There is a large body of research indicating that people with PTSD are significantly more likely to be diagnosed with a co-occurring substance use disorder. Post Traumatic Stress Disorder (PTSD) and substance abuse among military vets is known but anyone that suffered an emotional or physical trauma are at risk. There is some support for a potential relationship between substance use . CBT to individual addiction counseling among 53 individuals with PTSD and SUD.
Severe natural disaster, such as a tornado, hurricane, earthquake, etc.
Terrorism-related event Again, it is not necessary for an individual to actually be the victim of one of these situations. A Complicated Disorder This disorder has included a number of different changes in its conceptualization. Early on, the disorder was considered to only develop as a result of direct experience in some traumatic event, such as combat or attempted rape. As clinicians and researchers became more aware of the symptoms of the disorder, it was learned that individuals who experienced harrowing accidents or who were involved in natural disasters also sometimes displayed the symptoms associated with the disorder.
The disorder was also historically classified as an anxiety disorder — a disorder where the primary symptoms displayed by individuals who have it are related to anxiety.
- What Is Post-Traumatic Stress Disorder?
- Overview of PTSD and Substance Use Disorders
- Correlation between Stress, Drug Use, and Addiction
Research into PTSD and related disorders indicated that anxiety was indeed one of the major symptoms that occurred in individuals diagnosed with these disorders; however, there were a number of other symptoms, such as depression, dissociation, anger, cognitive issues, etc. As a result, PTSD is no longer considered to be primarily a manifestation of dysfunctional anxiety, but instead is considered to be a complicated and severe mental health condition that represents the interplay of many different processes.
Because this is a complicated disorder, clinicians diagnosing it need to understand the symptom profile of the disorder and the complete presentation and history of the person who is being considered for the diagnosis. There are no formal medical tests, such as laboratory tests or neuroimaging scans, that can diagnose PTSD. Instead, clinicians must evaluate the person based on their behaviors. The information used to diagnose a person is often gleaned from the person themselves and individuals close to the person.
Because the diagnostic process for psychiatric disorders requires understanding the intricacies of human behavior, significant training and supervision are required for clinicians to be able to accurately diagnose these conditions.Understanding the Relationship Between PTSD and Addiction - Sierra Tucson
According to the current diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders — Fifth Edition DSM-5 released by APA, the general presentation of PTSD includes the following types of symptoms These are not the specific diagnostic criteria but represent signs and symptoms based on the formal diagnostic criteria.
Exposure to a potentially fatal situation, serious injury, or sexual violence, either by directly being involved in the event, witnessing the event as it occurs to others, learning that the event has happened to someone close, or being repeatedly exposed to the details of traumatic events, such as medical personnel, police officers, firefighters, etc.
This is the only required sign; other signs may or may not be present but a person must express a specific number of them. Experiencing significant anxiety when one is reminded of details of the event Having repeated recollections or lucid reexperiences of the event, such as nightmares, intrusive thoughts, actual flashbacks, etc.
Feeling isolated and detached from other people Feeling as if things are not real being detached from reality Repeated attempts to avoid things that remind the person of the traumatic event Constantly lacking motivation Being unable to experience pleasure in situations that once brought pleasure Experiencing significant mood swings Continually experiencing negative emotions, such as irritability, restlessness, anxiety, depression, etc. Continued efforts to isolate oneself from contact with others Feeling suicidal or engaging in self-harm, such as cutting oneself Engaging in other self-destructive behaviors, such as substance abuse, numerous instances of unprotected sex, etc.
The formal diagnosis of PTSD in children under the age of 6 is based on alterations of the formal diagnostic criteria that are age-appropriate. The symptoms that the individual expresses must not be better explained by some other medical condition, a substance abuse, or some other mental health disorder.
Treatment of Co-occurring Posttraumatic Stress Disorder and Substance Use Disorders
Individuals need to display several symptoms from different categories in order to receive a formal diagnosis, and the symptoms must have been present for more than one month. Individuals presenting with similar symptoms that have not been present for at least one month are diagnosed with acute stress disorder, which may or may not develop into a formal PTSD diagnosis.
The diagnosis can be made in situations where the symptoms do not occur for six months or longer after the exposure to the event termed PTSD with delayed expression. While it appears that the specific type of traumatic event one experiences is not a justifiable criterion to diagnose specific subtypes of PTSD based on the symptom profile e.
