Joanne Salas1, Sonya B Norman2, Peter W Tuerk3, Carissa van den Berk-Clark4, Beth E Cohen5, F David Schneider6, Kathleen M Chard7, Patrick J Lustman8, Paula P Schnurr9, Matthew J Friedman9, Richard Grucza4, Jeffrey F Scherrer10. 1. Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, United States; Harry S. Truman Veterans Administration Medical Center, Columbia, MO, United States. Electronic address: joanne.salas@health.slu.edu. 2. National Center for PTSD and Department of Psychiatry, University of California San Diego, United States. 3. Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville, VA, United States. 4. Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, United States. 5. Department of Medicine, University of California San Francisco School of Medicine and San Francisco VAMC, United States. 6. Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States. 7. Trauma Recovery Center Cincinnati VAMC and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, United States. 8. Department of Psychiatry, Washington University School of Medicine, St. Louis MO. and The Bell Street Clinic Opioid Addiction Treatment Programs, VA St. Louis Healthcare System, St. Louis, MO, United States. 9. National Center for PTSD and Department of Psychiatry, Geisel School of Medicine at Dartmouth, United States. 10. Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, United States; Harry S. Truman Veterans Administration Medical Center, Columbia, MO, United States.
Abstract
BACKGROUND: Clinical trials reveal posttraumatic stress disorder (PTSD) improvement leads to decreased substance use among patients with comorbid substance use disorder (SUD). Using administrative medical record data, we determined whether clinically meaningful PTSD Checklist (PCL) (≥20 points) score decreases were positively associated with SUD treatment utilization. METHODS: We used a retrospective cohort of Veterans Health Affairs (VHA) medical record data (2008-2015). PTSD Checklist (PCL) scores were used to categorize patients into those with a clinically meaningful PTSD improvement (≥20 point decrease) or not (<20 point decrease or increase). PTSD and SUD were measured by ICD-9 codes. Propensity score weighting controlled for confounding in logistic and negative binomial models that estimated the association between clinically meaningful PTSD improvement and use of SUD treatment and number of SUD clinic visits. RESULTS: The 699 eligible patients were, on average, 40.4 (±13.2) years old, 66.2% white and 33.1% were married. After controlling for confounding, there was a 56% increased odds of any SUD treatment utilization among those with a PCL decrease ≥20 vs < 20 (OR = 1.56; 95%CI = 1.04-2.33) but there was no association with number of SUD treatment visits. CONCLUSIONS: Clinically meaningful reductions in PTSD symptoms were associated with any SUD treatment utilization but not amount of utilization. Improvement in PTSD symptoms, independent of the treatment modality, may enable SUD treatment seeking.
BACKGROUND: Clinical trials reveal posttraumatic stress disorder (PTSD) improvement leads to decreased substance use among patients with comorbid substance use disorder (SUD). Using administrative medical record data, we determined whether clinically meaningful PTSD Checklist (PCL) (≥20 points) score decreases were positively associated with SUD treatment utilization. METHODS: We used a retrospective cohort of Veterans Health Affairs (VHA) medical record data (2008-2015). PTSD Checklist (PCL) scores were used to categorize patients into those with a clinically meaningful PTSD improvement (≥20 point decrease) or not (<20 point decrease or increase). PTSD and SUD were measured by ICD-9 codes. Propensity score weighting controlled for confounding in logistic and negative binomial models that estimated the association between clinically meaningful PTSD improvement and use of SUD treatment and number of SUD clinic visits. RESULTS: The 699 eligible patients were, on average, 40.4 (±13.2) years old, 66.2% white and 33.1% were married. After controlling for confounding, there was a 56% increased odds of any SUD treatment utilization among those with a PCL decrease ≥20 vs < 20 (OR = 1.56; 95%CI = 1.04-2.33) but there was no association with number of SUD treatment visits. CONCLUSIONS: Clinically meaningful reductions in PTSD symptoms were associated with any SUD treatment utilization but not amount of utilization. Improvement in PTSD symptoms, independent of the treatment modality, may enable SUD treatment seeking.
Authors: Joanne Salas; Sarah Gebauer; Auston Gillis; Carissa van den Berk-Clark; F David Schneider; Paula P Schnurr; Matthew J Friedman; Sonya B Norman; Peter W Tuerk; Beth E Cohen; Patrick J Lustman; Jeffrey F Scherrer Journal: Nicotine Tob Res Date: 2022-02-01 Impact factor: 5.825