Integrated Cognitive Behavioral Therapy Best for People With PTSD and Addiction

New findings from an American research team indicate that a form of psychotherapy called integrated cognitive behavioral therapy can help people with PTSD address any co-existing problems with substance abuse and/or substance addiction. People affected by post-traumatic stress disorder (PTSD) have a sharply elevated chance of developing drug or alcohol problems and qualifying for a separate diagnosis of substance use disorder (substance abuse and/or addiction). In a study published in April 2015 in the journal Addiction, researchers from Dartmouth College’s Geisel School of Medicine assessed the effectiveness of a form of psychotherapy called integrated cognitive behavioral therapy as a treatment for the substance problems found in individuals with PTSD.

PTSD and Substance Problems

During his or her lifetime, any given person with PTSD has a roughly 21 percent to 43 percent chance of one day receiving a separate diagnosis for alcohol- or drug-related substance use disorder. This rate of substance use disorder exposure is substantially higher than the 8 percent to 25 percent rate found in people not dealing with post-traumatic stress disorder. Conversely, 15 percent to 41 percent of all people receiving treatment for substance use disorder currently meet the criteria used to identify cases of PTSD. Lifetime rates for PTSD in people receiving substance use disorder treatment are an even higher 26 percent to 52 percent. While any substance can cause diagnosable problems in a person with post-traumatic stress disorder, most affected individuals develop problems associated with the use of relatively heavy-duty substances such as opioids or amphetamine-related stimulants. There are multiple reasons for the connection between PTSD and diagnosable substance problems. For example, young children with PTSD may experience an altered development process that makes them more susceptible to serious drug- or alcohol-related issues later in life. A teenager or adult with PTSD may turn to drug or alcohol use in a misguided attempt to self-manage his or her emotional trauma symptoms. In addition, a person with existing substance problems may have an unusually elevated tendency to develop post-traumatic stress disorder after exposure to highly traumatic events or situations. In some cases, unknown or uncommon contributing factors may also increase the degree of overlap between substance problems and PTSD.

Integrated Cognitive Behavioral Therapy

Integrated cognitive behavioral therapy (ICBT) is a subtype of a larger psychotherapeutic approach known as cognitive behavioral therapy (CBT). Practitioners of CBT use a number of techniques to increase their patients’/clients’ awareness of dysfunctional emotional reactions and help their clients/patients gradually develop healthier responses to highly stressful situations. Integrated cognitive behavioral therapy expands on standard CBT by incorporating elements of mindfulness, a relaxing mental practice known to increase feelings of self-direction and centeredness. This approach is intended for use in people with separate or overlapping issues with substance use and diagnosable mental health problems not directly related to substance use.

Effectiveness for People With PTSD

In the study published in Addiction, the Dartmouth College researchers used a project conducted between the end of 2010 and the beginning of 2013 to help gauge the effectiveness of integrated cognitive behavioral therapy as a treatment for people with PTSD affected by co-existing substance problems. Of the 221 participants in this project, 73 received ICBT as part of a larger course of care. Another 75 participants received individual addiction counseling as part of a larger course of care, while the remaining 73 participants received a standard course of care that didn’t include ICBT or individual addiction counseling. Six months after receiving treatment, 172 of the original 221 study enrollees went through a follow-up examination designed to assess their substance- and PTSD-related symptoms. After comparing the results of the follow-ups for each group of participants, the researchers concluded that a course of standard care that includes ICBT, a course of standard care that includes individual addiction counseling and a course of standard care alone all have an essentially equal ability to reduce the symptoms of PTSD in affected individuals. However, they also concluded that a course of standard care that includes ICBT has an increased chance of decreasing the seriousness of substance problems in people with PTSD when compared to the two other treatment options. Based on their findings, the researchers believe that integrated cognitive behavioral therapy produces its unique benefits by addressing the substance-related problems in individuals with PTSD, not the symptoms of PTSD itself.

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