PTSD and Dual Diagnosis

Posted on September 27th, 2010
Posted in PTSD

Post-traumatic Stress Disorder, or PTSD, is an Anxiety Disorder caused by exposure to a traumatic event. It is characterized by symptoms of hyperarousal, re-experiencing of the trauma, emotional numbing and efforts to avoid reminders of the adverse events. PTSD can be a brief and acute condition or a more chronic and persistent one.
 

Considered a reaction to overwhelming stress, individuals with PTSD have levels of anxiety that are significant and problematic. Symptoms can be severe enough to impair daily functioning to the point of disability. Mild to moderate symptoms can cause discomfort or distress impactful enough to interfere with important activities of daily life. Some of these symptoms of Posttraumatic Stress Disorder are:

• distressful memories
• intrusive thoughts
• flashbacks
• nightmares
• sleep disturbance
• appetite disturbance
• fear
• anxiety
• panic
• withdrawal
• clinging to others
• agitation
• disorganization
• dissociation
• lack of memory
• poor concentration
• irritability
• distractibility
• depression
• tachycardia
• profuse sweating
• emotional numbing
• loss of a sense of reality

Co-occurring Disorders

Depression and Substance Disorders are common conditions that individuals with PTSD also experience. Since symptoms of PTSD can cause significant life changes until they are managed and resolved, many with PTSD become depressed and/or seek relief in substance use. In addition, some with PTSD will have experienced losses and related grief during the trauma that caused PTSD. While loss may be of a loved one, traumatic events can also incur losses in property, employment, relationships, self-image and the ability to trust, have intimacy and otherwise cope with daily life. Some will lose spiritual beliefs and faith as a result of trauma. These types of changes can be profound. Substance use is often used to cope with not only the symptoms of PTSD, but also the changes in one’s life due to adverse events.

Unresolved trauma, loss, grief and alterations in functioning in daily life often contribute to the development of a clinical depression as well.

Substance Disorders and PTSD

The relationship between Substance Disorders and PTSD is often intricate and profound. Some who have experienced trauma and PTSD find a partial relief from symptoms in substance use. There are also a significant number of people with PTSD who develop problematic substance use after experiencing trauma. Many who seek substance recovery find that in sobriety they have distressful and sometimes unmanageable trauma symptoms. These may have returned or, in some cases, if low level symptoms were experienced during substance use, they may worsen with sobriety. For those who seek substance recovery after a period of ‘self-medicating’ PTSD symptoms, it is important to also seek simultaneous treatment of PTSD. Since many will experience an uncomfortable sobriety as symptoms intensify without the use of substances, unsuccessful efforts to detox are possible if PTSD is not treated simultaneously. Re-emerging or worsening symptoms of PTSD can also place a newly sober person at significant risk for relapse.

Trauma-Informed Care

Since some with the dual disorders of PTSD and substance abuse or dependence continue to have problematic symptoms after detox and in early sobriety, they may need additional support to participate in usual substance recovery activities. In particular, some may experience distress in social settings such as 12 Step meetings. Dual Diagnosis treatment that is aware of the needs of traumatized individuals can help provide coping strategies to enable successful participation in substance abuse recovery.

Care providers and treatment centers that treat those who have trauma issues can also ensure a supportive therapeutic environment that is sensitive to the needs of individuals with PTSD. Similarly, clinicians trained in these types of dual disorders create safe and comfortable relationships in which triggers are minimized and interpersonal boundaries are respected. Such treatment settings and clinicians provide a therapeutic approach which can target PTSD as well as concurrent mental health problems without increasing distress.

Treatment of PTSD

Treatment of PTSD and co-occurring mental health problems requires trauma-informed care along with treatment for the concurrent disorder. Those with Substance Disorders and PTSD require care from providers trained in treating both. Programs for the dually diagnosed can create and plan a comprehensive course of treatment tailored to the individual needs of each person. Such treatment plans involve simultaneous and coordinated therapies for the treatment of PTSD and Substance Disorders. Individual and group counseling use supportive techniques and education to equip clients with the coping skills and strategies necessary to manage both. Specialized trauma-based therapies that use such modalities as Cognitive Behavioral Therapy, EMDR, desensitization, visualization and relaxation are common and effective. Treatment for the concurrent Substance Disorder will also typically involve individual and group counseling along with education, relapse prevention planning and 12 Step programs. The use of non-addictive medications for those with concurrent PTSD and Substance Disorders is sometimes indicated for the management of such symptoms as problematic anxiety, panic, sleep disturbance, nightmares or depression.

For individuals who have the dual disorders of PTSD and depression, similar treatment modalities are used. Specific to depression, however, patterns of depressive thinking are typically addressed in individual and group counseling. Such modalities as Cognitive Behavioral Therapy may be used to identify patterns of thought that contribute to a pessimistic outlook and feelings of hopelessness and helplessness. Additionally, supportive counseling techniques encourage the acquisition of new coping skills and strategies. Enhanced coping skills help eliminate self-defeating patterns that can perpetuate depression. For some, psychiatric services and medications are indicated to improve and stabilize mood so that overall functioning improves. Because severe depression may also cause suicidal thinking or self-harming behaviors, some may require a therapeutic environment that ensures safety and support until such a crisis is resolved.

Recovery

A successful and full recovery from PTSD and concurrent substance or mental health conditions is possible. Trauma-informed clinicians and treatment programs are skilled in successfully addressing these. Individualized plans for care provide goals and objectives that progressively manage and resolve symptoms of both disorders.

Treatment centers with Dual Diagnosis programs can provide information about the research-based therapies now available for PTSD and co-occurring disorders. These employ clinicians trained to address overall mental health concerns as well as the specific needs of those with PTSD. Clinicians in these programs often have various educational backgrounds in psychology and are further trained in techniques that target and resolve the symptoms of PTSD, Substance Disorders and other co-occurring mental health conditions.
 

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