Speaking generally, people with co-occurring substance use disorder and post-traumatic stress disorder require treatment sufficient to meet the complexity of their disorders. Sufferers and their families need to know that treatment works and can restore the committed patient to a healthy and happy life. The challenge is to determine what treatment is needed and how to access it. A good first step is to have the client evaluated by a clinician with expertise in co-occurring disorders. This could be a therapist or social worker, psychiatrist and some primary care physicians who may be well-versed in mental health and addictions.
Someone with a substance use disorder will in all likelihood require detoxification and then trauma-informed rehabilitation. Depending on the severity of the substance use disorder and the PTSD this care will need to delivered on an inpatient basis.
When I got clean and sober back in 1984, treatment systems were very different. For one they were sharply “bifurcated,” meaning that addictions and mental health treatments were split and separated. Nowadays they are more integrated as it has been determined, correctly I think, that treating the conditions at the same time and recognizing they are interrelated leads to better outcomes. The way it worked for me was a 30-day substance abuse treatment program, then resuming outpatient care with my therapist. In those days there was no such thing as: “trauma informed care.” Trauma informed care provides a framework for agencies and clinicians to best treat trauma. (See resources below for more information)
I was extremely fortunate to have found my therapist. My trauma and addictions had reduced me to a point of profound despair. She was the most empathetic, patient and non-judgmental person I’ve ever known. Had she been any less so, I doubt I’d have stayed in therapy. Over time, I came to trust her absolutely and this trust and acceptance enabled me to open up and share what had happened to me. She affirmed the pain I’d been through and provided insight into how I’d been affected. She affirmed my better qualities and encouraged me to see them in myself. Over time, I reoriented my viewpoint from that of a victim to one of a person with his own agency. I healed. So, with the right therapist and your own commitment to getting well, you can too!
The other solution was to reconfigure my paradigm of what a healthy relationship was. As I progressed in recovery and in therapy I became aware of what to look for in others and to build the skills necessary to maintain relationships. In the past, I could find love, but I could not keep it.
My work in therapy enabled me to develop the necessary skills to find the right mate and stay married for thirty-two years and counting. Which brings me to another solution for people struggling with trauma: love. At first blush this may sound hokey but it’s true. To be accepted, valued and loved as I am has made all the difference. This is true in my marriage and the friendships I’ve maintained over the years. I am no longer satisfied with pleasing others at my own expense. I see that relationships, though they come with conflict, must be value added overall. If not then it makes no sense to persevere in them.
To summarize: treatment whether in or outpatient should be safe, patient, non-judgmental and encouraging. Patients with co-occurring disorders may need detox before admission to an integrated program that can treat simultaneously the addictions and PTSD. Individual sufferers need to be committed and patient knowing that complex PTSD does not remit overnight. Medications may or may not be useful tools. For patients with severe trauma and addictions long-term residential treatment with wrap around services is sensible.
As a society, and as individuals, how do we find compassion and the resources to care for our most afflicted people? It’s to our own betterment to do so. Prevention, early intervention before conditions become chronic and training of frontline workers would help. The bottom line cost of these conditions when untreated is astronomical in dollars, and more importantly in lives adversely affected and lost. We must do better!
After all, nobody escapes this world without trauma.
Resources:
A screening form to assess for PTSD
https://www.ptsd.va.gov/professional/assessment/documents/pcl5_standard_form.pdf
Adverse Childhood Experience (ACE) Questionnaire
https://www.rockefellerfoundation.org/wp-content/uploads/2021/03/ACE-Questionnaire.pdf
Information about trauma informed care
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