Post-traumatic stress disorder (PTSD) is one of the most common mental health problems affecting around 7 to 8 percent of the general population, of which 10 to 30 percent are veterans meeting lifetime diagnostic criteria, as per an estimate by the U.S. Department of Veterans Affairs. A study has reported that around 45.7 percent of military personnel with PTSD continued to experience the symptoms even three years after quitting the service.
While PTSD alone may cause significant distress and impairment, comorbid psychiatric disorders including alcohol and drug abuse can further complicate the problem. The co-occurrence of PTSD and substance use disorders (SUD) reports a significant prevalence. According to a nationally representative sample of the United States population collated and published online in the Journal of Clinical medicine in January 2017, an estimated 46.4 percent individuals with PTSD have a comorbid drug use disorder or alcohol use disorder.
Veterans with co-occurring PTSD/SUD have reported poor response to treatment with problems including social aversion, violence and suicide attempts, warranting repeated episodes of substance abuse treatment. The comorbidity may aggravate PTSD symptoms resulting in a higher risk of SUD relapse during or after SUD treatment.
Researchers at the Medical University of South Carolina (MUSC) and the Ralph H. Johnson VA Medical Center, have first time, used N-acetylcysteine (NAC) in combination with group cognitive-behavioral therapy (CBT) for the treatment of comorbid PTSD and SUD.
NAC, CBT reduce cravings and depression symptoms
The treatment of comorbid PTSD and SUD requires both psychosocial and pharmacologic interventions. Conventionally, the sequential treatment model was in which patients were first treated for substance abuse and once a period of complete drug abstinence was established, the treatment of PTSD began. However, another model has gained ground over the past decade. Integrated and concurrent treatments for PTSD/SUD have been found to be effective in reducing symptoms of PTSD while bringing significant improvement in the symptoms of SUD.
A powerful antioxidant used in both conventional and alternative medicine, N-acetylcysteine (NAC) is particularly known for its role in treating patients abusing acetaminophen, a prescription drug used as a pain reliever and a fever reducer.
Results of the study suggest a significant reduction in craving for the substance and depressive symptoms in the group treated with NAC. The veterans who were treated with NAC reported a 46 percent reduction in PTSD symptoms and 81 percent drop in craving for the drug. Further, the study showed a 71 percent fall in the frequency of craving in NAC group, compared with 29 percent in the placebo group.
Sudie E. Back, Ph.D. and lead author on the article, said, “Craving is a key component of substance use in relapse. If you have a medication that can really reduce craving, that will go a long way to helping people stay clean and sober.” Overall, a significant reduction in self-reported and clinical–rated PTSD symptoms was noted in participants treated with NAC. The NAC-treated patients experienced a further decrease in PTSD symptoms when they appeared for the follow-up after one month.
Despite getting favorable results in terms of decreased craving and depression with NAC use in treating comorbid PTSD and SUD, researchers still do not recommend NAC as a monotherapy or as an alternative to evidence-based behavioral treatment. They emphasize the role of NAC as an adjunct therapy to enhance the efficacy of behavioral treatment.
Road to recovery
The current study provides encouraging evidence for combining NAC and cognitive-behavioral therapy to control PTSD symptoms, substance use disorders and depression. The pharmacologic intervention of NAC is also significant in the view that it is widely available, affordable and has less side effects. NAC is available as an over-the-counter drug. However, it is not advisable to use it without a physician’s recommendation.
Comorbid PTSD and SUD require early intervention for better treatment outcome. The Prescription Drug Abuse Helpline of California can help you or your loved one facing the problem by sharing details of state-of-the-art rehab centers in California. Chat online or call our 24/7 helpline 855-738-2770 for information on good facilities providing prescription drug addiction treatment in California.