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 co-occurring PTSD and AOD use. The evidence to date suggests that individual past-/trauma-focused psychological interventions delivered alongside AOD treatment are more efficacious than those that are present-/non-trauma focused. It is, however, important that both options be considered in the context of tailoring a person’s treatment to their individual needs and preferences. 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, yoga and music therapy also appear to convey benefit; however, further research is needed to determine efficacy in PTSD populations and people with co-occurring AOD use disorders in particular.
Box 20 illustrates the continuation of case study G, following Julie’s story after identification of her PTSD disorder was made.
Box 20: Case study G: Treating co-occurring PTSD and AOD use: Julie’s story continued
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Case study G: Julie’s story continued
The AOD worker organised for Julie to speak with one of the team’s psychologists. Over a series of sessions with her treating psychologist, Julie began to talk more about how the traumatic events in her life had affected her. She reported a mix of re-experiencing, avoidance and hyperarousal symptoms in relation to both the physical and sexual assaults she had experienced as a child and as an adult and became visibly upset - at times shaking - when she discussed the events. It also became apparent that Julie felt a great deal of guilt, shame and self-blame surrounding the events.
Throughout treatment, the psychologist continued to normalise Julie’s symptoms, providing psychoeducation and self-management techniques, and was able to explore the relationship between Julie’s trauma-related symptoms and her substance use. Julie was also able to recognise how these events had played a deciding role in how she viewed herself and others, and her relationships. Although distressing, over time Julie recognised that addressing these issues would be an important part of her treatment and worked with her psychologist on deciding on an evidence-based approach that she felt comfortable with. Julie struggled to reduce her substance use during this time and with the support of the psychologist, decided to commence opiate substitution therapy to further support her in reducing her substance use whilst still undertaking sessions with her psychologist. Both Julie and her psychologist were aware that it may take time, but they would both work together to help her work through the traumatic events she had experienced to achieve her long-term treatment goals.
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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.