Patients suffering from both substance abuse and post traumatic stress disorder are most successfully treated when the two conditions are addressed simultaneously, according to a study by Dartmouth Medical School faculty members published in the October issue of the journal Addictive Behaviors.
Study participants received cognitive behavioral therapy, a psychiatric treatment that changes thought patterns established as a result of the trauma, according to DMS researcher and project coordinator Stephanie Acquilano.
The study examined the effectiveness of a specific form of cognitive behavioral therapy in treating substance addiction and PTSD simultaneously. PTSD is traditionally not addressed until up to a year after addiction treatment, according to the study's principal investigator, DMS professor Mark McGovern.
"I've treated many patients with substance use disorders, and I noticed in my clinical work that many patients had experiences of trauma in their background," McGovern said in an interview with The Dartmouth. "With [trauma experience], their chances of getting better from substance abuse were particularly complicated."
Many people who suffer from PTSD initially turn to substances to avoid their symptoms, McGovern said. When substance abusers attempt to quit, their trauma symptoms "come back with a vengeance," he said.
"Because of the way addiction and PTSD interact with each other, people who have both are less likely to recover from either one," Acquilano said.
Many textbooks advise against treating PTSD at the same time as substance abuse to avoid drawing the patient's attention to the negative emotions resulting from the trauma, McGovern said, adding that recurring trauma symptoms often lead patients to discontinue treatment for substance abuse.
McGovern said, however, that "the best approach is an integrated approach dealing with both at the same time."
Between 25 percent and 42 percent of substance abusers also suffer from PTSD, Acquilano said. In some cases, the trauma resulted from the substance use itself.
Only 27 percent of patients suffered from PTSD immediately following the cognitive behavior therapy treatment, the researchers found. At the three month follow-up, only 20 percent of the patients still reported symptoms of PTSD. The number of patients suffering from substance abuse also decreased, Acquilano said, although the study did not specify by how much.
Patients continued to improve after the three month follow-up because they had learned a set of skills through the cognitive behavior therapy, including relaxation techniques, to help them cope with their disorders, Acquilano said. Patients were also taught about PTSD symptoms, she said.
Since research has already shown cognitive behavior therapy to be an effective treatment for PTSD, the study results were not surprising, DMS professor Janine Scheiner, who was not an author on the study, said in an interview with The Dartmouth.
Scheiner compared the findings of the study to previous findings about the treatment of co-occurring substance addiction and bipolar disorder.
"We used to say that you can't tell if there's a mood disorder unless the patient had been off substances for six to 12 months," Scheiner said. "Once they realized that they had to manage the mood instability, the substance abuse treatment was much more effective."
McGovern plans to expand on the cognitive behavior therapy study by focusing his efforts on a larger group of patients who suffer from both PTSD and substance abuse, Acquilano said.
