Sunday, February 24, 2008
Dual Diagnosis PTSD and Substance Abuse Treatments and Issues / Part 4
A third study of a hundred inner-city outpatient women compared Seeking Safety with relapse prevention treatment (RPT), both in individual format, with a treatment-as-usual (TAU) control condition in a randomized controlled trial (Hien, Cohen, Litt, Miele and Capstick). At the end of treatment, patients in both Seeking Safety and RPT had significant reductions in substance use frequency and intensity, PTSD symptoms, and psychiatric symptom severity, whereas subjects in the TAU comparison group did not show any significant changes. Improvements in PTSD severity were sustained at the six-month follow-up point but not at nine months, for participants in Seeking Safety and RPT. Although statistically significant improvements in substance use and psychiatric severity were not maintained for Seeking Safety or RPT at the six-month follow-up, trends in the direction of lower substance use and psychiatric severity were found.
Finally, a fourth study evaluated a combination of Seeking Safety and exposure therapy for PTSD in a sample of five men (Najavits, Weiss, Shaw, and Muenz). Significant improvements were found in drug use, family and social functioning, trauma symptoms, anxiety, dissociation, sexuality, hostility, overall functioning, meaningfulness, and feelings and thoughts related to safety. Treatment attendance, satisfaction and alliance were very high.
Najavits (2000) contends that Seeking Safety is designed to treat PTSD and substance abuse at the same time. An integrated model is recommended by experts as more likely to succeed, more sensitive to patient needs and more cost-effective than sequential treatment of the disorders. It also is preferred by patients. Yet, many treatment systems for substance abuse and mental health remain separate, leaving patients to integrate treatment themselves. In correctional settings, adding Seeking Safety treatment to existing programming appeared to work well.
It is important to note that integration in Seeking Safety means attention to both disorders in the present. It does not mean asking patients to discuss their pasts in detail. Despite the known efficacy of trauma processing for PTSD, such work may not be safe for substance abusers until they have achieved a period of stable abstinence and functionality. Correctional settings, in particular, may be unsafe, as inmates may be destabilized by such treatment. In Seeking Safety, integrated treatment means helping patients understand the two disorders and why they so frequently co-occur; teaching safe coping skills that apply to both; exploring the relationship between the two disorders in the present, such as using a substance to cope with flashbacks; and helping patients understand that healing from each disorder requires attention to both.
For example, the topic "honesty" combats denial, lying and the "false self." "Commitment" is the opposite of irresponsibility and impulsivity. "Taking good care of yourself" is a solution for the bodily self-neglect of PTSD and substance abuse. The language throughout emphasizes values such as respect, care, integration and healing. By aiming for what can be, the hope is that patients can summon the motivation for the hard work of recovery from both disorders. (Najavits, 2000)
While originally designed as a cognitive-behavioral intervention, the treatment was expanded to include equally strong attention to interpersonal and case management issues. Interpersonal topics now comprise one-third of the sessions, and case management begins in the first session and is addressed at every subsequent session throughout treatment. The interpersonal domain is an area of special need because PTSD most commonly arises from traumas inflicted by others, both for women and men. Interpersonal issues include when to trust others and how to avoid re-enactments of abusive power, both as victims and perpetrators. Similarly, substance abuse often is initiated and encouraged in negative relationships. The case management component of the treatment helps patients obtain help with problems such as housing, job counseling, HIV testing, domestic violence and child care.
Finally, a fourth study evaluated a combination of Seeking Safety and exposure therapy for PTSD in a sample of five men (Najavits, Weiss, Shaw, and Muenz). Significant improvements were found in drug use, family and social functioning, trauma symptoms, anxiety, dissociation, sexuality, hostility, overall functioning, meaningfulness, and feelings and thoughts related to safety. Treatment attendance, satisfaction and alliance were very high.
Najavits (2000) contends that Seeking Safety is designed to treat PTSD and substance abuse at the same time. An integrated model is recommended by experts as more likely to succeed, more sensitive to patient needs and more cost-effective than sequential treatment of the disorders. It also is preferred by patients. Yet, many treatment systems for substance abuse and mental health remain separate, leaving patients to integrate treatment themselves. In correctional settings, adding Seeking Safety treatment to existing programming appeared to work well.
It is important to note that integration in Seeking Safety means attention to both disorders in the present. It does not mean asking patients to discuss their pasts in detail. Despite the known efficacy of trauma processing for PTSD, such work may not be safe for substance abusers until they have achieved a period of stable abstinence and functionality. Correctional settings, in particular, may be unsafe, as inmates may be destabilized by such treatment. In Seeking Safety, integrated treatment means helping patients understand the two disorders and why they so frequently co-occur; teaching safe coping skills that apply to both; exploring the relationship between the two disorders in the present, such as using a substance to cope with flashbacks; and helping patients understand that healing from each disorder requires attention to both.
For example, the topic "honesty" combats denial, lying and the "false self." "Commitment" is the opposite of irresponsibility and impulsivity. "Taking good care of yourself" is a solution for the bodily self-neglect of PTSD and substance abuse. The language throughout emphasizes values such as respect, care, integration and healing. By aiming for what can be, the hope is that patients can summon the motivation for the hard work of recovery from both disorders. (Najavits, 2000)
While originally designed as a cognitive-behavioral intervention, the treatment was expanded to include equally strong attention to interpersonal and case management issues. Interpersonal topics now comprise one-third of the sessions, and case management begins in the first session and is addressed at every subsequent session throughout treatment. The interpersonal domain is an area of special need because PTSD most commonly arises from traumas inflicted by others, both for women and men. Interpersonal issues include when to trust others and how to avoid re-enactments of abusive power, both as victims and perpetrators. Similarly, substance abuse often is initiated and encouraged in negative relationships. The case management component of the treatment helps patients obtain help with problems such as housing, job counseling, HIV testing, domestic violence and child care.
Labels: Dual-Diagnosis-Treatment, Post-Traumatic-Stress-Disorder, Substance-Abuse
