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Objective Higher degrees of sensation seeking (SS) are reported in community and clinical samples of individuals with eating disorders with binge-type features (BTEDs), but no reports exist in representative probability samples of adult women. Additionally, SS has been linked to victimization and PTSD, also associated with BTEDs, yet interrelationships between these variables are unexplored. Methods A national, probability sample of 3006 adult women (≥18 y/o) completed structured telephone interviews including assessments for victimization, PTSD, bulimia nervosa (BN) and binge eating disorder (BED). The survey included the 6 items of the Disinhibition-Intentions for the Future (DIF) subscale of Zuckerman's Sensation Seeking Scale-VI, which asks how likely participants would be to engage in given activities. Total SS score (TSSS-DIFS) was the sum of the 6 items' scores. Differences among the 3 groups (BN, BED, non-BN/BED) were compared using ANOVA covaried by age and post-hoc t-tests. Multiple regression tested the effects of age, number of victimization experiences (NVE), lifetime PTSD, and BTEDs on TSSS-DIFS. Results There were significant differences in TSSS-DIFS across BTED diagnoses (p ≤ .001). Participants with BN (p ≤ .002) and those with BED (p ≤ .01) had significantly higher scores than those without BTEDs. These findings persisted in both groups after correcting for NVE and lifetime PTSD. TSSS-DIFS was significantly higher in participants with BTED with PTSD versus those without (p ≤ .025). Discussion SS traits related to disinhibition occur more commonly in U.S. adult women with BN and BED, even after controlling for NVE and PTSD, which were also associated with higher TSSS-DIFS.

Previous research with substance users has demonstrated, across a variety of psychiatric disorders, significant decreases in psychological symptoms during early substance abstinence. To build on this literature, the current study prospectively assessed trauma symptomatology over 28 days during acute and protracted cocaine and alcohol abstinence. Participants were 162 male and female cocaine and/or alcohol dependent outpatients who reported a history of trauma. Trauma-related symptoms and substance use were assessed at 2, 5, 10, 14, 21, and 28 days following last substance use. For participants who were known to relapse, assessments began again after the last day of substance use. Latent growth modeling was employed to estimate changes in posttraumatic stress disorder (PTSD) symptoms. Consistent with studies of other psychiatric syndromes, PTSD symptoms declined across the 28-day study period regardless of withdrawal substance (i.e., cocaine or alcohol). The majority of change in trauma symptoms occurred within two weeks of last substance use. Moreover, while trauma symptoms for the PTSD participants were more severe than those reported by the non-PTSD participants, trauma symptoms declined across the study period at the same rate irrespective of PTSD status.

Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) is a an integrated treatment cognitive-behavioral psychotherapy program designed for patients who have posttraumatic stress disorder (PTSD) and a co-occurring alcohol or drug use disorder. COPE represents an integration of two evidence-based treatments: Prolonged Exposure (PE) therapy for PTSD and Relapse Prevention for substance use disorders, where both the PTSD and substance use disorder are addressed concurrently in therapy by the same clinician, and patients can experience substantial reductions in both PTSD symptoms and substance use severity. The program includes information about how PTSD symptoms and substance use interact with one another; information about the most common reactions to trauma; techniques to help the patient manage cravings and thoughts about using alcohol or drugs; coping skills to help the patient prevent relapse to substances; a breathing retraining relaxation exercise; and in vivo (real life) and imaginal exposures to target the patient's PTSD symptoms.

This chapter describes session 7 of the COPE therapy. This chapter instructs the therapist to conduct and process the imaginal exposure. This chapter shows the therapist how to teach patients about the ABC model (Activating event, Beliefs, Consequences), as well as the basics of cognitive restructuring.

This chapter describes session 3 of the COPE therapy. The therapist will be guided in this chapter on how to provide the rationale for in vivo exposure exercises and will generate an in vivo hierarchy with the patient. This chapter provides the therapist with instructions for how to teach patients to use the Subjective Units of Distress Scale (SUDS). Cognitive behavioral techniques for how to manage cravings to use are reviewed for the therapist, such as decision delay, healthy distracting activities, breathing retraining exercise, play it out technique, cognitive restructuring, and urge surfing.

This chapter describes session 1 of the COPE therapy for post-traumatic stress disorder (PTSD) and substance use disorders. It provides the therapist with an overview of the COPE treatment program and how it works, reviews the treatment contract, addresses goals for therapy, and guides the therapist on how to teach the breathing retraining exercise.

