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Background: Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) are often comorbid and difficult to treat. The availability of evidence-based treatment guidelines is very limited and there is significant uncertainty about what best practice looks like.Objective: This paper describes the methodology used to develop expert recommendations for the assessment and psychological treatment of PTSD and comorbid SUD and presents the final recommendations.Methodology: A small committee of experts in the field of PTSD and SUD was formed on behalf of the European Society for Traumatic Stress Studies (ESTSS) Board. The committee developed recommendations based on a two-stage process. In the first stage a systematic review of randomised controlled trials of psychological interventions aimed at treating PTSD-SUD comorbidity was completed, and other recent relevant reviews systematic were also considered. To complement the recommendations based on systematic review, the second stage involved the review and collation of existing guidance, good practice and consensus recommendations made in methodologically rigorous clinical practice guidelines.Results: The two-stage process resulted in 9 recommendations related to assessment and 21 recommendations related to treatment planning and delivery.Conclusions: To our knowledge, this is the first attempt to provide expert recommendations based on a systematic review of the literature and through collation of guidance provided in other authoritative and reliable sources. These expert recommendations will provide helpful guidance to clinicians and service providers in both addiction and mental health settings about appropriate clinical care for those with PTSD SUD comorbidity.

This project aimed to develop expert recommendations for the assessment and psychological treatment of PTSD and comorbid substance use disorder.Trauma-focused psychological intervention combined with treatment for SUD is the most effective treatment for PTSD symptoms and for alcohol use disorder treatment benefits appear to be strongest when combined with alcohol targeted pharmacotherapy.The presence of co-occurring SUD should not prevent or exclude individuals from receiving established evidence-based treatments for PTSD and readiness to engage in evidence-based treatment should be evaluated on an individual basis.

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Durante la pandemia producida por la infección por el Covid-19 se produjeron una serie de cambios sociosanitarios excepcionales para evitar su propagación como el confinamiento en el hogar y la supresión de los servicios asistenciales sanitarios habituales. Se consideró que estos cambios podrían implicar un incremento en el consumo de alcohol y un mayor riesgo de recaídas para los pacientes en tratamiento. El objetivo de este estudio fue valorar los cambios en el consumo durante el período de confinamiento (marzo a mayo de 2020) en los pacientes en tratamiento en el programa de alcohol del Hospital Doce de Octubre de Madrid. Fueron valorados 311 pacientes mediante entrevista telefónica dentro de la práctica clínica habitual durante ese período. Un 76 % de los pacientes no presentaron cambios en su situación de consumo, un 9,2% de estos cesaron en el consumo, algunos de ellos con cuadros de abstinencia graves, y un 7,5% recayeron. El sexo femenino, el consumo en solitario o en el hogar, en atracón, o el de otras drogas de forma concomitante y el no estar en terapia grupal o no asistir a grupos de las asociaciones de ayuda mutua por videoconferencia durante el confinamiento fueron factores predictores de mal pronóstico. Un 31,6% presentó alteraciones psicopatológicas debidas al confinamiento, sobre todo, aquellos pacientes con comorbilidad psiquiátrica. Por lo tanto, en situaciones similares a esta, la mayoría de los pacientes en tratamiento no modifican el patrón de consumo, pero, ciertas características identifican un subgrupo de sujetos más vulnerables. (AU)

During the COVID-19 pandemic, several exceptional measures were put in place in order to avoid virus propagation, such as lockdown and the discontinuation of usual health care assistance services. It was considered that these changes might be associated with an increase in alcohol consumption and a higher risk of relapse for patients under treatment. The aim of this study was to assess changes in alcohol consumption during the lockdown period (between March and May, 2020) in patients following treatment under the Alcohol Use Disorders Programme at the “Hospital 12 de Octubre” in Madrid. A total of 311 patients were assessed through interviews carried out by telephone in accordance with usual clinical practice during that period. 76% of the total number of patients did not experience changes in their alcohol consumption, 9.2% stopped drinking and some experienced severe withdrawal syndrome, while 7.5% relapsed. The risk factors found for worsening the prognosis of the patients were: being female, drinking alcohol alone or at home, binge drinking, concomitant substance misuse and failure to attend therapy groups or self-help groups online during the lockdown. 31.6% of the sample described psychopathological symptoms due to the lockdown, especially those who already had psychiatric comorbidities. For this reason, we can conclude that during the lockdown as a result of the pandemic, most of our alcohol dependent patients did not modify their drinking patterns, but specific factors enabled us to identify a more vulnerable subgroup. (AU)

