Monday, February 18, 2008
Dual Diagnosis Post-Traumatic Stress Disorder and Substance Abuse
Dual-diagnosis PTSD and substance abuse has a complex history and position within the field of psychiatry and the context of treatments for mental disorders.
One of perhaps the most relevant studies on dual-diagnosis published by Najavits and Weiss (1999), assessing the clinical characteristics of twenty-eight women with dual diagnosis PTSD and substance abuse compared to the characteristics of twenty-nine women who had only PTSD. The findings demonstrated that the twenty-eight women with dual diagnosis PTSD and substance abuse consistently had "a more severe clinical profile, including worse life conditions (e.g. physical appearance, opportunities in life) both as children and as adults; greater criminal behavior; a higher number of lifetime suicide attempts; a greater number having a sibling with a drug problem; and fewer outpatient psychiatric treatments" (Najavits and Weiss, 1999). The two groups did not differ in the number or type of lifetime traumas, PTSD onset or severity, family history of substance use; coping styles, functioning level, psychiatric symptoms, or sociodemographic characteristics (Najavits and Weiss, 1999).
The findings of this study and a number of other similar studies strongly suggest that severe PTSD leads to substance abuse, PTSD-sufferers with "severe clinical profiles" are at high risk for substance abuse issues, likely brought on as a means of coping with symptoms and issues related to PTSD (Najavits and Weiss, 1999; Back, Sonne, Killeen, Danksy, and Brady, 2003; Mills, Lynskey, Teesson Ross, and Darke, 2005). Najavits et al. (1997) also points out that substance abuse itself, can put a client in situations that are high risk for trauma experiences. Therefore, the substance abuse can facilitate later trauma and PTSD. An example of this may be a woman who has a substance abuse problem, who is then raped after a night of drinking in a bar.
Mills et al (2005), explored the links between post-traumatic stress disorder among people with heroin dependence, documenting the "high rates of psychiatric comorbidity among [heroine addicts], most commonly mood disorders, anxiety disorder, and anti-social personality disorder." Links between these psychiatric conditions and substance abuse have also been identified by other researchers (see Brooner et al, 1997; Darke and Ross, 1997; Darke et al, 1994; Krausz et al, 1998) but only a few studies are identified as having explored the link between PTSD and heroine dependency (Clark et al, 2001; Hien et al, 2000; Milby et al, 1996; Villagomez et al, 1995).
The study undertaken by Mills et al (2005) demonstrated trauma exposure affecting 92% of the study participants, with lifetime PTSD affecting 41% of the study participants. The study also found that PTSD was more common among those in treatment, affecting 52% of those in residential rehabilitation, 42% in maintenance therapies, and 37% detoxification. The study also found that although men and women are both affected by trauma (93% of men and 89% of women reported exposure to traumatic events) women were more likely to develop longtime PTSD. Interestingly, approximately 72% of individuals in methadone maintenance treatment have been exposed to trauma (Clark et al, 2001). Between 14% and 29% have been diagnosed with lifetime PTSD, and 19% and 31% have been diagnosed with current PTSD (Clark et al, 2001; Hien et al, 2000; Milby et al, 1996; Villagomez et al, 1995), although the results of these studies offer only a limited view of the link between heroin use and PTSD outside of methadone maintenance treatment programs in the US (Mills et al, 2005).
One of perhaps the most relevant studies on dual-diagnosis published by Najavits and Weiss (1999), assessing the clinical characteristics of twenty-eight women with dual diagnosis PTSD and substance abuse compared to the characteristics of twenty-nine women who had only PTSD. The findings demonstrated that the twenty-eight women with dual diagnosis PTSD and substance abuse consistently had "a more severe clinical profile, including worse life conditions (e.g. physical appearance, opportunities in life) both as children and as adults; greater criminal behavior; a higher number of lifetime suicide attempts; a greater number having a sibling with a drug problem; and fewer outpatient psychiatric treatments" (Najavits and Weiss, 1999). The two groups did not differ in the number or type of lifetime traumas, PTSD onset or severity, family history of substance use; coping styles, functioning level, psychiatric symptoms, or sociodemographic characteristics (Najavits and Weiss, 1999).
The findings of this study and a number of other similar studies strongly suggest that severe PTSD leads to substance abuse, PTSD-sufferers with "severe clinical profiles" are at high risk for substance abuse issues, likely brought on as a means of coping with symptoms and issues related to PTSD (Najavits and Weiss, 1999; Back, Sonne, Killeen, Danksy, and Brady, 2003; Mills, Lynskey, Teesson Ross, and Darke, 2005). Najavits et al. (1997) also points out that substance abuse itself, can put a client in situations that are high risk for trauma experiences. Therefore, the substance abuse can facilitate later trauma and PTSD. An example of this may be a woman who has a substance abuse problem, who is then raped after a night of drinking in a bar.
Mills et al (2005), explored the links between post-traumatic stress disorder among people with heroin dependence, documenting the "high rates of psychiatric comorbidity among [heroine addicts], most commonly mood disorders, anxiety disorder, and anti-social personality disorder." Links between these psychiatric conditions and substance abuse have also been identified by other researchers (see Brooner et al, 1997; Darke and Ross, 1997; Darke et al, 1994; Krausz et al, 1998) but only a few studies are identified as having explored the link between PTSD and heroine dependency (Clark et al, 2001; Hien et al, 2000; Milby et al, 1996; Villagomez et al, 1995).
The study undertaken by Mills et al (2005) demonstrated trauma exposure affecting 92% of the study participants, with lifetime PTSD affecting 41% of the study participants. The study also found that PTSD was more common among those in treatment, affecting 52% of those in residential rehabilitation, 42% in maintenance therapies, and 37% detoxification. The study also found that although men and women are both affected by trauma (93% of men and 89% of women reported exposure to traumatic events) women were more likely to develop longtime PTSD. Interestingly, approximately 72% of individuals in methadone maintenance treatment have been exposed to trauma (Clark et al, 2001). Between 14% and 29% have been diagnosed with lifetime PTSD, and 19% and 31% have been diagnosed with current PTSD (Clark et al, 2001; Hien et al, 2000; Milby et al, 1996; Villagomez et al, 1995), although the results of these studies offer only a limited view of the link between heroin use and PTSD outside of methadone maintenance treatment programs in the US (Mills et al, 2005).
Labels: Dual-Diagnosis-Treatment, Post-Traumatic-Stress-Disorder, Substance-Abuse
