RESUMO
OBJECTIVE: Veterans with alcohol use disorder (AUD) and co-occurring posttraumatic stress disorder (PTSD) have access to various residential and outpatient treatment programs through the VA Healthcare System. There is a need to better understand the characteristics and needs of veterans who engage in residential versus outpatient treatment in order to help inform veteran care and decisions about treatment services. METHODS: The present study examined whether veterans with both AUD and combat-related PTSD who were enrolled in residential (n = 103) or outpatient treatment programs (n = 76) differed on pretreatment psychiatric symptoms, substance use and associated problems/behaviors, or demographics. Veterans completed self-report measures (which referenced symptoms in the past 30 days or 2 weeks) within the first week of PTSD/AUD treatment. RESULTS: Veterans in residential treatment had slightly worse PTSD symptoms compared to outpatient veterans; the groups reported similar levels of depression symptoms. Residential veterans had higher frequency of drug use, were more confident in their ability to be abstinent, attended more self-help meetings, spent more time around risky people or places, were more satisfied with their progress toward recovery goals, were more bothered by arguments with family/friends, and spent fewer days at work or school compared to outpatient veterans; the groups did not differ on drinking (frequency of use, binge drinking) or cravings. With respect to demographics, residential veterans were more likely to be married and non-Hispanic Caucasian (rather than minority races/ethnicities) compared to outpatient veterans. CONCLUSIONS: The finding that PTSD symptoms were more severe among veterans in residential substance use treatment highlights the importance of taking advantage of this crucial opportunity to engage veterans in evidence-based PTSD treatment. Consistent with other research, findings also indicated that individuals entering residential care have a higher level of impairment than those beginning outpatient care.
Assuntos
Transtornos Relacionados ao Uso de Álcool/psicologia , Assistência Ambulatorial , Serviços de Saúde Mental , Tratamento Domiciliar , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Distúrbios de Guerra/diagnóstico , Distúrbios de Guerra/epidemiologia , Distúrbios de Guerra/psicologia , Comorbidade , Diagnóstico Duplo (Psiquiatria) , Feminino , Humanos , Masculino , Avaliação das Necessidades , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologiaRESUMO
A retrospective pilot study was conducted to determine whether a relatively brief integrated outpatient treatment for patients with dual disorders reduced inpatient hospital service utilization. Outpatients (n=44) with substance dependence and either comorbid schizophrenia, major depressive disorder, or bipolar disorder were studied. A multidisciplinary team provided relatively brief (up to 24 weeks), integrated, dual-diagnosis outpatient treatment. A significant 60% reduction in the number of psychiatric hospitalization days was found for the year after treatment as compared to the year before. Patients with schizophrenia showed the greatest reduction (74%) in hospitalization days. Thus, even brief integrated outpatient dual-diagnosis treatment can reduce inpatient psychiatric hospitalizations.