Clinical presentations, social functioning, and treatment receipt among individuals with comorbid life-time PTSD and alcohol use disorders versus drug use disorders: findings from NESARC-III.

Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 9304118 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1360-0443 (Electronic) Linking ISSN: 09652140 NLM ISO Abbreviation: Addiction Subsets: MEDLINE

Publication: Oxford : Wiley-Blackwell
Original Publication: Abingdon, Oxfordshire, UK : Carfax Pub. Co., c1993-

Alcoholism/*epidemiology ; Stress Disorders, Post-Traumatic/*epidemiology ; Substance-Related Disorders/*epidemiology; Adult ; Alcoholism/psychology ; Alcoholism/therapy ; Comorbidity ; Cross-Sectional Studies ; Educational Status ; Female ; Food Assistance/statistics & numerical data ; Health Surveys ; Ill-Housed Persons/statistics & numerical data ; Humans ; Insurance, Health/statistics & numerical data ; Linear Models ; Logistic Models ; Male ; Marital Status/statistics & numerical data ; Medically Uninsured/statistics & numerical data ; Middle Aged ; Odds Ratio ; Poverty/statistics & numerical data ; Prevalence ; Prisons/statistics & numerical data ; Public Assistance/statistics & numerical data ; Stress Disorders, Post-Traumatic/psychology ; Stress Disorders, Post-Traumatic/therapy ; Substance-Related Disorders/psychology ; Substance-Related Disorders/therapy ; Unemployment/statistics & numerical data ; United States/epidemiology

Aims: To compare individuals with comorbid life-time post-traumatic stress disorder (PTSD) and alcohol use disorders [AUD; i.e. no drug use disorders (DUD)] with those with comorbid PTSD and DUD on past-year prevalence of these disorders, social functioning, life-time psychiatric comorbidities, and treatment receipt. The comorbid groups were also compared with their single diagnosis counterparts.
Design and Setting: Cross-sectional cohort study using data from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC-III).
Participants: The total sample size was 36 309. Six groups were established: PTSD/AUD, PTSD/DUD, AUD, DUD, PTSD, and neither PTSD nor AUD/DUD. Life-time prevalence of AUD among those with PTSD/DUD was 80.2% and among those with DUD was 73.8%.
Measurements: The Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 version assessed life-time and past-year psychiatric disorders and treatment receipt. Demographics and social stability indicators were queried. Group characteristics were summarized using weighted means. Prevalences and estimates for adjusted differences in means and adjusted odds ratios (aORs) were derived from multiple linear regression and logistic regression models, respectively. Analyses were conducted in R and accounted for the NESARC-III's complex survey design, clustering, and non-response.
Findings: Compared with those with life-time PTSD/AUD, those with life-time PTSD/DUD were significantly less likely to have neither disorder in the past year (PTSD/AUD = 16.1%; PTSD/DUD = 8.5%; aOR = 0.54), and were more likely to report worse social and psychiatric functioning, and to have received both addiction and mental health treatment (PTSD/AUD = 18.4%; PTSD/DUD = 43.2%; aOR = 3.88). Compared with their single disorder counterparts, those with PTSD/DUD reported greater impairment than both groups, whereas the comorbid PTSD/AUD group differed more from the AUD than the PTSD group.
Conclusions: People with comorbid PTSD and drug use disorder have greater social and psychiatric impairment and may require different types and intensity of intervention than people with comorbid post-traumatic stress disorder and alcohol use disorder.
(© 2019 Society for the Study of Addiction.)

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IK2 CX000867 United States CX CSRD VA; R01 AA020252 United States AA NIAAA NIH HHS

Keywords: Alcohol use disorders; comorbidity; cross-sectional Cohort Study; drug use disorders; epidemiology; post-traumatic stress disorder

Date Created: 20190130 Date Completed: 20200716 Latest Revision: 20221207

20221213

PMC6719550

10.1111/add.14565

30694592