Many survivors of complex trauma meet the criteria for other diagnostic categories as well. Trauma related disorders like PTSD and substance abuse frequently co-exist, for example. Historically, clients may have had to choose between focusing on trauma or substance abuse before receiving treatment for the other issue. Some therapists and treatment programs believe that people need to get clean and sober before they can do other therapy work. In my experience, many trauma survivors develop substance abuse problems in attempts to cope with their trauma symptoms. Alcohol or drug abuse becomes a way of trying to self-medicate. It has always seemed unrealistic to me to expect trauma survivors to put down their coping mechanisms, even those that are unhealthy, prior to developing alternatives.
This study (found at Belleruth Naparstek’s Blog) supports the idea that treating trauma first is important and effective in terms of also decreasing substance abuse:
Reduced PTSD Symptoms Lead to Reduced Substance Abuse, but Not the Other Way Around
A new study from researchers at C.C.N.Y. (City College of New York) examined the connection between improvements in posttraumatic stress and improvement in substance abuse over the course of time in 353 women diagnosed with both conditions.
Participants were randomly assigned to 12 sessions of either trauma-focused treatment or health education. Assessments were made on the PTS and the substance use during treatment at 1 week and posttreatment after 3, 6, and 12 months.
Subjects showing no improvement, an improvement in the substance use only, or a total, global improvement early on, tended to maintain their original diagnosis over time; but subjects initially exhibiting improvement in their PTSD symptoms were significantly more likely to transition into a global response over time, indicating that they maintained their PTSD improvement, and that it was associated with subsequent improvements in substance use.
Additionally, trauma-focused treatment was significantly more effective than the health education method in achieving substance use improvement, but only among those who were heavy substance users at baseline and had achieved significant PTSD reductions.
This study concludes that reductions in PTSD severity were more likely to be associated with substance use improvement, but that it did not work the other way around: reductions in substance abuse did not lead to improved PTSD symptoms. These results support the self-medication model of coping with PTSD symptoms, and an empirical basis for integrated interventions for improved substance use outcomes in patients with severe symptoms.
Citation: Hien DA, Jiang H, Campbell AN, Hu MC, Miele GM, Cohen LR, Brigham GS, Capstick C, Kulaga A, Robinson J, Suarez-Morales L, Nunes EV. Do treatment improvements in PTSD severity affect substance use outcomes? A secondary analysis from a randomized clinical trial in NIDA’s Clinical Trials Network. American Journal of Psychiatry. 2010 Jan; 167(1):95-101.