Simultaneous Treatment of Co-occurring Posttraumatic Stress Disorder and Substance Use Disorder

Abstract

Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) frequently co-occur. Existent evidence suggests that SUD often develops in reaction to PTSD symptoms, as individuals attempt to “self-medicate” their PTSD symptoms. Once the SUD develops, the disorders establish a bi-directional loop, with PTSD driving further substance use behaviors, and the SUD symptoms mirroring and reinforcing symptoms of PTSD. Once this bi-directional cycle is locked in, the disorders become more resistant to treatment and result in poorer prognoses and worse health outcomes versus having only one of these disorders. Traditional approaches to treatment of co-occurring PTSD and SUD have involved segregated and sequential treatment models. Normally, this involves treatments focused first on the SUD followed by a referral to different providers to address the PTSD. This traditional sequential and segregated treatment model presents several challenges to patients and treatment providers and may unintentionally contribute to the poorer prognosis observed in individuals with co-occurring PTSD-SUD. There are now state-of-the-art treatment approaches that focus on simultaneously treating PTSD and SUD. Psychotherapeutic protocols are available to simultaneously treat PTSD and SUD. Findings show that psychotherapies that simultaneously address PTSD and SUD show superior outcomes in reducing PTSD versus SUD treatment as usual. Recent studies also support the efficacy of several medications, including sertraline, naltrexone, and prazosin in treating co-occurring PTSD-SUD. Although treatments are shown to produce benefits to either reduce PTSD or improve SUD outcomes, no psychotherapeutic treatment, psychopharmacologic treatment, or combination thereof is shown to produce greater benefits versus SUD treatment as usual for simultaneously reducing both PTSD symptoms and improving SUD outcomes. The current research suggests that clinicians should consider simultaneous treatment approaches for co-occurring PTSD and SUD.