Study shows PTSD symptoms improve when substance abuse treatment added
A new study on PTSD and substance abuse treatment is "practice-changing," one expert says.
August 15th, 2012
03:49 PM ET

Study shows PTSD symptoms improve when substance abuse treatment added

Combining treatments for post-traumatic stress disorder and substance abuse resulted in improved PTSD symptoms without worsening symptoms of substance abuse, according to a study released Tuesday in the Journal of the American Medical Association.

The findings, explain the Australian researchers, are contrary to conventional wisdom on how to treat PTSD and substance abuse, which commonly co-exist in patients. The common belief, they explain, has been that using the so-called "gold standard" of PTSD treatment might exacerbate substance abuse by resurfacing negative memories.

Therefore, people with substance abuse and PTSD have commonly been excluded from prolonged exposure therapy-based PTSD treatments and clinical trials using exposure therapy.

Prolonged exposure therapy is considered one of the most effective PTSD treatments. In fact, prolonged exposure therapy is the only “treatment for PTSD endorsed in a U.S. Institute of Medicine study as evidence based,” according to corresponding study author Katherine L. Mills of the University of New South Wales.

During the therapy, patients work with therapists to go back to their traumatic event and describe it in present tense, allowing the person to relive the trauma. By repeating this process, the brain reacts less severely over time, making the memory seem less traumatic.

University of New South Wales researchers enrolled 103 participants in their trial. All participants met the diagnostic criteria for both PTSD and substance abuse. The subjects were randomly selected to either receive both prolonged exposure therapy and treatment for substance abuse, or to only receive treatment for substance abuse.

At the nine-month mark, while both groups experienced reductions in PTSD symptoms, the subjects in the combined treatment group also showed a reduction in the severity of their PTSD symptoms without any increase in the severity of their substance abuse.

Dogs: A medicine for mental health problems?

Barbara Rothbaum, a professor of psychiatry and PTSD expert at Emory University, calls the study results "practice-changing."

"So many therapists are scared, because treating PTSD is a painful, grieving process," for patients, she says, and this study provides evidence-based data that there is no increase in substance abuse when both treatments are combined. Rothbaum says these findings will benefit therapists who treat PTSD and patients who have both conditions.

Post-traumatic stress disorder is a mental health condition that occurs after a person is exposed to a terrifying event. PTSD, while often associated with veterans who've been exposed to the trauma of combat, can be experienced by anybody who’s been exposed to a traumatic event including natural disasters, assaults, a heart attack, the death of a loved one, or a major injury or accident.

PTSD symptoms include anxiety, experiencing nightmares or flashbacks, and its common for people with PTSD to avoid situations that will remind them of the frightening experience. Another common coping mechanism is self-medication leading to  substance abuse in an effort to dull the devastating thoughts that PTSD can bring to its victims.

Music helps war vet cope with PTSD

soundoff (21 Responses)
  1. Tom Ballard

    I think one one of the issues being ignored about PTSD are the Intergenerational implications which I discuss in my blog. http://www.armybratswar.com

    August 15, 2012 at 23:29 | Report abuse | Reply
  2. martin

    that is ridiculous. Same thing as saying someone molested once, let's do it over and over and they are less stigmatized from it.

    August 17, 2012 at 00:08 | Report abuse | Reply
    • Tram

      Hi Kim yaaay, I'm so glad you accidentally sent it! I'll dnitefiely email you today or tomorrow. I talk a lot about various aspects of my recovery in my blog posts. I know they're lengthy, but it might answer some of your questions. Your recovery (which will happen) might look a little different from mine but here are helpful tips we can all benefit from. I'd suggest you start a journal and write everything you feel. The connection between your unconscious mind (which we react to) and conscious mind is usually damaged when we are depressed. Without judgement, start writing, if you haven't already. I write about the benefit of my journal in my recovery in my blog. Looking forward to connecting with you.

      July 28, 2013 at 22:57 | Report abuse |
  3. Jim

    There was a statistic that something like 65% of foster children suffer from PTSD whereas 45% of soldiers do. The difference I see and can't understand is that soldiers sign up to expose themselves to war, blood, gore, and ghastly unforgettable images. I didn't sign up to be put through hell in foster homes that have effected me in the same way, but it appears the media gives more sympathy to them. One should evaluate their choice before joining the military knowing ahead of time, that their military-partner's head may end up in their lap one day from an IED and they had better be ready for it. I honestly don't know how any foster children can prepare themselves for the unknown but they never did have a choice to begin with...

