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dcyphr | Clinical challenges in the treatment of patients with posttraumatic stress disorder and substance abuse

Abstract 

The aim of this article is to review the prognosis and existing treatments for co-occurring PTSD and Substance-Use Disorder (i.e., Alcohol Use Disorder). PTSD and substance-use disorder (SUD) often occur together (25-50% in clinical populations), spelling out worse outcomes for patients and more challenges for clinicians. 

Introduction

The prevalence of PTSD varies by sample, but there is a strong co-occurrence between the two disorders. People with lifetime PTSD have much higher chances of also having lifetime SUD. There is also an elevated association between ‘harder’ substance-use disorder (i.e., amphetamine) and PTSD than ‘softer’ substance-use disorder (i.e., alcohol). Many explanations exist for the relationship and high co-occurrence of PTSD/SUD, but the one receiving the most support is that PTSD has a strong influence over developing a substance-use disorder. This does not mean that their relationship is not highly complex and that both disorders act on each other. Patients with PTSD/SUD have worse physical and psychiatric symptoms than those with only one disorder. For example, PTSD/SUD patients are more likely to also have major depression and anxiety disorders. Thus, these patients experience many other psychological issues that make them complex to treat. 

Psychotherapy Treatment

Only treatments with at least one published study and tailored specifically to PTSD/SUD patients were assessed. 


Seeking Safety

So far, this is the only model shown to be effective. It focuses on the present, providing 25 topics to teach coping skills for both disorders.


Concurrent treatment of PTSD and cocaine dependence

This is a 16-session therapy that combines effective treatments for PTSD and SUD. An example would be combining Cognitive Behavioral Therapy (CBT) and Exposure Therapy for SUD and PTSD, respectively. 


Transcend

This is a 12-week program in which veterans are partially hospitalized together and go through CBT, 12-step models, constructivist (learning through experience), and psychodynamic therapies (focusing on unconscious processes). 


Substance dependence PTSD therapy

This is also known as assisted recovery from trauma and substances (ARTS) and employs the same strategies as concurrent treatment of PTSD and cocaine dependence, but is instead 40 sessions. 


Collaborative Care

This is a prevention model aimed at those affected by trauma that resulted in medical injury. It functions to prevent at-risk individuals from developing PTSD and SUD. 

Pharmacological Treatment  

Few studies have examined pharmacological treatments for PTSD/SUD. One study suggests that naltrexone and disulfiram are safe medications that can be clinically applicable to patients suffering from PTSD and alcohol dependence. 

Conclusion 

PTSD and substance-use disorder frequently co-occur, having devastating effects on patients. More research is needed on treatments for this as well as how the two disorders influence each other.