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Polysubstance Use Among Veterans in Intensive PTSD Programs: Association With Symptoms and Outcomes Following Treatment

Ish P. Bhallaa,b , Elina A. Stefanovicsa,c, and Robert A. Rosenhecka,c,d

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Polysubstance Use Among Veterans in Intensive PTSD Programs: Association With Symptoms and Outcomes Following Treatment
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aDepartment of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA; bNational Clinician Scholars Program, University of California Los Angeles, Los Angeles, California, USA; cMental Illness Research, Education, and Clinical Center, Veterans Affairs New England, West Haven, Connecticut, USA; dSchool of Public Health, Yale University, New Haven, Connecticut, USA.

ABSTRACT Objective: A distinct group of patients has recently been described who experience poly- substance use disorder characterized by use of multiple addictive substances. This study examines baseline characteristics and longitudinal outcomes of a group of such patients in specialized intensive Veterans Health Administration posttraumatic stress disorder (PTSD) programs and followed 4 months after discharge. Methods: Patients with diagnosed PTSD or subsyndromal PTSD and who used a single substance at baseline were compared to those who used two or three and more than three different addictive substances on meas- ures of PTSD symptom severity and functioning. Comparisons were also adjusted for differ- ences in total days of any substance use and other potentially confounding factors. Patients were reclassified according to the number of substances used at follow-up and again com- pared on symptoms and functioning. Results: Bivariate analysis of baseline data (N¼ 8,240) showed frequent polysubstance use (n¼ 3,695, 44.8% of the sample) and that use of greater numbers of substances was associated with more severe PTSD symptoms as well as more total days of substance use. At follow-up after treatment, 58.2% of the original sample (n¼ 4,797) was assessed. Polysubstance use was less frequent (n¼ 756, 15.8% of the follow- up sample), but showed a similar association with more severe symptoms, although differ- ences were attenuated after adjusting for total days of substance use. Conclusions: Polysubstance use, conceptualized within the multimorbidity perspective, is associated with increased severity of PTSD symptoms among veterans with dual diagnoses requiring com- plex interventions, the evaluation of which will require innovative trial designs.

KEYWORDS Polysubstance use; PTSD; multimorbidity; dual diagnosis; psychiatric comorbidity


Substance use disorders are common comorbidities among veterans with posttraumatic stress disorder (PTSD) and are associated with more severe symptoms and impaired functioning (McCauley, Killeen, Gros, Brady, & Back, 2012). Many such patients with dual diagnoses use multiple substances, potentially leading to an even greater degree of clinical and therapeutic complexity. Despite evidence suggesting that polysub- stance use is increasing (Connor, Gullo, White, & Kelly, 2014), outcome research to date has primarily focused on patients with a single substance use disorder, pri- marily alcohol, opiate, or stimulant use disorders. However, some recent studies suggest that compared to a single substance use disorder, use of multiple substan- ces is associated with additional medical and psychiatric comorbidities as well as a greater risk of homelessness,

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