An estimated 350,000 Australians suffer from post traumatic stress disorder and addictions simultaneously. On treatment programs for substance use the figures are much higher with around 80 -90 per cent having suffered multiple past traumas and close to 50 per cent experiencing active PTSD.
Yet clinicians have been conservative about offering PTSD treatment for clients still using alcohol and other drugs for fear that the gold standard “exposure therapy” will exacerbate substance use issues.
Now a landmark study from led by Dr Katherine Mills and colleagues from the National Drug and Alcohol Research Centre at the University of New South Wales, has found for the first time that these clients frequently can in fact benefit from psychological therapy.
The study published this week in the prestigious international journal JAMA is already creating ripples around the world. Barbara Rothbaum, a professor of psychiatry and PTSD expert at Emory University has called the study “practice changing” in a report on the US’s CNN online.
The study randomly assigned patients to an integrated therapy called COPE which involved exposing patients to their traumatic memories and treating their substance use at the same time. Patients were administered the treatment over thirteen 90 minute sessions with a clinical psychologist. The control group received usual treatment, of their choice, for substance use only
From the beginning of the study to nine month follow-up the integrated treatment group had significantly greater reductions in PTSD symptoms compared with the control group. And their drug use did not increase while undergoing exposure therapy.
“Currently a majority of people with substance use disorders are excluded from receiving PTSD treatment as there is a widely held view that patients need to be abstinent before any trauma work, let alone prolonged exposure therapy, can be undertaken,” says Dr Mills. “However, this is often very difficult for patients to achieve as their trauma symptoms tend to resurface when they stop using.”
“Our positive findings indicate that by using an integrated treatment program such as this, the many Australians who suffer from both of these conditions can be treated successfully.”
Mental health and substance use disorders account for more years of life lost due to disability than any other disorder and are second only to cancer and cardiovascular disease as leading causes of disease burden.
The issue is finally beginning to resonate with governments and policy makers. Last week the Australian Government announced the establishment of a $2.5 million Centre of Research Excellence in Mental Health and Substance Use: Translating Innovative Prevention and Treatment. The Centre will be led by NDARC’s Professor Maree Teesson. Dr Mills is an investigator for the CRE.