PTSD and Distress Tolerance Affect Substance Use Treatment Outcomes

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.

Reference:
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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  • rosa

    rosa

    September 12th, 2012 at 3:11 PM

    as if an addiction is not bad enough, they have to be subjected to the stress of PTSD too? Man, that’s tough

  • Eric S

    Eric S

    September 13th, 2012 at 4:14 AM

    This is a tough one.
    Because I know that there are many addicts out there who want so badly to kick their bad habits that they have picked up along the way of life but they always feel like there are so many other things holding them back that they fail to have success with their efforts.
    If we realize from the outset that this is a person who needs to be treated for muiltiple afflictions, then perhaps they will be taught the skills and given the mean to break those addictive cycles that they have established while also healing their hearts from the other stress and anxiety that has continually plagued them, and truth be told, probably contributed very heavily to the first usage and abuse in the first place.

  • Tom Ballard

    Tom Ballard

    September 13th, 2012 at 11:58 AM

    What’s sad is that these vet’s children are subject to the secondary and intergenerational effects of PTSD and addiction.

  • Parson

    Parson

    September 13th, 2012 at 1:24 PM

    I know that there is nothing that proves that these programs can actually work to improve distress tolerance, but anything is worth a shot, And I strongly feel that as you help to heal one ailment then maybe, just maybe, that will lead to more healing on another level as well.

  • sally

    sally

    September 13th, 2012 at 2:43 PM

    so how exactly do they measure distress tolerance(DT)?

    seems logical that those who cannot handle distress would have trouble making it through a program or even keeping their addiction in check.but I really hope they have ways of helping these people.because first experiencing trauma and then drowning your life in drugs seems just so pathetic and sad.

  • Lisa Marriott

    Lisa Marriott

    September 13th, 2012 at 2:50 PM

    totaly agree with everything this post sais i have been on the recieving end of someone who is very dear to me suffering with ptsd and coming of meds too early and then resorting to marajuana and now as a result i feel i am loosing my dearest friend totaly to this addiction he has now aquired and he has become a stranger to me in his personality and refuses to aknowlege he now has a problem Its heartbreaking i have tried everything to get him to get help and he led me to believe that he actually was getting help but i have since found out he has been lying & decieving not only to me but to himself that he is trying to stop and get proper help which he clearly still needs from his Dr. I have had to cut him out my life for now until he manages to help himself there is nothing more i can do as he is not only destroying his life but mine too .

  • LISA MARRIOTT

    LISA MARRIOTT

    September 13th, 2012 at 3:01 PM

    totaly agree with everything this post sais i have been on the recieving end of someone who is very dear to me suffering with ptsd and coming of meds too early and then resorting to marajuana and now as a result i feel i am loosing my dearest friend totaly to this addiction he has now aquired and he has become a stranger to me in his personality and refuses to aknowlege he now has a problem Its heartbreaking i have tried everything to get him to get help and he led me to believe that he actually was getting help but i have since found out he has been lying & decieving not only to me but to himself that he is trying to stop and get proper help which he clearly still needs from his Dr. I have had to cut him out my life for now until he manages to help himself there is nothing more i can do and he is not only destroying his life but mine too .

  • trainHopper

    trainHopper

    September 15th, 2012 at 3:48 AM

    It is one thing to have simply PTSD or an addiction, but facing the reality that you are experiencing these two things in conjunction could lead one to believe that fighting this addiction and illness will be such an uphill battle. But the good news is that I have faith that for many people as soon as one issue is resolved, then that could go a very long way in helping to resolve, or at least alleviate many of the symptoms of the other. The doom and gloomers will say that this isn’t true, but I think that any of us who have lived with this know that this is the case. This is not something that should make you give up, but should rather encourage you that there is some hope out there for you.

  • Lisa Marriott

    Lisa Marriott

    September 15th, 2012 at 2:08 PM

    No Never Ever Give Up I totally agree… where there is a heartbeat there is always hope <3 … And as long as they know that they have friends, loved ones and people who believe in them and who are always there for them, if and when they ever need. At the same time it is THEY with the problem who have to admit This to Themselves 1st in order for for help to work. Never Ever give up on Them but just give them the space they need to realise this and do something about it.

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