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This study used data from the national evaluation of VHA specialized intensive PTSD programs to evaluate the psychosocial burdens associated with comorbid polysubstance use. Higher levels of polysubstance use were associated with more severe PTSD symptoms at the time of program entry. After controlling for the number of total days of substance use, higher levels of polysubstance use remained significantly associated with two of these subscales: violent behavior and sui- cidality, even with Bonferroni adjustment for multiple comparisons.

Longitudinally, although polysubstance use remained a persistent problem for some veterans, fol- lowing treatment, it became far less prevalent. However, among those who used multiple substances at follow-up, symptoms of PTSD remained more severe after treatment than among those who use none or only one.

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Table 2. Least squares means at baseline by substance use group adjusted for potentially confounding factors. Group 1 Group 2 Group 3

1 substance 2 or 3 substances 4 or 5 substances

LS Mean SE LS Mean SD LS Mean SD p value Comparisons� Employment 0.448 0.003 0.446 0.003 0.439 0.008 .517 ns Medical problems 0.556 0.005 0.577 0.007 0.596 0.015 .009 ns Violence at admission 1.779 0.021 2.024 0.025 2.416 0.058 <.0001 3> 2 > 1 PTSD total 3.604 0.007 3.656 0.008 3.709 0.018 <.0001 3> 1 PTSD subscales Numbness 3.675 0.007 3.714 0.009 3.730 0.020 .001 ns Hyperarousal 3.669 0.007 3.741 0.009 3.801 0.020 <.0001 3> 1 Reexperiencing 3.814 0.011 3.834 0.014 3.911 0.031 .014 ns Avoidance 4.086 0.014 4.130 0.017 4.162 0.039 .071 ns Suicidality 2.734 0.015 2.826 0.018 2.920 0.042 <.0001 ns Agitation 3.688 0.015 3.731 0.018 3.771 0.042 .081 ns

Note. Adjusted for age, year of program entry, White race, married, diagnosis of drug abuse/dependence or personality disorder, hospitalization for suicide attempt, possession of a valid driver’s license, and participation in war atrocities.

PTSD¼ posttraumatic stress disorder; ns¼ not significant; LS ¼ least squares; SD ¼ standard deviation.�Significance threshold of p <.005 and effect size of Cohen’s d> 0.20 or < �0.20.

40 I. P. BHALLA ET AL.

 

 

Table 3. Least squares means at baseline by substance use groups adjusted for the index of the total days of substance use in the past 30 days.

Group 1 Group 2 Group 3

1 substance 2 or 3 substances 4 or 5 substances

LS Mean SE LS Mean SD LS Mean SD p value Comparisons� Employment 0.444 0.003 0.449 0.004 0.456 0.010 .526 ns Medical problems 0.569 0.006 0.567 0.007 0.539 0.018 .268 ns Violence at admission 1.817 0.023 1.997 0.026 2.256 0.069 <.0001 3> 2,1 PTSD total 3.620 0.007 3.645 0.008 3.642 0.022 .103 ns PTSD subscales Numbness 3.685 0.008 3.707 0.009 3.688 0.024 .187 ns Hyperarousal 3.700 0.008 3.720 0.009 3.670 0.024 .043 ns Reexperiencing 3.828 0.012 3.824 0.014 3.848 0.037 .792 ns Avoidance 4.104 0.015 4.118 0.018 4.090 0.047 .709 ns Suicidality 2.730 0.016 2.829 0.019 2.938 0.050 <.0001 3> 1 Agitation 3.708 0.016 3.718 0.019 3.690 0.050 .808 ns

Note. Adjusted for age, year of program entry, White race, married, diagnosis of drug abuse/dependence or personality disorder, hospitalization for suicide attempt, possession of a valid driver’s license, and participation in war atrocities.

PTSD¼ posttraumatic stress disorder; ns¼ not significant; LS ¼ least squares; SD ¼ standard deviation.�Significance threshold of p< .005 and effect size of Cohen’s d> 0.20 or < �0.20.

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Baseline 4 Months A�er Discharge

0 1 2-3 Substances 4-5 Substances

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