Treating Co-Occurring Posttraumatic Stress Disorder and Substance Use Disorders in an Outpatient Setting in New Zealand

By Benton, David M.; Deering, Daryle E. A. et al. | New Zealand Journal of Psychology, March 2012 | Go to article overview

Treating Co-Occurring Posttraumatic Stress Disorder and Substance Use Disorders in an Outpatient Setting in New Zealand


Benton, David M., Deering, Daryle E. A., Adamson, Simon J., New Zealand Journal of Psychology


The incidence of anxiety disorders including post traumatic stress disorder (PTSD) is very high among women who abuse alcohol and/or other drugs (Briere & Runtz, 1987; Najavits, Weiss, & Shaw, 1997; Paone, Chavkin, Wiliets, Friedman, & Jarlais, 1992), and data from the US National Comorbidity Survey (Kessler, Berglund, Demler, Jin, Merikangas, & Walters, 1995), an Australian epidemiological study (Mills, Teesson, Ross, & Peters, 2006) and a New Zealand study of alcohol and drug treatment patients found one third were diagnosed with current PTSD (Adamson, Todd, Sellman, Huriwai, & Porter, 2006).

The co-existing disorders of PTSD and SUDS have deleterious effects on the social, psychological and physical wellbeing of sufferers, predict poorer treatment outcomes (Brown, Stout, Mueller 1999; Najavits, Weiss, Shaw, Muenz, 1998; Rosen, Ouimette, Sheikh, Gregg, & Moos, 2002), and tend to persist over many years (Bartels, Drake, & Wallach, 1995). The presence of PTSD is consistently associated with poorer addiction treatment outcomes, and is related to distinct barriers to treatment such as failure to assess PTSD, failure to address or refer to treatment for PTSD issues, and on the part of the patient, emotional pain, shame, and self blame (Ouimette, Brown & Najavits, 1998). Study findings consistently reveal a very vulnerable population with extensive histories of abuse, substantial physical and mental health service needs, and women who often use numbers of different services in an attempt to find help and/or relief (Becker, Noether, Larson, Gatz, Brown, Heckman, & Giard, 2005).

Compared to experiencing either disorder alone therefore, the combination of PTSD and SUDS is marked by a more severe clinical profile and significantly greater impairment on a wide range of variables, including interpersonal and medical problems as well as motivation for treatment and treatment adherence (Brady, Killeen, Saladin, Dansky, & Becker, 1994; Brown, Stout, Mueller, 1999; Najavits, Weiss, & Shaw, 1999). As therapy patients, those with co-occurring PTSD and SUD are anecdotally reported to be very difficult, have fragile treatment alliances and evoke negative emotional responses by therapists (Cramer, 2002). Moreover, PTSD, unlike many other disorders, is widely reported to worsen in early abstinence, making treatment of the SUD particularly challenging (Brady et al., 1994; Freidman and Yehuda, 1995). This may in part be due to the symptoms of substance withdrawal being similar to the arousal symptoms of PTSD (Jacobsen, Southwick, Kosten, 2001), i.e. difficulty sleeping, agitation, anxiety, autonomic hyperactivity or restlessness, tremors, and nausea.

Although consensus is lacking regarding best practices a number of integrated psychosocial treatments (e.g., Seeking Safety, Substance-Dependence PTSD Therapy, Concurrent Treatment of PTSD and Cocaine Dependence) have shown empirically supported promise in reducing symptoms of both disorders (Back, 2006). Evidence regarding integrated treatment for those with co-existing disorders is consistent and positive (Kofoed, Friedman, & Peck, 1993; Brady et al., 1994; Brown, Recupero, & Stout, 1995). However, while there are recently published guidelines on the assessment and management of people with coexisting mental health and substance use problems (Todd, 2010), there is to date no published New Zealand studies that have investigated the provision of integrated treatment, despite the same levels of acuity.

The aim of the present study was to evaluate outcomes of a manualised psychotherapy programme, Seeking Safety which was designed for women who present with concurrent PTSD and SUDS (Brown, Recupero, & Stout, 2002; Najavits Drake, & Wallach, 2002), and eleven published outcome studies establishes its efficacy as a treatment of co-existing PTSD and SUDS (e.g. Hien, Cohen, Miele, Litt, Capstick, 2004; Morrissey, Jackson, Ellis, Amaro, Brown, Najavits, 2005; Desai & Rosenbeck, 2006; Najavits, 2007). …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Treating Co-Occurring Posttraumatic Stress Disorder and Substance Use Disorders in an Outpatient Setting in New Zealand
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.