Oral Papers: Addiction, Pain, & Transplant I
Alcohol related liver disease (ALD) is a common indication for liver transplantation (LT) in the US. Due to the incidence of drinking after transplant (nearly 50% of organ recipients) identification of risk and protective factors for alcohol use is essential. Past studies have focused on demographic and psychosocial variables without considering the impact of the transplant experience on future alcohol use patterns. Studies have demonstrated 3-15% of all organ transplant recipients experience post-traumatic stress disorder (PTSD) symptoms after surgery. Conversely, some patients report a greater appreciation for life and newfound strength and priorities, after transplant. (Tedeschi 2004, Fox 2014) This “post-traumatic growth” (PTG) may be associated with a stronger commitment to health goals. (Fox 2014) We are investigating the potential correlation between PTSD, PTG, and alcohol use outcomes one year after ALD LT.
Methods: Patients complete a survey one year after transplant, with standardized, validated measures, including the Perceived Stress Scale (PSS), PTSD Symptom scale, Alcohol Abstinence Self Efficacy Scale (AASE), and PTG Inventory. Patients also complete a calendar measure of alcohol consumption in the year since LT. PTSD and PTG items are anchored to the transplant experience.
Results: 42 patients (of projected sample n=50) have been recruited (88% completed the survey), resulting in descriptive data from 37 predominantly male (81%) patients, median age 60 years, 73% with spouse/partner. 27% had PTSD composite scores >23, representing a “probable PTSD diagnosis”. 49% had PSS scores >20, indicating high stress. The average AASE item response was 4.7 (1=no confidence, 5=extremely confident), indicating a majority felt “extremely confident” to not drink. The median PTG composite score was 72, corresponding to a moderate/great degree of PTG. 22% of patients endorsed “thoughts or urges to drink”, but only 11% (4 patients) reported alcohol consumption. Alcohol use began >4 months post-transplant and ranged from 5-23 total drinks. Two patients resumed regular alcohol-use patterns. Upon reaching the target sample size (n=50) we hope to investigate any meaningful difference between alcohol-use and abstinence in terms of PTSD, PTG, and PSS scores.
Discussion/Conclusion: Preliminarily, our cohort demonstrates both high perceived stress and high PTG. PTSD symptomatology was more prevalent than expected (3-15% in previous studies). Responses indicate high alcohol abstinence confidence, despite some urges to drink. Fewer individuals endorsed drinking than anticipated based on past studies, possibly due to self-report without collateral data. Future analyses on a complete sample will determine correlations between PTSD, PTG, and alcohol use in a LT for ALD cohort.
1.) Tedeschi, RG. & Calhoun, LG. (2004) Posttraumatic Growth: Conceptual Foundations and Empirical Evidence, Psychological Inquiry, 15(1):1-18
2.) Fox KR, Posluszny DM, DiMartini AF, et al. (2014). Predictors of posttraumatic psychological growth in the late years after lung transplantation. Clinical Transplantation, 28(4): 284-393.