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The importance of providing trauma-informed care in the context of AOD treatment is now well recognised. Due to the inter-relatedness of PTSD and AOD use, an integrated approach to the treatment of these disorders is recommended. Several psychotherapeutic interventions have been developed for the treatment of comorbid PTSD and AOD use; but few have undergone rigorous evaluation. The evidenceto date suggests that individual past-focused psychological interventions delivered alongside AOD treatment show most promise. There is little evidence to support the use of present-focused individual or group-based interventions. Findings from pharmaceutical trials indicate that pharmacotherapies (SSRIs in particular) may be a useful adjunctive treatment if sufficient benefit has not been gained from psychological interventions. E-health interventions, physical exercise and yoga also appear to convey benefit among individuals with PTSD; however, further research is needed to determine efficacy in PTSD populations and individuals with comorbid AOD use disorders in particular.

Box 19 illustrates the continuation of case study G, following Emily’s story after identification of her PTSD disorder was made.

Box 19: Case study G: Treating comorbid PTSD and AOD use: Emily’s story continued

While Emily was an inpatient, the psychologist took the opportunity to talk with her a little more about her past trauma, continuing to normalise her symptoms, providing psychoeducation and self- management techniques, and exploring the relationship between her trauma-related symptoms and her substance use. The psychologist suggested that Emily might like to try a residential rehabilitation program for women only, where her trauma-related symptoms could also be addressed. Emily had previously been reluctant to enter residential rehabilitation but she had not ever heard of a women’s- only service.

The psychologist organised for a telephone assessment with the residential program, and Emily entered the program following her detoxification. While the program was hard, Emily benefited greatly from the trauma-informed approach taken by the service. Importantly, Emily felt safe and over time gradually opened up more about her life. She engaged in a combination of group and individual therapy. Her individual therapy in particular focused on providing integrated treatment for both her PTSD and AOD use.

It was during one of these sessions that Emily made a link between the onset of her substance use and previous traumatic events. Unbeknownst to the therapist or any other treatment provider, Emily had been sexually abused by a male relative from the age of 5 to 11 years when she left home to live with her grandparents. Emily drank cough medication when she was little as it made her feel good when she was upset. She also reported using her father’s Valium. After moving to her grandparents’ house, which also involved a change of schools, she starting hanging out with new friends who liked to drink and smoke cannabis. Her substance use and truancy from school caused continual fights with her grandparents, who threw her out when she was 16 years old. Emily quit school and moved into a shared house with people who introduced her to heroin around age 17. Within a year she had developed a ‘habit’.

As Emily’s treatment progressed, she began to open up about numerous assaults, including rapes, which had occurred in the context of the drug-using environment, but did not report any PTSD symptoms in relation to these experiences. While she was clean she was also involved in a car accident. She suffered major injuries and was not able to get into a car for 2 ½ years. She reported residual trauma symptoms, and had previously worked with a psychologist on this. Her therapy continued to concentrate on the domestic violence, for which she was currently experiencing the most distress, and later the sexual abuse she experienced as a child. Emily was aware that it would likely take a long time for her to come to terms with what she had experienced. Emily successfully completed the residential rehabilitation program, and continued to receive ongoing psychological treatment for her PTSD and substance use.

Key points

  • Symptoms of PTSD and other mental disorders may only become apparent during AOD treatment.
  • Many clients have experienced multiple traumas and re-victimisation.
  • It is recommended that treatments for PTSD and AOD use should be carefully integrated.