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Cited by 48Posttraumatic Stress Disorder ResearchSubstance Abuse Treatment and OutcomesPsychotherapy Techniques and Applications

Alcohol, cannabis, and other drug use: Engagement and outcome in PTSD treatment

Open access
Bedard-Gilligan, Michele, Garcia, Natalia, Zoellner, Lori A., Feeny, Norah C.·2018·Psychology of Addictive Behaviors
DOI 10.1037/adb0000355PMC PMC9377391
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Abstract

The co-occurrence of posttraumatic stress disorder (PTSD) and substance use is related to poorer outcome and increased dropout from trauma-focused treatment. Investigating PTSD and substance use can inform the intervention approaches. Exploring cannabis use in particular is especially important because rates of cannabis use have been increasing with recent legalization trends. A better understanding of how substance use is associated with treatment processes and outcome for individuals with PTSD is needed to enhance care. In this study, both lifetime diagnoses of alcohol and drug use disorders and current alcohol and drug use severity were examined in 200 men and women with chronic PTSD who received either prolonged exposure (PE) or sertraline. No lifetime or current alcohol use variables predicted dropout, adherence, or poorer outcome. However, lifetime diagnosis of both an alcohol and drug disorder (OR = 3.42) and recent cannabis use (OR = 3.38) strongly predicted higher dropout. Recent cannabis use and drug use severity predicted poorer adherence to PE (β = -.22 to -.29) but not to sertraline. Drug use severity (β = -.22) also predicted worse treatment outcome, as did lifetime diagnosis of an alcohol and drug disorder (β = -.48). Overall, patients with drug use improved with treatment but had less treatment retention, adherence, and symptom reduction. Strategies to increase engagement and retention may be indicated for these patients. Individuals who are using cannabis or other drugs may be at higher risk for not completing PTSD treatment, potentially prolonging the cycle of PTSD and substance use. (PsycINFO Database Record

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  • Baseline cannabis use is associated with increased dropout and less improvement in PTSD symptoms during PTSD treatment.

    “a randomized controlled trial (RCT) found that baseline cannabis use was associated with increased dropout and less improvement in PTSD symptoms during PTSD treatment (Bedard-Gilligan et al., 2018).”

    From Cannabis use and trauma-focused treatment for co-occurring posttraumatic stress disorder and substance use disorders: A meta-analysis of individual patient data (2024) · cites this paper as Bedard-Gilligan et al., 2018

    The Results (Dropout Prior to Likely Therapeutic Benefit) associate current cannabis use with higher dropout. But the Results (PTSD Severity at Post-Treatment and Six-Month Follow-up) say cannabis use in the last 30 days did not predict PTSD symptoms; only a lifetime cannabis use disorder predicted slightly higher post-treatment symptoms. The claim conflates recent use with a lifetime disorder history. (LLM, conf=0.90)

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Research works printed but not linked: 1

  1. First MB Spitzer RL Gibbon M Williams JB 1995 Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Edition, SCID-I/P Version 2.0 New York, NY Biometrics Research Department, New York State Psychiatric Institute

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Related

Authors
Bedard-Gilligan, M., Garcia, N., Zoellner, L. A., & Feeny, N. C.
Affiliations
  • University of Washington (US)
  • Case Western Reserve University (US)
ORCID
Venue
Psychology of Addictive Behaviors
Publisher
American Psychological Association (APA)
Published
2018-05
Volume
32
Issue
3
Pages
277-288
ISSN
  • 0893-164X (ISSN-L)
  • 1939-1501
DOI
10.1037/adb0000355
PMC
PMC9377391
OpenAlex
W2794448262
Cited by
48
References
70
Citations by year
2026: 1 · 2025: 9 · 2024: 6 · 2023: 8 · 2022: 7 · 2021: 7 · 2020: 6 · 2019: 3 · 2018: 1
FWCI
4.98
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychology of Addictive Behaviors (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (R01 MH066347, R01 MH066348)
  • National Institute on Alcohol Abuse (R34 AA022966)
  • National Institute on Drug Abuse (R34 DA040034)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
post-traumatic stress disorder, substance use, cannabis use, alcoholism, drug use disorders, treatment discontinuation, medication adherence, treatment engagement, prolonged exposure therapy, sertraline, chronic PTSD, treatment outcomes
MeSH terms
Adult, Alcohol Drinking, Combined Modality Therapy, Female, Humans, Implosive Therapy, Male, Marijuana Smoking, Stress Disorders, Post-Traumatic, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Substance-Related Disorders, Sertraline

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