    August 17, 2012 at 03:18 | Report abuse | Reply
    • Seriously, people

      Jim, as someone who has PTSD due to a deployment–I think you're right. There are a lot of people who have PTSD who are forgotten or ignored. If PTSD in veterans is going to be an issue, PTSD in foster kids should be, too. The only thing I'd point out is that knowing you might experience something bad doesn't prepare you for actually experiencing it. I knew what I could be getting into and thought I was prepared, but here I am. That said, I take your point, and it's a good one.

      August 17, 2012 at 12:08 | Report abuse |
    • Mark

      Jim, You are correct in saying that I signed up for my PTSD. I agree, but with out the Patriots of this nation your would not be able to exercise your first amendment first right of freedom of speech here in this posting. I chose my life again you are correct, but I chose for you and for everyone else that enjoys the freedom of this country.

      September 9, 2012 at 14:30 | Report abuse |
    • Heather

      What you have said is extremely insensitive. Our service members have signed up voluntarily to protect our freedoms and to give their contribution to America. You sound very bitter. You should bring up your issue with foster care by itself. Saying one is worse than the other is just ignorant. You will never understand the experiences and pains that combat veterans go through, and should not compare it to your experiences. Think before you speak!

      September 24, 2012 at 10:30 | Report abuse |
  4. CKM

    I have what is known as "multi-event PTSD." It's the sort of PTSD experienced by combat veterans and is typical in cases of prolonged child abuse. This type of therapy DOES NOT WORK, at least for people with more than one, sometimes dozens of events to deal with. It can make things worse, it did for me. I really wish the discussion of the "disorder" would get more physical. It's no longer a secret that people with serious PTSD have a atrophied hippocampus in the brain. That area can regenerate, but that envolves NOT being re-traumatized! As far as substance abuse therapy, I don't see while doctors would shy from that specifically for people with PTSD.

    August 17, 2012 at 10:00 | Report abuse | Reply
    • Steven Bulcroft

      EMDR is a form of "exposure treatment" though it is combined with elements that help the brain calm down while thinking about the trauma expediting the healing process. Also combining this exposure treatment with mindfulness meditation practices actually helps the hippocampus grow in volume along with the Insular (in the ACC) and the prefrontal cortex bringing the brain back into balance that it was forced out of due to the traumas.

      August 17, 2012 at 16:11 | Report abuse |
  5. Kari Orkney

    There are many differences between childhood and adult PTSD including the causes and symptoms. Children are still in developmental stages necessary for healthy adjustment. Attachment is the single most important element for normal development. Many children in foster homes have no had that essential attachment, basic security and trust in a caregiver. They have often been moved to many homes, left with many different people and many broken attachments. When you think of the reasons they maybe in foster homes such as abuse, neglect, mentally ill or parents with alcohol and drug addictions, family violence that contributes to their emotional situation. How adults process trauma has a lot to do with their own backgrounds before the trauma and resilience. Resilience is the most common response to trauma. Most war veterans, 9/11 survivors and even holocaust survivors responded with resilience and went onto have fulfilling, happy functional lives. PTSD affects many areas of the brain and the brain chemistry. There is only one approved drug for PTSD and it is only effective for 20-25% of users. Other medications treat the associated symptoms like anxiety and depression. Alcohol and drug use to have a negative impact on PTSD and needs to be dealt with as they impact the same areas of the brain that PTSD does. However some experts do believe that marijuana has a therapeutic effect on PTSD. As far as addiction and PTSD I've always found it interesting that 80% of the Vietnam soldiers addicted to heroin kicked the habit totally on their own immediately on their own when they returned home. Never underestimate the power of resilience!

    August 17, 2012 at 11:54 | Report abuse | Reply
    • Steven Bulcroft

      Not a lot of difference as to what it does to the brain. However, that said, the exposure to trauma as a child predisposes one to PTSD as an adult. The more you were neglected, abused or endangered and scared as a child the more likely you will be traumatized by war and other catastrophes.

      August 17, 2012 at 16:12 | Report abuse |
  6. DanielHaszard75

    Good to go Bravo! I salute non-drug therapy as first choice of treatment.
    PTSD treatment for Veterans found ineffective.

