Chapter 10

Substance Use Disorders in Patients with Posttraumatic Stress Disorder

A Review of the Literature

Leslie K. Jacobsen, M.D.

Steven M. Southwick, M.D.

Thomas R. Kosten, M.D.

Substance use disorders, particularly abuse of and dependence on central nervous system (CNS) depressants, are common in patients with posttraumatic stress disorder (PTSD). This chapter reviews clinical, epidemiologic, and neurobiologic studies relevant to the problem of comorbid PTSD and substance use disorders and discusses the clinical implications of these findings.


CLINICAL PHENOMENOLOGY AND EPIDEMIOLOGY

PTSD develops in some people after exposure to a severe traumatic event. The DSM-IV diagnosis of PTSD consists of symptoms in three clusters: (1) reexperiencing symptoms, including intrusive recollections of the trauma that are triggered

Received May 11, 2000; revision received Aug. 22, 2000; accepted Nov. 17, 2000. From the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, and the VA Connecticut Healthcare System. Address correspondence to Dr. Jacobsen, Department of Psychiatry (116A), VA Connecticut Healthcare System, Yale University-West Haven Campus, 950 Campbell Ave., West Haven, CT 06516; leslie.jacobsen@yale.edu (e-mail).

Supported in part by grants DA-00167, DA-04060, and DA-09250 from the National Institute on Drug Abuse.

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