Patients – women and men – who have suffered trauma and engage in substance abuse may be helped through integrated treatment methods that concurrently focus on both. This is particularly true when the trauma is post traumatic stress disorder (PTSD), but may also be applicable with other forms of trauma.

If you currently abuse substances (alcohol, illicit drugs or prescription drugs used nonmedically), and have suffered trauma (early childhood physical, sexual and/or emotional abuse, PTSD, or other trauma type), there is hope for you to heal. You can’t do this on your own. No matter how strong and self-reliant you are, there are some things that you can’t sort out without professional help. Fortunately, there are treatment programs that are currently available – and more are being developed – to help you overcome trauma and substance abuse.

PTSD-Targeted Treatment

Several recent studies with homeless addicted women with substance abuse and significant history of early and subsequent trauma point to the effectiveness of the Seeking Safety targeted treatment program. Seeking Safety is an integrated cognitive behavioral approach that actively links PTSD symptoms with unsafe substance use behaviors. Its effectiveness has been widely demonstrated with active substance users.

When used to treat dual-diagnosis patients (those with PTSD and substance abuse), the Seeking Safety approach is generally modified from the standard 25 core sessions to 12 to better fit standard substance abuse treatment duration. The following is an example of the modification of the Seeking Safety approach when used in a research study.

Sessions included:

• Basic education on substance use disorders and PTSD
• Skill-building to prevent drug use and manage PTSD
• Cognitive restructuring with attention to maladaptive thoughts linked to substance use and trauma symptoms
• A focus on developing effective communication skills to build healthy support networks

Each session used the same format:

• Initial check-in, including brief reports of good coping skills or any “unsafe” behaviors
• Session quotation – a brief inspirational point to engage participants and link to the topic of the session
• Relating of material to patients’ lives (including hand-outs to facilitate discussion and skill practice)
• Check out – including a commitment by the patients to specific practice of skills between sessions

Researchers concluded that when the comorbidity between PTSD and substance use was examined during active study intervention, PTSD changes were found to impact outcomes of substance use. Reductions in PTSD severity were associated with improvement in substance use disorder, specifically among women with severe baseline substance use. Researchers, however, found minimal evidence of substance use reduction improving PTSD symptoms. These findings support the self-medication model (people use substances to cope with PTSD) for persons with comorbid PTSD and addictive disorders.

While research studies have control groups and specific study limitations (i.e., obtaining their pool of volunteers from patients in substance abuse treatment facilities who are already abstinent), the positive results obtained here with women will undoubtedly lead to additional studies with men to see if the same benefits (i.e., reduction of PTSD and reduction in substance use) occur. And such studies included assessment at 1-week, 3, 6, and 12-month post treatment. In any event, use of such targeted and integrated treatment programs at the onset of treatment in residential treatment facilities may prove to be an effective way to let the healing begin.

Eye Movement Desensitization and Reprocessing (EMDR)

Eye movement desensitization and reprocessing (EMDR) is a psychological methodology that is being applied to a wide variety of psychological disorders and to the treatment of substance abuse. EMDR is a structured, client-centered treatment modality that integrates key elements of several different approaches: behavioral, cognitive, body-oriented, intrapsychic, and interactional.

EMDR should only be administered by a trained clinician who is both experienced and educated in this approach. Use of EMDR requires a comprehensive client history and extensive preparation so that the client is able to deal with the high levels of disturbance the treatment often engenders. EMDR uses horizontal eye movements or other repetitive or bi-lateral (which means both eyes, or ears, receive the same) stimulation such as tapping or auditory tones during the session.

How does EMDR work? According to the EMDR International Association (http://www.emdria.org/displaycommon.cfm?an=1&subarticlenbr=2), EMDR seems to have a direct effect on the way the human brain processes information. After a successful EMDR session, normal information processing resumes. The patient no longer relives the images, sounds, and feelings when the traumatic event is brought to mind. It isn’t that you don’t remember what happened, but the memory is less upsetting. While many therapies have similar goals, EMDR seems to be similar to what occurs during rapid eye movement (REM) sleep or day dreaming. Think of EMDR as a psychological-based therapy that helps you see disturbing things in a new, different and less upsetting way.

A typical EMDR session lasts between 60 and 90 minutes. The treatment is conducted in phases in order to identify traumatic experiences (or memories), desensitize the patient to those experiences or memories so they’re no longer disturbing from an emotional standpoint, and help the patient form positive feelings about themselves and their experiences. EMDR may be used within a standard “talk” therapy, as an adjunct therapy with a separate therapist, or as a standalone treatment. The type of problem, life circumstances, and amount of previous trauma will determine how many treatment sessions are necessary.

Studies have shown that 78 percent of veterans who have undergone EMDR treatment no longer met the criteria for PTSD after 12 sessions. The EMDR Institute website cites studies reporting 77 to 90 percent of civilians who underwent the treatment no longer suffered from the symptoms meeting PTSD diagnosis after 3 to 7 sessions. Some drug rehabs offer EMDR as part of the drug addiction treatment program.