    Eli Lilly made $65 billion on the Zyprexa franchise.Lilly was fined $1.4 billion for Zyprexa fraud!
    The atypical antipsychotics (Zyprexa,Risperdal,Seroquel) are like a 'synthetic' Thorazine,only they cost ten times more than the old fashioned typical antipsychotics.
    These newer generation drugs still pack their list of side effects like diabetes for the user.All these drugs work as so called 'major tranquilizers'.This can be a contradiction with PTSD suffers as we are hyper vigilant and feel uncomfortable with a drug that puts you to sleep and makes you sluggish.
    That's why drugs like Zyprexa don't work for PTSD survivors like myself.

    -Daniel Haszard

    August 17, 2012 at 13:31 | Report abuse | Reply
  7. Steven Bulcroft

    But what kind of substance abuse treatment was used? Abstinence only? If so as long as they were adhering to treatment of course the SA disorder would not get worse as they were being abstinent (which is not very successful for the majority of people with substance abuse problems) or did the use "controlled drinking" or " harm reduction" treatment for SA? This article does not explain enough.

    August 17, 2012 at 16:06 | Report abuse | Reply
  8. Krista Holmes

    I suffered from this due to years in an abusive marriage, I would have these triggered moments, a smell , sound, or especially if a male became the least bit confrontational. I don't even have knowledge of these times , My husband ( never abusive) and I were arguing and he lunged for the dog who was about to run by me out the door, he tells me I grabbed him , punched repeatedly kicked,and when he put his hands on my shoulders to get me attention I bit him , nearly through and through. I didnt always have blackout reactions, but I would always have night terrors. That's where my memories lived, in my dream world.....It caused poor judgement and decision making , also. I could not for see consequences...was misdiagnosed with every thing from severe depression to bi-polar, ...I was referred to a Dr. that explained a treatment... he said it is a combination of a pulse felt on a finger tip an headphones that would use a tone in one ear then the other.. He would ask me to try and remember these situations, not relive them just recall... one lead to another then another so on and so on. but it not only a brief thought it was ok to move to next one... with in 2 weeks, my regular counselors, close friends and family began noticing these improvements, it was almost immediate that I felt like I shook my head and the dark clouds that dominated me were lifted, I understood life better, choices became clear, I COULD SEE CONSEQUENCE!!! I remember saying , Life is so simple, not easy, much much simpler...The dr. said they were not even sure exactly how or why it works but IT DOES!!!
    I think my brain could not process these trauma's so My brain could not store them in my memory banks (long/short Term) they simply became the clouds that when triggered would come to life. The "system " of distracting the brain while recalling them somehow allows them to be stored in memory bank . I remember the trauma, but it' s better .than having them having them triggered and way better than always being so afraid to go to sleep!!! It has been 8 years since the Dr. visits, and almost 7 since I have had a ptsd symptom.I am off all the psych meds , no longer even see counselors.I don't know if anyone has knowledge of this , but I want to know more...

    August 22, 2012 at 12:49 | Report abuse | Reply
  9. Symptoms Of Cancer

    Woah this weblog is wonderful i really like studying your posts. Keep up the good work! You know, many people are looking round for this information, you can help them greatly.

    August 24, 2012 at 09:22 | Report abuse | Reply
  10. mark

    Help make this happen. http://igg.me/p/268225?a=357694 Service dogs work for ptsd

    November 17, 2012 at 03:01 | Report abuse | Reply
  11. s629

    While recreational pot usage is controversial, many people agree and believe that the drug should be legal for medical uses. Online Budz

    September 6, 2016 at 06:25 | Report abuse | Reply
  12. frolep rotrem

    wonderful put up, very informative. I wonder why the other specialists of this sector don't notice this. You must proceed your writing. I am sure, you've a huge readers' base already!


    February 6, 2021 at 15:18 | Report abuse | Reply
  13. https://europa-road.eu/

    Having read this I thought it was very informative. I appreciate you taking the time and effort to put this article together. I once again find myself spending way to much time both reading and commenting. But so what, it was still worth it!


    February 9, 2021 at 03:36 | Report abuse | Reply
  14. vreyro linomit

    I believe you have observed some very interesting details , appreciate it for the post.


    February 25, 2021 at 08:53 | Report abuse | Reply
  15. vreyrolinomit

    Wow, superb blog structure! How lengthy have you been blogging for? you made blogging glance easy. The entire glance of your web site is fantastic, let alone the content!


    February 26, 2021 at 02:14 | Report abuse | Reply

Post a comment


CNN welcomes a lively and courteous discussion as long as you follow the Rules of Conduct set forth in our Terms of Service. Comments are not pre-screened before they post. You agree that anything you post may be used, along with your name and profile picture, in accordance with our Privacy Policy and the license you have granted pursuant to our Terms of Service.

About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.