Screening and treatment of posttraumatic stress disorder in patients with substance use disorders

Roughly, one out of four patients with a substance use disorder (SUD) also meets criteria for PTSD. Both disorders seem to be highly intertwined. Two chapters of this thesis focus on the development of a screening questionnaire to detect PTSD within substance abuse treatment centers. For this purpose, a PTSD screener from the United States army was used, the Primary Care posttraumatic stress disorder screen (PC-PTSD). Based on the results of this study a new screener was assembled and cross-validated: the Jellinek-PTSD screening questionnaire (J-PTSD). Results indicated a high sensitivity and a high specificity for the J-PTSD. Another subject of this thesis was the treatment of patients with concurrent PTSD and SUD. One chapter reviews the scientific studies of treatment protocols that were published in international journals. Also, two randomized controlled trials (RCTs) were performed as part of this thesis. Both RCTs examined the effectiveness of trauma-focused treatment for PTSD combined with SUD treatment. The SUD treatment was cognitive behavioral treatment for SUD. The PTSD intervention was Structured Writing Therapy (SWT). All patients participating in the studies received psycho-education about the possible functional relationship between PTSD and SUD. In both studies, the combined treatment for concurrent PTSD and SUD led to improvements in PTSD and SUD symptoms. In one study, the integrated treatment proved to be more effective than SUD treatment if patients received at least 75% of the treatment sessions. The trauma-focused intervention was not associated with an increase in PTSD symptoms or higher dropout rates.