Academic journal article European Journal of Psychotraumatology

Why Clinicians Do Not Implement Integrated Treatment for Comorbid Substance Use Disorder and Posttraumatic Stress Disorder: A Qualitative Study

Academic journal article European Journal of Psychotraumatology

Why Clinicians Do Not Implement Integrated Treatment for Comorbid Substance Use Disorder and Posttraumatic Stress Disorder: A Qualitative Study

Article excerpt

CLINICAL RESEARCH ARTICLE

Why clinicians do not implement integrated treatment for comorbid substance use disorder and posttraumatic stress disorder: a qualitative study

Nele Gielen1,2*, Anja Krumeich3, Remco C. Havermans2, Feikje Smeets4 and Anita Jansen2

1Mondriaan, MAIAR, Heerlen, The Netherlands; 2Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands; 3Department of Health, Ethics & Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; 4Department of Psychiatry & Psychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

Abstract

Background : Healthcare providers working in addiction facilities do not often implement integrated treatment of comorbid substance use disorder (SUD) and posttraumatic stress disorder (PTSD) while there is empirical evidence to do so.

Objective : This study aims to get insight into the views of clinicians with regard to the diagnosis and treatment of PTSD in SUD patients.

Method : A qualitative research method was chosen. Fourteen treatment staff members of different wards of an addiction care facility were interviewed by an independent interviewer.

Results : Despite acknowledging adverse consequences of trauma exposure on SUD, severe underdiagnosis of PTSD was mentioned and treatment of PTSD during SUD treatment was not supported. Obstacles related to the underestimation of PTSD among SUD patients and to the perceptions of SUD clinicians concerning the treatment of comorbid SUD/PTSD were reported.

Conclusions : It is concluded that SUD facilities should train their clinicians to enable them to provide for integrated treatment of SUD/PTSD.

Keywords: Addiction; trauma; qualitative; healthcare provider; perceptions

*Correspondence to: Nele Gielen, Mondriaan, MAIAR, J.F. Kennedylaan 305, 6419 XZ Heerlen, The Netherlands, Email: n.gielen@mondriaan.eu

For the abstract or full text in other languages, please see Supplementary files under Article Tools online

Received: 12 September 2013; Revised: 20 December 2013; Accepted: 2 January 2014; Published: 5 February 2014

European Journal of Psychotraumatology 2014. © 2014 Nele Gielen et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 Unported (CC-BY 4.0) License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format, and to remix, transform, and build upon the material, for any purpose, even commercially, under the condition that appropriate credit is given, that a link to the license is provided, and that you indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

Citation: European Journal of Psychotraumatology 2014, 5: 22821 - http://dx.doi.org/10.3402/ejpt.v5.22821

Posttraumatic stress disorder (PTSD) is a frequent co-occurring disorder in patients who seek treatment for their substance use disorder (SUD). Prevalence rates around 35% are mentioned in previous studies (Bonin, Norton, Asmundson, Dicurzio, & Pidlubney, 2000; Driessen et al., 2008; Gielen, Havermans, Tekelenburg, & Jansen, 2012; Ouimette, Coolhart, Funderburk, Wade, & Brown, 2007; Read, Brown, & Kahler, 2004; Reynolds, Mezey, Chapman, Wheeler, Drummond, & Baldacchino, 2005), while trauma exposure was found to be prevalent in 89 - 97.4% of SUD patients (Dansky, Saladin, Coffey, & Brady, 1997; Farley, Golding, Young, Mulligan, & Minkoff, 2004; Gielen et al., 2012; Read et al., 2004; Reynolds et al., 2005). SUD patients with PTSD often use substances to deal with the emotional pain caused by their trauma (Khantzian, 1997; Leeies, Pagura, Sareen, & Bolton, 2010; Ouimette, Read, Wade, & Tirone, 2010). …

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