Substance Abuse on Posttraumatic Stress

¶ … Substance Abuse on Posttraumatic Stress Disorder

What is the incidence of substance abuse in individuals with this disability?

According to a recent study by Janikowski, Donnelly and Lawrence (2007), "As a group, people with disabilities have a higher rate of alcohol and drug use problems when compared to the general population. Up to six million people with disabilities also have co-existing substance abuse problems and that these disabilities may present obstacles to recovery" (p. 15). People who experience or witness some type of psychological trauma do not always experience long-term emotional distress or engage in substance abusing behaviors. According to Volpicelli, Balaraman, Hahn, Wallace and Bux (1999), "Rather, the likelihood of experiencing adverse consequences is related to the victim's ability to cope with the trauma" (p. 256). Even the most resilient individual with sufficient coping skills, though, may not be able to avoid the onset of PTSD and will turn to substance abuse for relief. A study of Vietnam combat veterans with PTSD found that more than 50% eventually evinced indications of alcohol addiction; likewise, women who experienced or witnessed rape during their childhoods frequently report using alcohol to mitigate the symptoms of the resulting PTSD (Volpicelli et al.). Other researchers have determined that fully 40% of inpatients who were undergoing treatment for substance abuse also met the established criteria for PTSD (Volpicelli et al.). Given the large numbers of troops serving in enormously stressful combat zones in Afghanistan and Iraq today, it is reasonable to suggest that the incidence of PTSD among these returning combat veterans will equal or exceed those experienced by their also heroic Vietnam counterparts in ways that will contribute to their engaging in substance-abusing behaviors in the future as well (Mckelvey, 2008).

2.

What seem to be some of the reasons for this rate of abuse?

The high incidence of substance abuse among PTSD sufferers is not surprising because many people will have drink (or use other mind-altering substances) following a traumatic experience. As Volpicelli et al. point out, "After a traumatic event, people often report using alcohol to relieve their symptoms of anxiety, irritability, and depression. Alcohol may relieve these symptoms because drinking compensates for deficiencies in endorphin activity following a traumatic experience" (p. 256). Likewise, a Web site devoted to this issue states that, "An emerging body of research has documented a very strong association between Posttraumatic Stress Disorder (PTSD) and substance abuse. In most cases, substance use begins after the exposure to trauma and the development of PTSD, thus making PTSD a risk factor for drug abuse" (the link between PTSD and substance abuse, 2009).

Substance abuse, then, tends to provide PTSD sufferers with some temporary relief for their traumatic memories of an event but the rebound effect is profound and severe. When the effects of the abused substance wear off, the individual's endorphin levels return to their pre-abuse levels or even lower in ways that may in fact contribute to the onset of PTSD in the first place. In this regard, Volpicelli and his associates emphasize, "After the trauma is over, endorphin levels gradually decrease and this may lead to a period of endorphin withdrawal that can last from hours to days. This period of endorphin withdrawal may produce emotional distress and contribute to other symptoms of posttraumatic stress disorder" (p. 256).

3.

What are some important issues a rehabilitation counselor needs to be aware of that are specific to this disability type and substance abuse?

An old adage advises that, "There is no problem so great that drinking can't make it worse," and this is certainly the case with PTSD. As Janikowski and his associates (2007) emphasize, "Substance abuse treatment is a daunting prospect for clients, even under the best of circumstances. The challenges presented in treatment may be compounded when clients' face functional limitations from disabilities that co-exist with their addiction or drug abuse" (p. 16). Moreover, although PTSD has been associated with poorer outcomes in substance abuse treatment time and again, initial screening is rarely conducted with standardized and validated procedures (Janikowski et al.).

According to Green (2006), "Substance-abusing women with post-traumatic stress disorder (PTSD) may benefit significantly more from gender-specific programs designed to address PTSD and addiction problems simultaneously. These programs provide gender-specific content and address, in a comfortable setting (i.e., with only female participants), traumatic experiences and sexual assault" (p. 55). Likewise, men who suffer PTSD based on traumatic combat experiences can potentially benefit from male-only treatment groups (Green). The National Institute on Drug Abuse cautions that while no standardized, effective treatment has been identified for PTSD sufferers, researchers have determined that cognitive behavioral therapy, group therapy, or exposure therapy has shown some promise, with the latter technique being viewed as one of the more efficacious approaches available. In this regard, the National Institute on Drug Abuse reports that, "Exposure therapy is thought to be one of the most effective ways to manage PTSD. Recent studies suggest that some individuals with PTSD and comorbid cocaine addiction can be successfully treated with exposure therapy. Individuals in a recent study who suffered from both disorders showed significant reductions in all PTSD symptoms and in overall cocaine use" (quoted in the link between PTSD and substance abuse at p. 3). The use of cognitive behavioral therapies to treat substance-abusing PTSD patients is also reported by Tull (2008) who notes, "Alcohol and drug use can interfere with standard treatments for PTSD. Therefore, people have developed specialized cognitive-behavioral treatments for substance abuse and PTSD. One such treatment is called Seeking Safety" (p. 3). The Seeking Safety treatment regimen is comprised of 24 sessions that are designed to teach PTSD sufferers a variety of coping skills that can help them avoid substance abuse as their treatment of choice for their condition. According to Tull, "Some of these coping skills include learning how to ask others for help, recognizing warning signs or high risk situations for drug/alcohol use, self-care, and coping with PTSD symptoms" (p. 4). Although more clinical-based studies are needed, the research to date has found that the Seeking Safety regimen has reduced drug/alcohol use; reduced PTSD symptoms; reduced risk for suicide; reduced thoughts about suicide; reduced depression; improved social skills; improved family life and improved problem-solving skills (Tull).

3.

What are some Web sites that address this issue? List the site link, name of the site, and a paragraph describing it..

A.

Department of Veterans Affairs' National Center for Post-Traumatic Stress Disorder at http://www.ncptsd.va.gov/ptsd101/modules/walser_substance_abuse.html. This Web site provides an overview of PTSD, some of the reasons contributing to the co-morbidity of substance abuse among this population and provides a series of course modules with instructor's narration that is available for downloading by those interested in this subject as well as counselors seeking to treat this population. Some of the topics included in these modules include assessment methods, typical issues and their implications for treatment, as well as empirically-based treatment considerations that should be taken into account for PTSD sufferers.

B.

The Link between PTSD and Substance Abuse at http://www.4therapy.com/consumer/conditions/item.php?uniqueid=7077&categoryid=534. This Web site provides a scholarly analysis from the National Institute on Drug Abuse to explain the inextricable relationship between PTSD and substance abuse, including an overview of PTSD, current treatment and support methods for PTSD sufferers in general and those with comorbid substance abuse problems in particular. A series of links to other PTSD and substance abuse information is also provided.