This chapter describes the last session (session 12) of the COPE therapy for post-traumatic stress disorder (PTSD) and substance use disorders. In this chapter, the therapist is instructed to assess the patient’s progress since the beginning of treatment and review areas in need of continued work. Finally, this chapter instructs the therapist on how to elicit and provide the patient feedback, and treatment is terminated.

This chapter describes session 2 of the COPE therapy. It guides the therapist through the common reactions to traumatic experiences, such as fear and anxiety, avoidance, intrusive memories, trouble concentrating, sleep impairment, and irritability. Next, cravings for alcohol or drugs are reviewed for the therapist, as well as common triggers, including PTSD-related triggers, for cravings.

This chapter describes session 6 of the COPE therapy. The therapist will be guided in this chapter on how to address ‘hot spots.‘ Finally, the therapist will be guided on how to teach patients ways to increase their awareness and understanding of high-risk thoughts for using alcohol or drugs. The chapter reviews common high-risk thoughts for using (including PTSD-related thoughts), such as escape, crisis, relaxation, nostalgia, and testing control.

Chapter 2 discusses if the prolonged exposure program is right for you and your symptoms, considering the presence of drug or alcohol abuse and dependence, and if you live or work in a high-risk environment. Processes for enhancing motivation for treatment are also explored.Chapter 2 discusses if the prolonged exposure program is right for you and your symptoms, considering the presence of drug or alcohol abuse and dependence, and if you live or work in a high-risk environment. Processes for enhancing motivation for treatment are also explored.

This chapter provides the therapist with an outline of the COPE treatment and components of each session (e.g. check-in, review homework, post-traumatic stress disorder [PTSD] focus, substance use disorder focus). Questions regarding who can deliver the therapy are addressed, as well as questions regarding the role of medications. Finally, special considerations for delivering treatment to patients with PTSD and comorbid substance use disorders are reviewed for the therapist.

This chapter describes session 5 of the COPE therapy. The therapist’s instructions for how to provide and process imaginal exposure are reviewed in this chapter. Then, the therapist will be guided on how to help the patient generate a personal emergency coping plan for high-risk situations that may increase risk for using alcohol or drugs. The difference between a lapse (e.g. a slip) and a relapse is reviewed for the therapist.

Chapter 1 presents background information on the characteristics of posttraumatic stress disorder (PTSD) and substance use disorders (SUD), and discusses why the two disorders often coincide. The chapter also outlines Prolonged Exposure (PE) Therapy and how it works, the background to the COPE program and what it that program will involve.

This chapter describes session 8 of the COPE therapy. This chapter instructs the therapist to conduct and process the imaginal exposure. The therapist is shown how to teach patients skills for effectively refusing offers to use alcohol or drugs, and a role-play is conducted during the session.

This chapter describes session 11 of the COPE therapy. This chapter instructs the therapist to conduct and process the final imaginal exposure. Next, this chapter shows the therapist how to teach the patient effective anger management techniques.

This chapter describes session 10 of the COPE therapy. This chapter instructs the therapist to conduct and process the imaginal exposure. Then, this chapter shows the therapist how to help patients increase their awareness and understanding of anger. The chapter instructs the therapist to review constructive and destructive anger, and triggers for anger (both PTSD- and substance use—related). Finally, this chapter instructs the therapist to teach the patient about daily wellness strategies to help keep anger levels at a minimum.

This chapter describes session 4 of the COPE therapy. This session is dedicated to conducting the first imaginal exposure. The therapist will be guided in this chapter on how to provide the rationale for imaginal exposure, as well as how to conduct and process the imaginal exposure. In addition, the therapist will be guided on how to handle problems that may arise (e.g. under-engagement, over-engagement, avoidance).

Chapter 11 discusses the ninth session of the COPE treatment sessions. This session introduces the concept of seemingly irrelevant decisions (SIDs),which may not involve making a direct choice of whether to use, but can move you one step at a time closer to using. Common SIDs are presented, as well as strategies for recognizing SIDs.

This chapter provides the therapist with introductory information on the program, reviews the COPE treatment and how it works, and discusses what type of patients are most appropriate for the COPE therapy. In addition, it provides the therapist with the diagnostic criteria for post-traumatic stress disorder (PTSD) and substance use disorders.