Predictors of evidence-based psychotherapy initiation among veterans with co-occurring PTSD and substance use disorder.

Objective: To compare initiation of PTSD evidence-based psychotherapy (EBP) between Veterans with and without a co-occurring substance use disorder (SUD), and identify factors associated with EBP initiation among Veterans with PTSD-SUD. Method: A national sample of Veterans with PTSD (n = 301,872) and PTSD-SUD (n = 94,515) were identified from VA Electronic Health Record data. Treatment initiation was defined as having at least one mental health encounter associated with Cognitive Processing Therapy or Prolonged Exposure therapy. Generalized estimating equations were used to compare EBP initiation between Veterans with and without co-occurring SUD, and to identify patient- and facility characteristics associated with EBP initiation among Veterans with PTSD-SUD. Results: The majority of Veterans were 30 - 44 years old, male sex, and Non-Hispanic White. No significant differences were observed in EBP initiation between Veterans with and without a co-occurring SUD (OR=1.00, p=0.985). Among Veterans with PTSD-SUD, co-occurring bipolar disorder (OR=0.83, p=.000), co-occurring psychotic disorder (OR=0.69, p=.000), service connection (OR=0.94, p=.001), female sex (OR=0.87, p=.000), and being 60 years or older (OR=0.57, p=.000) were associated with a reduced likelihood of initiating a PTSD EBP. Having a co-occurring anxiety disorder (OR=1.06, p=.020), MST history (OR=1.95, p=.000), and high risk for suicide (OR=1.15, p=.000) were associated with an increased likelihood of initiating EBP. Discussion: These findings support VA provision of EBP for Veterans with PTSD regardless of the presence of co-occurring SUD. Identifying characteristics that increase or reduce the likelihood of EBP initiation may provide insight into treatment pathways and subgroups warranting augmented outreach.

Characterizing and Comparing Evidence-Based Psychotherapy Utilization Among Veterans with Co-occurring PTSD and Substance Use Disorder.

Objective: The current study sought to describe a nationally representative sample of Veterans diagnosed with co-occurring PTSD and substance use disorder (SUD) who initiated and completed evidence-based psychotherapy (EBP) for PTSD, and explored whether completion rates differed by SUD subtype. Methods: Using electronic health record data from the Veterans Health Administration (VHA) Corporate Data Warehouse, Veterans with a dual diagnosis of PTSD and SUD who initiated either Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE) between January 01, 2019 and July 16, 2019 were identified (N = 2,996). Logistic analyses were employed to determine whether there were differences in EBP completion rates among Veterans with an alcohol use disorder (AUD; n = 1,383) versus all other SUDs (n = 1,613). Results: On average, Veterans were 45 years old, and identified as male, White, and non-Hispanic. Logistic regression analyses revealed there was not a significant difference between Veterans with AUD only and other SUDs in the probability of completing EBP treatment, OR = 1.02, 95% CI =0.87, 1.17, p = 0.79. Conclusions: No differences in EBP completion rates were observed between SUD subtypes, indicating that EBPs for PTSD are tolerated well for individuals with various types of SUDs and may be offered as treatment options.

Organotin and organochlorine toxicants activate key translational regulatory proteins in human immune cells.

Environmental contaminant exposures occur due to the widespread use of synthetic chemicals. Tributyltin (TBT), dibutyltin (DBT), and pentachlorophenol (PCP) are each used in a variety of applications, including antifouling paints and stabilizers in certain plastics. Each of these compounds has been found in human blood, as well as other tissues, and they have been shown to stimulate pro-inflammatory cytokine production in human immune cells, Inflammatory cytokines mediate response to injury or infection. However, if their levels are increased in the absence of an appropriate stimulus, chronic inflammation can occur. Chronic inflammation is associated with a number of pathologies including cancer. Stimulation of pro-inflammatory cytokine production by these toxicants is dependent on activation of ERK 1/2 and/or p38 MAPK pathways. MAPK pathways have the capacity to regulate translation by increasing phosphorylation of key translation regulatory proteins. There have been no previous studies examining the effects of TBT, DBT, or PCP on translation. The current study shows that ribosomal protein S6 (S6), eukaryotic initiation factor 4B (eIF4B), and eIF4E are phosphorylated (activated) and/or their total levels are elevated in response to each of these compounds at concentrations found in human blood. Activation/increased levels of translational proteins occurred at concentrations of the compounds that have been shown to elevate pro-inflammatory cytokine production, but where there is no increase in mRNA for those proteins was seen. Compound-stimulated increases in translation appear to be part of the mechanism by which they elevate protein production in immune cells.

Measuring Experiential Avoidance and Posttraumatic Stress in Families.

Experiential avoidance (EA) is receiving attention as an emotion regulation strategy and critical factor in the development and maintenance of posttraumatic stress disorder (PTSD) Evidence suggests that EA explains co-varying relationships among topographically dissimilar problem behaviors. The transmission of emotion regulatory strategies is important to understanding the development of these problems. EA may be a learned response style. This conceptual framework was used to test parent EA as a predictor of young adult/older adolescent (offspring) EA, posttraumatic stress symptoms (PTSS), and problem behaviors in a university context as well as to test the best predictors of these outcomes individually for parents and offspring. Two measures of experiential avoidance, the unwillingness to be in contact with distressing emotions, thoughts, and memories were used to predict the outcomes of interest. The Acceptance and Action Questionnaire-II (AAQ-II) was the strongest and only statistically significant predictor of PTSS and problem behaviors for parents and offspring above and beyond trauma history, while the Multidimensional Experiential Avoidance Questionnaire (MEAQ) remained non-significant. Implications regarding measurement discrepancies, PTSS, and harmful behavior trajectories are discussed.

Measuring Experiential Avoidance: Evidence toward Multidimensional Predictors of Trauma Sequelae.

The current study sought to investigate measurement discrepancies in self-report assessment of experiential avoidance (EA). Recent research indicates that EA may be more appropriately conceptualized as a multidimensional construct, operationally defined in terms of specific avoidance strategies. To test this notion, EA was measured using two self-report assessment instruments, the Acceptance and Action Questionnaire-II (AAQ-II) and the Multidimensional Experiential Avoidance Questionnaire (MEAQ) in a convenience sample of university students. Measurement differences across measures and unique contributions to prediction of posttraumatic stress symptoms (PTSS) and engagement in problematic behaviors were evaluated. Both the AAQ-II and MEAQ were found to significantly mediate the effect of childhood trauma exposure on PTSS. However, when levels of PTSS were dummy coded into dichotomies of those with a likely PTSD diagnosis and those without, the MEAQ was a stronger predictor symptoms of those with a likely PTSD diagnosis than AAQ-II did. These results provide initial support for the discriminant validity of the MEAQ, which appears to be a more specific predictor of trauma-related symptoms.