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Treatment of Comorbid PTSD and Substance Abuse Shows Support of the Self-Medication Model

By Michael Constantino and Jeffrey Magnavita.

Summary

In an RCT study of 353 women assigned to either 12 sessions of trauma-focused or health education group treatment the researchers found that PTSD severity reductions were more likely associated with substance use improvement whereas minimal reduction in PTSD was found with substance use reduction (Hein et al., 2010). These findings have important implications because of the high rate of comorbidity between PTSD and substance abuse (Back, 2010). These findings also support earlier research. This research calls into question the commonly held assumption that abstinence from substances should be gained before undertaking exposure therapy. The previously held assumption that beginning trauma therapy before reduction or elimination of substance use will lead to an increase in substance use has not been borne out.

Clinical Implications

The evidence suggests that when treating comorbid PTSD and substance use the clinicians should actively initiate integrated treatment to address the PTSD actively while working on the substance abuse.

References

Hein, D. A., Jiang, H., Campbell, A. N., Hu, M-C et al. (2010). 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, 167(1), 95-101.

Back, S. E. (2010).  Toward an improved model of treating co-occurring PTSD and substance use disorders. American Journal of Psychiatry, 167(1), 11-13.