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Najavits, Weiss, and Shaw (1997) specifically discuss the relationship between PTSD and substance abuse, identifying that "the syndromes appear to be strongly linked. For example, the presence of either disorder alone can increase the risk of developing the other disorder." Najavits et al (1997) also supports the findings that he disorders consistently co-occur across various types of traumas and substances (Keane and Wolfe, 1990; Kofeod, Friedman, and Peck, 1993).

Najavits (2002) also discusses many of the key features of dual-diagnosis PTSD and substance abuse. Most people with PTSD and substance abuse are vulnerable to repeat trauma (Fullilove et al, 1993; Herman, 1992). The risk is found to be greater with dual-diagnosis patients than with those who only have substance abuse issues (Dansky, Brady, and Saladin, 1998). PTSD and substance abuse have also consistently been found to co-occur, regardless of the nature of the trauma or the type of substance use (Keane and Wolfe, 1990; Kofoed et al, 1993).

In Najavits et al (1998), the severity of addiction is compared to trauma and PTSD. The findings of this study demonstrated that a high rate of co-occurring PTSD in patients with substance use disorder (SUD). One study found that 59% of inner-city female drug users had a history of PTSD (Fullilove et al, 1993). Fifty-eight percent of male substance abuse inpatient veterans (Triffleman, 1993), 25% of inpatients in substance abuse treatment (Brown et al, 1995), and 20.5% of cocaine-dependent outpatients (Najavits et a, 1995; Rounsaville et al, 1982; Yandow, 1989). The conclusion drawn by Najavits et al (1998) and these other studies is that the association between PTSD and SUD is definitely clinically significant, "not just because of its frequency but because of the increased treatment difficulties presented by [dual-diagnosis patients]" (p. 3).

Evidence supports that women are increasingly susceptible to PTSD. A study of the link between substance abuse and post traumatic stress disorder undertaken by Najavits et al (1997) also revealed the particularly high rates of dual diagnosis PTSD and substance abuse in women; rates were reported to be between 30% and 59%. It is important to note that none of these articles take complex PTSD into account, thus, if those suffering multiple traumas presenting with the Complex PTSD were included, it is estimated that the statistics would be much higher for women.

The study also found strong links between PTSD diagnosis and histories of repetitive childhood physical or sexual assault among the women featured in the study (Najavits et al, 1997). Instances of dual diagnosis PTSD and substance abuse are two to three times lower among men.

Among women with substance abuse, studies have found frequent histories of childhood physical and sexual assault; the rates range from 32% to 66%: sexual assault, 66% (Miller, Downs, and Testa, 1993); sexual assault and physical assault (Fullilove, Fullilove, Smith, et al, 1993); sexual assault (Grice, Brady, Dustan, et al, 1995); physical or sexual assault (Brady, Killeen, Saladin, et al, 1994); sexual assault and physical assault (Najavits, Gastfriend, Barber, et al, 1995).

Labels: Dual-Diagnosis-Treatment, Post-Traumatic-Stress-Disorder