Trauma and Substance Abuse - When They Coexist

I worked for several years at a methadone program for the treatment of opiate addiction (usually heroin). This is where I was originally introduced to trauma and its treatment, or lack thereof. I was surprised to see how many war veterans were in the populations. As I continued to talk to clients, I was further surprised to find that a great majority had serious symtpoms of trauma, or PTSD. However, this was rarely addressed. The heroin addiction was addressed first and foremost. Then they might see a psychiatrist and get medications for various symptoms. Anxiety was the primary complaint, then depression. Insomnia was also a common complaint with nightmares, restlessness, hypervigilance, and the inability to fall asleep or stay asleep cited as problems. But never was the entire picture put together. These are all symptoms of trauma. And the opiates were often being used to treat the trauma symptoms. Working with the trauma through counseling offered some relief from the symptoms and some insight to what the real problem was. However, this is not the norm, especially in substance abuse treatment.

I read a recent article in which the author, a psychologist, had discovered the same high proportion of trauma survivors in the substance abuse community with which he was working. Statistically, clients struggling with substance abuse issues report a much higher percentage of trauma symptoms than the general public. The author also stated that the substance abuse community recommends that someone be clean and sober for one year before engaging treatment for trauma. This is what I found as well, on both counts.

This makes no sense. If the substances are being used to treat the trauma symptoms, abstaining from the substances are going to be impossible for any long period of time unless you help the client develop better, alternative methods for addressing the trauma symptoms. This has to occur simultaneously, or they are doomed to fail in their attempts to abstain. The effects of these repeated "failures" on the client's self esteem and sense of self confidence are devastating.

I have often observed the same phenomenon in the psychiatric arena. Clients present with complaints of anxiety or depression, a pill is tossed to them which is promised to address the symptoms, but no attempt is made to examine the underlying causes of the stress or grief. It's important to look at the entire person, not just the criteria for a DSM IV diagnosis. This becomes increasingly important in a culture which is becoming more and more violent and which now has a constant influx of veterans coming home from war.