Again, it should be noted that most individuals have these experiences from time to time. The diagnosis of a formal disorder requires these experiences to be relatively frequent to the point of being almost constant and fixed.
The obvious answer to this question is that individuals who witness, learn of, or experience traumatic events may develop PTSD.
However, the vast majority of individuals with these experiences do not develop the disorder. Thus, while some type of exposure to a potentially traumatic or stressful event must be present before one can be considered for a diagnosis of PTSD, simply having this exposure is not sufficient for the diagnosis to be made.
An analogy might be to keep your foot on the gas pedal without letting up. Sooner or later the engine will begin to burn out. A sizeable portion also go on to develop an addiction. The Role of Addiction in PTSD Chemical dependency is often described as an attempt at self-regulation, not so terribly different from self-injury other types of trauma-related impulsive behavior.
From this perspective, we come to see that addiction is a result of an attempt to ward off the intrusive memories, smooth out hypervigilance, and disconnect from anxiety. When alcohol or drugs are used to manage PTSD symptoms, the symptoms of the disorder only become more severe. As a central nervous system depressantalcohol and opiates can worsen depression and anxiety and interfere with normal sleep patterns.
We might mistakenly believe that treating the trauma will stop the alcohol and drug abuse. However, addiction may continue to persist given that the substance has hijacked our reward systemcausing us to develop enduring tolerance need more of the substance to get the same effect and withdrawal physical consequences and discomfort when substance use stops symptoms.
Treatment of Co-occurring Posttraumatic Stress Disorder and Substance Use Disorders
Similarly, trauma issues should always be addressed concurrently in addiction recovery, given that the presence of trauma symptoms makes substance abuse much more likely. Successful recovery requires clients to understand how the addictive substances have helped them survive: We need to know this because the trauma symptoms will increase when we enter sobriety, and we will need coping strategies to manage the triggers of PTSD when they appear.
Relapse prevention plans must create strategies to manage both addiction and PTSD symptoms and triggers. Psychoactive medicationif necessary, to address hyperarousal. However, the sample size was limited, and there was no control condition. However, there was no assessment of substance use outcomes, the treatment groups were not randomly assigned, and the comparison condition was a waitlist. TAU consisted of twice weekly abstinence-based recovery groups and a variety of other groups and individual appointments as deemed necessary by the patients and treatment providers.
The SS condition consisted of the same treatment approach with the exception of the recovery groups being replaced by SS groups. Following treatment, there were no group differences in PTSD symptoms or alcohol use; however, participants in SS reported fewer days of illicit drug use compared with TAU, as well as better treatment attendance and satisfaction.
It should be noted that TAU recovery groups were conducted by individuals with a bachelor's or master's degree, while SS groups were conducted by a Ph. Taken together, SS has evidenced limited benefit above and beyond TAU conditions among studies with more rigorous methodologies and should likely not be considered a stand-alone treatment for individuals suffering from co-occurring PTSD-SUD.
Transcend is a week eclectic, partial hospitalization program for veterans that includes concepts from psychodynamic, cognitive behavioral therapy CBTand step treatment programs.
Results from the study must be interpreted with caution since there was no control group employed in the design and no follow-up studies have been conducted to our knowledge [ 48 ]. Integrated CBT is an 8—12 session protocol that includes modules such as breathing retraining, PTSD psycho-education, and CBT coping skills eg, relapse prevention, cognitive restructuring [ 49 ]. It is worth noting that treatment completion was significantly better in the individual addiction counseling condition.
Both treatments were delivered by trained community counselors with master's level degrees or lower, which may speak to the dissemination potential for Integrated CBT [ 50 ]. With regard to SS, results of randomized controlled trials have indicated that it is not more effective than relapse prevention or healthy living interventions alone; therefore, pursuing dissemination or further in depth study of SS is likely not warranted, given more promising results of other treatment approaches.
The therapist then instructs the client on breathing retraining, a relaxation skill enabling clients to regulate their physiological arousal and distress following exposure sessions. Exposure consists of both in vivo and imaginal exposure. Finally, imaginal exposure consists of clients repeatedly recounting their most bothersome trauma to the therapist in the present tense for 45—60 minutes without stopping. The imaginal exposure sessions are audiotape-recorded, and clients listen to the recordings daily.