TREATMENT OF PTSD AND SUBSTANCE ABUSE COMORBIDITY

Approximately 50% of individuals in inpatient substance abuse treatment centers will also meet criteria for comorbid PTSD (Brown et al., 1999). This combination of disorders has severe consequences for the individual in terms of course, symptom severity, and effectiveness of treatment. When working with a PTSD-SA population, there are several forms of substances which are more likely to be abused when compared to substance users that do not meet criteria for PTSD. Furthermore, these substances appear to be related to the specific symptoms pattern exhibited by the individual (Stewart, Conrod, Pihl, & Dongier, 1999). Research also indicates that some symptoms of PTSD are more likely than others to elicit substance use in general (Sharkansky, Brief, Peirce, Meehan, & Mannix, 1999). Additionally, the negative impact that substance use relapse risk situations have on an individual may further interfere with the individual's ability to cope effectively with the symptoms of PTSD, which would lead to an increase in both PTSD and SA symptoms/behaviors (Sharkansky et al., 1999). The combination of PTSD-SA also poses several barriers to effective treatment. Some of these barriers are based on clinical lore, and have not undergone the rigorous empirical testing pivotal in the field of psychology. Other barriers have been supported in the empirical field, and these must be addressed in order for treatment to be effective. Post-traumatic Stress Disorder Post-traumatic Stress Disorder (PTSD) was first recognized by the American Psychiatric Association as a diagnosable condition in 1980 when it was introduced into the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DMS-III) (American Psychiatric Association, 1980). Since that time, PTSD etiology, symptomology, and treatment have been extensively studied. PTSD is defined as the development of three categories of symptoms following exposure to a traumatic event in which the individual both (1) came into contact with an event that involved actual or threatened death or serious injury to self or others, and (2) responded to this event with intense fear, helplessness, or horror (American Psychiatric Association, 2000). In essence, exposure to a traumatic event is not sufficient to warrant a diagnosis of PTSD. The subjective, emotional experience of the individual in the aftermath of the trauma must also be taken into account (APA, 2000). The three clusters of symptoms that classify PTSD are reexperiencing, avoidance and numbing, and hyperarousal. Each of these symptom clusters is distinct and affects different areas of psychological functioning. Additionally, disturbances in each category can give rise to comorbid diagnoses associated with that cluster of symptoms that will further disrupt the individual's level of functioning (Taylor, 2006). Lastly, the DSM-IV-TR (2000) states that the symptoms must occur for a minimum of one month and cause clinically significant distress and impairment in several areas of functioning. The first cluster of symptoms, reexperiencing, refers to the persistent emergence of thoughts and feelings associated with the traumatic event. This can occur in several modalities. These include intrusive images, distressing nightmares, acting and feeling as if the event were occurring again, and psychological distress and/or physiological reactivity when confronted with reminders of the traumatic event (American Psychiatric Association, 2000). The second cluster of symptoms, avoidance and numbing, involves both the persistent avoidance of stimuli associated with the trauma and the numbing of general responsiveness that was not characteristic of the individual prior to the trauma (American Psychiatric Association, 2000). Examples of avoidance include all efforts to keep oneself from coming into contact with thoughts, feelings, conversations, activities, places, or people that remind the individual of the trauma. …