Treatment for Adolescents

A considerable body of literature points to the fact that youth who have been traumatized do not do well with treatment that focuses only on substance abuse. Several treatment approaches have been developed for complex trauma specific to adolescents. These use group therapy to address skills development, affect regulation, competence, resiliency building, and interpersonal connections. All these interventions emphasize the relationship between symptoms and the traumatic experience, how to develop concrete coping skills to manage symptoms, and use of peer support groups to help increase normalization, develop healthy interpersonal skills, and establish strong social supports.

One program for sexually-exploited teens emphasizes how important it is for youth to make the connection between their physical symptoms and their mental health. The blending of mental health and other strategies, such as music, art and equine therapy, have proven to be especially promising in treating adolescents with trauma and substance abuse.
Adolescents in treatment for trauma and substance abuse also benefit from therapy that helps them engage in decision making, develop valued social roles, and participate in leadership opportunities.

Alternatives to Traditional Therapies

Besides the therapies already mentioned, many residential treatment facilities specializing in treating dual-diagnosis disorders use nontraditional approaches in conjunction with traditional ones. Alternative methods that help build self-esteem, improve connection with self, and increase empowerment are important adjuncts to traditional therapies. Some examples of alternative approaches include journaling, drama, poetry, song writing, outdoor physical activities, yoga, meditation, acupuncture, massage, healing touch, and body work.

Given the fact that trauma survivors have great difficulties with self-soothing, it is not surprising that many treatment facilities use music as an alternative approach. In addition, some programs offer organized religious or spiritual activities as a way to help patients connect to something that will last beyond the timeframe of the treatment program.

How to Find Treatment

You can start by talking with your doctor and asking for a referral to a treatment facility that specializes in trauma treatment or dual diagnosis treatment.

Once you find several treatment facilities you wish to explore further, go to their website and do some in-depth research. Make a list of any questions you have that aren’t answered on their website and then call for information. Be sure to inquire if the treatment facility accepts your insurance and what type of service is covered. If your insurance doesn’t cover the treatment (or the facility doesn’t accept your insurance), ask about sliding-pay scale, payment assistance, grants, or financial loans. Don’t let money concerns keep you from seeking treatment for trauma and substance abuse. Many treatment facilities and centers will be willing to work with you to help you find appropriate funding for treatment, or will refer you to a federal, state or local agency for assistance.

There is also a listing of state substance abuse agencies at the SAMHSA website (http://findtreatment.samhsa.gov/ufds/abusedirectors). Contact them and find out how they may be able to help you find treatment.
What to Keep in Mind about Treatment for Trauma and Substance Abuse

Chances are that you’ve lived with the effects of trauma for quite some time. You most likely use alcohol or drugs as a coping mechanism to deal with the pain of the frightful memories, to forget or numb out for a while. But, as you well know, the memories are still there, working their havoc on your ability to live a normal life.

Why suffer through the humiliation, shame, depression, anxiety, acting out, and all the physical and psychological symptoms associated with addiction to substances? There is a way out of this. You can be healed from the trauma, and you can overcome your addiction.

Will it be easy? No, and to say otherwise would be counter-productive. If someone tells you they got treatment for trauma and substance abuse and it was a piece of cake, would you believe it? Either they’re telling you that so they can look heroic, or to somehow be elevated in your mind, or they need to reassure themselves somehow that they’re okay. Hopefully, they are. But the truth of the matter is that treatment is different for each individual. What one person finds difficult to face (a particularly painful memory) may be less stressful for another person with a similar memory or experience.

Sometimes it depends on how far along you are in treatment. When you have some time in the program (which will be individually tailored to your particular needs), you will find that you can address certain issues with greater clarity and focus and less fear than you could initially. This is progress. But it takes time. And you have to allow yourself the time and trust in the integrity of your therapists and other treatment professionals to help you achieve the stability and safety and self-esteem you deserve.

During treatment, you will meet other people who have similar backgrounds, possibly even shared traumatic experiences (others with PTSD, rape, incest or childhood abuse victims, etc.). In group therapy sessions, you may begin to understand that you are not alone, that others have the same types of issues, and that there are solutions – coping skills – that you can use to help manage your symptoms and reduce cravings. This is all part of effective treatment.

You will also be introduced to the 12-step group concept and will likely be required to participate in regular 12-step meetings while you are in the active treatment phase. Your therapists will recommend that you continue to attend 12-step meetings when you are in recovery, as this is a strong support network that can help you immensely during your early recovery (the first 6 to 9 months after conclusion of treatment).

Family and close friends also play an important part in your treatment and subsequent recovery. The more supportive they are for your healing process, the more they take an active part in family treatment, lectures, discussions, and family component 12-step group meetings, the greater the likelihood that you will succeed in your recovery.

Think of the journey toward being whole and complete as a process that you can and will be able to undertake. Then, let the healing from trauma and substance abuse begin.