I agree with the points made in Alison Knopf’s article “To treat addiction, treat trauma” (November/December 2011 issue). The article is very relevant to the addiction provider. I would like to clarify further, though, that trauma by itself is not defined as an Axis 1 diagnosis but is defined as such in the context of post-traumatic stress disorder (PTSD), according to the Diagnostic and Statistical Manual of Mental Disorders. This is a common co-occurring diagnosis in patients with substance use disorders. Despite the documented prevalence of this particular dual diagnosis, relatively little is known about effective treatment for patients with both a substance use disorder and PTSD.
We should not assume that trauma is a prerequisite to addiction. It is well-documented that most trauma survivors recover from adversity and that only some of them go on to develop PTSD. We also should understand that addiction professionals have an evidence-based treatment model of intervention for serving the addicted client. The relapse prevention model has been a mainstay of addictions theory and treatment since its introduction three decades ago. Notable advances in relapse prevention in the last decade include the introduction of a reformulated cognitive-behavioral therapy (CBT) model. There is empirical evidence that CBT is effective for the treatment of a variety of problems, including mood, anxiety, personality, eating, substance abuse and psychotic disorders.
Therefore, I conclude that use of a professional intervention model such as CBT will enhance treatment providers’ ability to offer informed care to those clients who may suffer from the effects of trauma and substance use.
Doris Patillo, PsyD, LPC, CAC II, CCS
Faculty Development Program, Morehouse School of Medicine