Posttraumatic Stress Disorder and Substance Abuse Clinical Issues

Alcohol abuse in individuals exposed to trauma: A critical review.

“…Information regarding the individual's use of alcohol before and after the trauma should be obtained. The frequency of drinking occasions and quantity of alcohol used per occasion (e.g., Vogel-Sprott, 1983 ), frequency of drinking to intoxication (e.g., , situational triggers for drinking (e.g., Annis, Graham, & Davis, 1987;Carrigan & Stewart, 1995;Stewart, 1995b), and self-perceived drinking motives (e.g., Cooper et al, 1992;Stewart & Zeitlin, 1995;Stewart, Zeitlin, & Samoluk, 1996) should be assessed, as should any areas of functioning (i.e., social, occupational, and physical) that have been adversely affected through heavy alcohol use (Nace, 1988 ). There are several interviews available for diagnosing alcohol abusedependence (for a review, see Jacobson, 1989).…”

“…There are several problems inherent in this viewpoint. Independent of etiological factors, once the abusive drinking has begun, the alcohol disorder may take on a life of its own (Brinson & Treanor, 1989;Hurley, 1991;Nace, 1988;Pihl & Stewart, 1991 ). Thus, discontinuing abusive drinking, even following PTSD symptom management, is difficult for these individuals.…”

“…Some experts recommend treating the alcohol disorder first (e.g., Bartucci & Stewart, 1986;Brinson & Treanor, 1989;Nace, 1988;Schnitt & Nocks, 1984;Skorina & Kovach, 1986). Barlow (1988), for example, suggested that the efficacy of psychological treatments for anxiety may be diminished when patients are concurrently taking arousal-dampening drugs, such as alcohol.…”

The Comorbidity of Post-Traumatic-Stress Disorder (PTSD) and Substance Use Disorders

“…Historically, psychosocial treatment approaches for individuals with PTSD and SUDs have adhered to the sequential treatment model, in which the SUD is treated first and trauma work is deferred until a period of sustained abstinence (e.g., 3-6 months) has been achieved (Schnitt and Nocks 1984;Nace 1988). This generally entails two separate providers (i.e., one provider addresses SUD and another addresses PTSD) in two separate clinics with little cross-communication.…”

Neurowissenschaften und Traumatherapie

“…Diejenigen Patienten, die Therapien für beide Störungen erhalten, erhalten diese meist sequentiell: zunächst eine Drogentherapie, dann, meist mit einem anderen Therapeuten und noch öfter in einer anderen Klinik, die PTBS-Therapie. Befürworter dieser sequentiellen Therapie führen an, dass weitergeführter Drogenkonsum während der Therapie diese behindere und/oder dass PTBSTreatment zu anstrengend für die Klienten sei und Rückfälle induziere (Nace, 1988;Pitman et al, 1991). Es gibt weder Daten zur Unterstützung dieser Annahme, noch gibt es empirische Daten, die die Effektivität des sequentiellen Modells allein oder im Vergleich zu anderen Treatment-Modellen stützen.…”