Trauma-focused cognitive behavioral therapy for abuse-related PTSD and substance abuse in adolescents

Treating Child Abuse Related Posttraumatic Stress

Comorbid Substance Abuse in Adolescents

Judith a Cohen et.al

Strong empirical evidence based on previous research shows a clear association between child abuse and subsequent development of PTSD (Post Traumatic Stress Disorder) and SUD (Substance Use Disorder). This article by Cohen et.al is a research review of several independent studies that show correlation between PTSD and SUD. The authors also discuss specific treatment modalities that are effective in treating child abuse related PTSD and SUD.

The Co-occurrence of child abuse and development of PTSD and SUD as co-morbid conditions implies the necessity of specific treatment methods that take into account the previous history of abuse.

Method

The authors performed a literature review of current treatment practices for adolescents with abuse related PTSD and SUD and synthesized the results. Empirical treatment methods for abuse related PSTD and SUD are discussed. Over a broad spectrum of epidemiological studies it was observed that childhood abuse results in disturbed and abnormal emotional development. Adolescents with a past history of abuse develop negative coping behavior such as avoidance instead of seeking support or counsel. Suppressed emotional behavior carries a strong risk for developing PTSD, which further leads to substance abuse. The co existent and interdependent nature of PTSD and SUD has also been documented in several studies. Giaconia et.al. 2003 for example, documents that substance abuse practiced as a coping strategy may further reinforce PTSD symptoms resulting in adolescents being trapped in a vicious cycle. Stigmatization and isolation by peers may also contribute to increased substance dependence. [Judith A Cohen]

To identify the best possible treatments for adolescents with abuse related PTSD and consequent SUD the authors analyzed outcome of many RCT (randomized controlled Trials) and there was clear evidence in favor of the efficacy of Trauma focused Cognitive behavioral therapy over other non-directive therapies. Studies by Cohen, Deblinger 1998, and King et.al 2000 indicate that TFCBT is the best therapy for adolescents with a history of abused childhood. A previous study by Kolko (1996) also showed that cognitive behavioral therapy in combination with family therapy provided better outcome than 'standard community treatment' for children exhibiting violent behavior. Further the authors also focused on therapy for adolescents with SUD. Research evidence (Grella & Joshi) indicates that adolescents with abuse related SUD require more comprehensive treatment methods than those with primary SUD. Liddle & Hogue 2001 proved that abused adolescents with SUD responded better to multi-dimensional family therapy than personalized Cognitive behavioral therapy. These results are also supported by separate studies conducted by Azrin et. al and Donahuc and Azrin (2001), which indicate that family-based CBT, is more effective in treating substance usage disorders in abused adolescents. [Judith A Cohen]

Conclusions

An integrated approach in treating PSTD and SUD is essential and adolescents reporting for treatment for either of these conditions need to be crosschecked for a history of child abuse. Future research must include children with comorbid conditions of PSTD and SUD alongside subjects with primary conditions, (Non abuse related PSTD or SUD) so that the effect of child abuse in context of subsequent development PSTD and SUD can be analyzed as an individual measure.