Posttraumatic stress disorders and addiction

Disorders related to stress or trauma are common among patients with substance use disorders (SUD). In clinical samples of patients with SUD, the prevalence of lifetime Posttraumatic Stress Disorder (PTSD) ranges from 26 % to 52 %, and from 15 % to 41 % for current PTSD. A substantial number of these patients suffer from the consequences of severe and prolonged interpersonal trauma usually referred to as “Complex PTSD”. Another common consequence of repeated interpersonal trauma in childhood are dissociative symptoms that may or may not co-occur with PTSD in SUD patients. While several hypotheses can explain the relationships between SUD and PTSD, the self-medication hypothesis has the strongest empirical support. Patients with both disorders have a more severe clinical profile than SUD patients without PTSD, poorer adherence to treatment, a shorter duration of abstinence, and worse outcomes across a variety of measures. Their clinical needs often make a treatment approach necessary that integrates SUD specific and trauma specific interventions. Several trauma treatments focusing on the present (i.e. providing skills training and psycho-education) and, more recently, also past-focused (i.e. exposure-based) treatments have been evaluated in SUD patients with co-occurring PTSD. Some of them outperformed SUD treatment-as-usual on PTSD and/or substance use outcomes. Findings on the effects of medication in patients with SUD and co-occurring PTSD are scarce and remain inconclusive.