomatology. Secondary goals include a reduction in HIV high-risk behaviors and improved functioning in associated areas, such as anger and negative affect management.
The estimated prevalence rates of posttraumatic stress disorder (PTSD) among cocaine-dependent individuals are higher than in the general population and are among the highest of any substance-dependent group. Recent investigations involving clinical samples estimate that approximately 45% of cocaine-dependent individuals meet criteria for lifetime and 18% to 24% for current PTSD Brady et al., 1998, Dansky et al., 1999 and Najavits et al., 1998. These reported rates are much higher than that of the general population lifetime PTSD estimate of 7.8% (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Data from the Epidemiologic Catchment Area study (Cottler, Compton, Mager, Spitznagel, & Janca, 1992) reveal that, in comparison to other substance use groups (i.e., hallucinogens, marijuana, alcohol), cocaine/opiate users report higher rates of exposure to traumatic events, are more vulnerable to developing PTSD after exposure, and experience more severe symptoms and social impairment. Comorbid PTSD among treatment-seeking, cocaine-dependent samples is associated with more severe symptom profiles, higher rates of Axis II character pathology, and greater risk for revictimization Back et al., 2000, Brady et al., 1995, Dansky et al., 1998 and Najavits et al., 1998. Comorbid PTSD not only affects clinical presentation but also exerts substantial influence on treatment service utilization, course, and outcome of substance-dependent individuals Brown et al., 1995, Brown et al., 1999, Najavits et al., 1999, Ouimette et al., 1998, Ruzek et al., 1998 and Triffleman et al., 1999. Substance-dependent individuals with PTSD (SUD-PTSD), in comparison to those without PTSD (SUD-only), have been found to be at greater risk for relapse (Brown, Stout, & Mueller, 1996), drink significantly more drinks per drinking day (12.1 vs. 2.6 drinks; Brown & Stout, 1997), and have significantly more heavy drinking days (Brown & Stout, 1997; c.f., Ouimette et al., 1998). SUD-PTSD individuals evidence greater psychological, psychosocial, and occupational impairment during follow-up periods and report a greater number of hospital overnight stays for addiction treatment than do SUD-only individuals Brown et al., 1999 and Ouimette et al., 1999. In spite of these issues, systematic development and study of treatment for this comorbid population has been largely neglected. There have been several recent studies of the treatment of PTSD and substance use disorders (SUDs). Najavits (in press-a) and Najavits, Weiss, and Liese (1996) have developed an impressive treatment, Seeking Safety, that combines cognitive–behavioral and interpersonal therapy techniques for patients with various SUDs and PTSD; it has been tested in group format with women (Najavits, Weiss et al., 1998) and is currently undergoing further empirical testing. Triffleman et al. (1999) designed an individual, cognitive–behavioral treatment for men and women with SUDs and PTSD which includes in-vivo, but not imaginal, exposure techniques. These psychotherapies have offered insights and shown promising preliminary results. This article describes a manualized psychotherapy for the treatment of PTSD and cocaine dependence that was designed as a part of a NIDA-funded psychotherapy development trial. One of the unique features of this treatment is the inclusion of imaginal exposure therapy techniques to treat PTSD among cocaine-dependent individuals.