Posttraumatic stress disorder and psychological trauma

Abstract

Community and clinical epidemiologic studies indicate that adults and adolescents with -substance use disorders (SUD; especially involving opiates or cocaine) are highly likely (as high as 90% prevalence in treatment-seeking samples) to have experienced psychological trauma at some time in their lives and as much as 11 times more likely than persons who do not have a SUD to meet diagnostic criteria for posttraumatic stress disorder (PTSD). Adults and adolescents with PTSD are as much as 14 times more likely to meet criteria for SUD (including alcohol or other drugs) than those without PTSD. SUD and PTSD may occur prior to the other, but research indicates that it is more likely that SUD develop or are worsened as a result of attempts to cope with PTSD than the reverse. PTSD and SUD also exacerbate and sustain each other over time. An evidence-based screening measure and promising treatments have been developed and preliminarily validated for PTSD in SUD treatment populations, including integrated approaches to simultaneous SUD/PTSD treatment rather than sequential or compartmentalized treatments. Implications for clinical identification and treatment of SUD/PTSD are presented.