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Hasta la fecha, ningún estudio de seguimiento había evaluado simultáneamente la función ejecutiva, otras funciones no ejecutivas relacionadas con funciones cognitivas y la impulsividad en una muestra suficientemente grande de pacientes con trastorno por uso de alcohol(TUA) entre moderado y grave. Este estudio tuvo como objetivo principal comparar el desempeño neuropsicológico y su relación con el usode alcohol en pacientes con TUA y en controles sanos, y determinarla evolución del deterioro cognitivo y el uso de alcohol a largo plazo.Con este fin, se diseñó un estudio de seguimiento de seis meses paracomparar una muestra de 100 pacientes ambulatorios con TUA (criterios del DSM-5) emparejados con 100 controles sanos. Los pacientesse reclutaron de tres centros sanitarios diferentes de España, Orense,Gijón y Barcelona. La evaluación consistió en una batería sistematizadade pruebas cognitivas para evaluar las siguientes funciones: atención,memoria anterógrada, velocidad de procesamiento, fluidez verbal, función ejecutiva y actitud implícita hacia bebidas alcohólicas. También secompararon variables clínicas asociadas al consumo de alcohol, comoel craving y la impulsividad. Después de seis meses, la memoria anterógrada, memoria de trabajo y resistencia a la interferencia mejoraron notablemente en los pacientes con TUA, aunque no llegaron a igualar lapoblación general. Respecto de las variables clínicas, hubo una pequeña pero significativa mejoría cognitiva relacionada con una reduccióndel consumo de alcohol y de la impulsividad. La disfunción ejecutiva yotras funciones no ejecutivas relacionadas con el deterioro cognitivopueden considerarse factores pronósticos en pacientes ambulatorioscon TUA entre moderado y grave. (AU)

Until now, no follow-up studies had simultaneously evaluated executive functions, other non-executive functions related cognitive functions, and impulsivity in a large enough sample of moderate to severealcohol use disorder (AUD) patients. The main objective of the present study was to compare neuropsychological performance and its relation to alcohol use in patients with AUD and healthy controls, andto determine the evolution of cognitive impairment and alcohol useover time. For this purpose, a 6-month follow-up study was designed tocompare a sample of 100 outpatients with AUD (DSM-5 criteria) with100 matched healthy controls. The patient group was recruited fromthree different health centres in Spain located in Orense, Gijón andBarcelona. The assessment consisted of a systematic battery of cognitive tests to evaluate the following functions: attention, anterogradememory, processing speed, verbal fluency, executive function, andimplicit attitude toward alcoholic beverages. We also compared clinical variables associated with alcohol use, such as alcohol craving andimpulsivity. After 6 months, anterograde memory, working memory,and resistance to interference improved remarkably in AUD patients,although not enough to match the normal population. With regard toclinical variables, there was a small but significant cognitive improvement related to a reduction in alcohol use and impulsivity. Executivedysfunction and other non-executive functions related cognitive functions impairment can be considered prognostic factors in outpatientswith moderate to severe AUD. (AU)

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AIM: To describe the detection by general practitioners (GP) of alcohol use disorders (AUD) and alcohol dependence, and their prevalence in primary health settings. DESIGN: Cross-sectional study. SETTINGS: Twenty Catalan primary health care centres (Spain). PARTICIPANTS AND MEASUREMENTS: Twenty three randomly selected GP were surveyed about alcohol and other diseases of their patients. A total of 1,372 patient interviews were collected. Patients and GPs were asked about AUD and other mental and health conditions. The Composite International Diagnostic Interview (CIDI) as the gold standard was used, as well as other structured interviews (K10 screening and World Health Organization Disability Assessment Schedule 2.0). RESULTS: The CIDI diagnosed 9.6% of the total sample with an AUD, and 4.8% diagnosed by GPs. CIDI could detect more AUD in young adults, while GPs diagnosed more AUD and alcohol dependence in elderly people, who also had more health conditions. GPs recognised AUD in 28.8% of patients diagnosed with CIDI, but 42.4% of patients diagnosed by GPs were not detected with CIDI. Taking both into consideration, the gold standard and the GP clinical impression, 11.7% of patients had an AUD and 8.6% an AD. CONCLUSIONS: GP recognise AUD better in the elderly with worst health conditions than CIDI. AUD and alcohol dependence prevalence is high in primary health care centres.

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