Traditional PTSD therapy doesn't trigger drug relapse
People with addiction aren't getting effective treatment for PTSD due to incorrect presumptions
July 20, 2020
Science Daily/Johns Hopkins Medicine
Researchers have now demonstrated that behavior therapy that exposes people to memories of their trauma doesn't cause relapses of opioid or other drug use, and that PTSD severity and emotional problems have decreased after the first therapy session.
About a quarter of people with drug or alcohol use disorders also suffer from post-traumatic stress disorder (PTSD), which is typically caused by a traumatic or stressful life event such as rape or combat, and which leaves the person with intense anxiety. However, patients and health care providers have been reluctant to pursue the gold-standard treatment for PTSD -- cognitive behavioral therapy -- because they anticipate that thinking and talking about traumatic events during therapy will cause relapse.
Johns Hopkins researchers have now demonstrated that behavior therapy that exposes people to memories of their trauma doesn't cause relapses of opioid or other drug use, and that PTSD severity and emotional problems have decreased after the first therapy session.
These findings were published June 29 in the Journal of Traumatic Stress.
This work originated from a larger project in which Jessica Peirce, Ph.D., associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, and her colleagues tested how to get often reluctant patients in addiction treatment to participate in PTSD therapy. In a 2017 article in the Journal of Consulting and Clinical Psychology, her team showed that patients with opioid dependence attended on average nine exposure therapy sessions for treating PTSD when given money as an incentive, compared with only one session without the incentive.
Building on this earlier work, for the new study, her team examined week-to-week comparisons of cravings for opioids or other drugs before and after therapy sessions, self-reported days of drug use, and other distress. The researchers found there was no increase in use of opioids or other drugs, or in reported instances of stress after therapy sessions to treat PTSD. By the ninth therapy session, PTSD severity scores decreased, on average, by 54% compared to the first session.
"Now that we have evidence that treating PTSD won't impact recovery, patients can request therapy, and mental health providers have a duty to make it available to their patients," says Peirce. "There is a lot more resilience within this population than many health care providers give them credit for, and not offering the proper treatment is doing patients a disservice."
https://www.sciencedaily.com/releases/2020/07/200720092838.htm
PTSD and Addiction Among Veterans: Causes, Comorbidity, and Treatment
April 2, 2019
By: Cassidy Webb
While the United States is fighting a fatal drug epidemic that is at fault for the deaths of far too many young people, veteran substance abuse continues to pose a growing problem in the nation. As military personnel are returning home from deployment, they are suffering from a vast variety of mental and physical health problems as a result of their experiences. With the comorbidity of co-occurring mental illnesses, such as Post-traumatic Stress Disorder (PTSD), and substance abuse being so prevalent, many veterans are suffering in silence from the progressive, chronic disease of addiction.
PTSD and Veterans
Due to the nature of military service and combat, many veterans are frequently exposed to life-threatening events that can lead to the development of PTSD. When stress is brought on by a traumatic experience, the brain enters a fight or flight response causing the alteration of brain chemicals and heart rate. Adrenaline begins to flow and blood pressure rises. While this response is a natural way for people to protect themselves against harm, those who experience this stress persistently after the danger has passed may have PTSD.
Symptoms of PTSD can begin shortly after the traumatic event occurs and could last a lifetime without treatment. These symptoms can include:
Recall of memories from the event or flashbacks
Difficulty coping with and expressing emotions
May avoid situations that remind them of the traumatic event
Jittery composure or unprecedented anger
Difficulty sleeping
Feelings of hopelessness or despair
Although statistics vary depending on the length of time in the military and the severity of the trauma, there is substantial evidence that veterans suffer from high rates of PTSD. In a study on veterans from Iraq and Afghanistan, it suggests that 14% suffer from PTSD and 39% suffer from alcohol abuse. For Vietnam veterans, rates of PTSD have been found to be as high as 31%. Despite the high necessity for treatment, as many as 50% of veterans who have PTSD do not receive the treatment they need.
PTSD can be a terrifying disorder that is difficult to cope with. For this reason, many veterans turn to alcohol or drugs to cope with their emotions.
Co-Occurring Disorders
The symptoms of PTSD are severe and can cause a lot of emotional distress on those who suffer from it. Unfortunately, many find solace by turning to drugs or alcohol to suppress their emotions and manage their symptoms as drugs and alcohol can increase pleasure, decrease anxiety, and distract an individual from their emotions. The comorbidity of PTSD and drug abuse is so severe that studies have found that nearly 52% of men and 28% of women with PTSD also have a substance use disorder.
While drugs and alcohol may allow individuals with PTSD to cope with their emotions in the short term, this often turns into a pattern of abuse that can lead to an addiction. After a substance is abused over an extended period of time, it becomes harder for the brain to regulate healthy amounts of dopamine. When the substances are suddenly removed, a person may experience a shortage of dopamine resulting in withdrawal symptoms. In turn, using substances to cope with the symptoms of PTSD can actually worsen symptoms. An affected person may suffer from insomnia, impaired judgment, and may engage in risky behaviors such as impaired driving or other illegal, dangerous activities.
Dual-Diagnosis Treatment
The cycle of PTSD and drug abuse is a vicious one if left untreated. On the other hand, if a person seeks treatment but only one condition is treated, they are left highly susceptible to relapse. Fortunately, forms of integrated therapy like dual-diagnosis can help treat both mental illness and substance use disorders simultaneously.
In order to get away from the persistent fight or flight mode that is so common with a PTSD diagnosis, it is important that the individual learns to identify and cope with their PTSD triggers by working closely with psychiatric and addiction specialists. Dual diagnosis therapy will generally consist of different treatment modalities, such as group therapy, individual therapy, cognitive behavioral therapy, and trauma-informed care. Individuals will be encouraged to look at their past and get to the root of their problems as well as learn of healthy coping techniques like deep breathing, meditation, and yoga.
Another benefit of dual diagnosis therapy is that clients will be able to get the right medications, like antidepressants and anti-anxiety drugs, to better treat their mental health. This combination of counseling, support, and medical treatment is typically used to help an individual with co-occurring PTSD and addiction reach a place where they are mentally and physically stable.
Treating addiction hand in hand with mental illness increases the likelihood of maintaining sobriety in the long term, and with the proper diagnosis and medications, symptoms of PTSD can be effectively managed.
Cassidy Webb is an avid writer from South Florida. She advocates spreading awareness on the disease of addiction. Her passion in life is to help others by sharing her experience, strength, and hope. cassidy@recoverylocal.org