Individuals with substance use disorders (SUDs) have disproportionately high rates of co-occurring posttraumatic stress (PTSD). Numerous studies have shown that people who have experienced a traumatic event may resort to maladaptive coping strategies as a result. Specifically, the symptoms of PTSD, which include avoidance of things that trigger memories and numbing to avoid feeling the emotional pain of the event, can lead to negative behaviors such as substance misuse. This can be especially problematic when individuals with PTSD and SUD seek treatment for their addiction, because these people are more likely to terminate treatment early, relapse, or attempt suicide than individuals without PTSD. To better understand how PTSD can affect SUD treatment outcome, Matthew T. Tull of the Department of Psychiatry and Human Behavior at the University of Mississippi Medical Center led a study involving 214 individuals receiving inpatient treatment for SUDs.
The participants were all part of an inpatient program and were assessed for levels of PTSD and distress tolerance (DT). Tull looked at DT because it demonstrates how much stress an individual is capable of adaptively coping with. Low levels of DT could predict impulsive and negative coping strategies and increase the chances of relapse or early termination. Tull found that the individuals with PTSD and SUD had similar treatment completion rates to individuals with SUD alone. However, he did discover that the men with PTSD and low levels of DT had much higher dropout rates than the other participants.
Tull believes that the low DT could put the men at risk for negative behaviors, including aggression and violence, which could cause them to violate treatment rules and result in their eviction from the program. The study did not follow the men after discharge from treatment to determine the rates of relapse with respect to PTSD and DT. Also, the relatively small sample size should be increased in future studies to further test this relationship. Overall, the findings show that men with PTSD and SUD may improve their chances of treatment success if they increase their DT. Tull said, “Although there are available treatments for individuals with a combined PTSD-SUD diagnosis, the extent to which these treatments actually improve DT is unclear.” Future research should focus on existing treatments such as skills for improving distress intolerance and dialectal behavioral therapy, two methods shown to improve DT and treatment adherence, to ascertain if they are viable options for individuals with SUD, PTSD, and low DT.
Tull, M. T., Gratz, K. L., Coffey, S. F., Weiss, N. H., McDermott, M. J. (2012). Examining the interactive effect of posttraumatic stress disorder, distress tolerance, and gender on residential substance use disorder treatment retention. Psychology of Addictive Behaviors. Advance online publication. doi: 10.1037/a0029911
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