SUBSTANCE ABUSE AND TREATMENT
Joint Treatment of PTSD and Cocaine Abuse
By Lauren Gilmore
A recent study suggests that exposure therapy, a
common form of treatment for people with post-traumatic stress
disorder (PTSD), in addition to substance abuse counseling, may
significantly decrease the severity in symptoms of both disorders.
Symptoms of PTSD are characterized by three main categories:
"intrusions," which includes re-experiencing the trauma
through flashbacks or nightmares; "hyperarousal," which
contributes to symptoms of anxiety, irritability, poor concentration
and hypervigilance; and "avoidance," an inappropriate
evasion of people, places or situations which may trigger memories
of the event. Research has suggested a correlation between PTSD
sufferers and cocaine abuse, as an estimated 30-60 percent of
those diagnosed with PTSD also abuse substances such as cocaine.
Some experts feel that abusing substances may greatly intensify
certain PTSD symptoms. An additional concern is that the use of
exposure therapy, a common method of treatment that involves reliving
the traumatic experience, may increase drug abuse due to the emotional
difficulty of the experience.
The study, conducted by Dr. Kathleen Brady of the
Medical University of South Carolina, combined exposure therapy
and substance abuse counseling in PTSD/cocaine-dependent subjects.
The study involved 39 subjects, 32 of whom were female, who participated
in a treatment protocol consisting of 16 therapeutic sessions.
The first three weeks focused on substance abuse counseling and
development of coping strategies. Subjects were then treated by
the method of "imaginal exposure," which gradually desensitizes
them from fear-inducing stimuli and situations. Fifteen out of
39 actually completed the study, attending at least 10 out of
16 therapeutic sessions and three exposure sessions.
Significant decreases in both cocaine use and active
symptoms of PTSD were found in those subjects that completed the
study. Study participants reported a 53 percent decrease in intrusion
and a 27 percent decrease in avoidances. Clinicians completed
a 30-item structured interview and noted a 66 percent decrease
in intrusion, a 70 percent decrease in avoidances, and a 47 percent
decrease in hyperarousal in study participants. Upon completion
of the study, subjects also reported a 60 percent reduction in
cocaine use and a significant decrease in substance-related problems.
The marked improvements in the subjects were similar to those
found in other studies. However, the low number of participants
in the study and high dropout rate indicates a need for more controlled
studies in order to produce results of higher accuracy. Dr. Brady
feels that this study can perhaps provide essential information
on identifying those patients who do, and those who do not, benefit
from this method of treatment and other approaches that may prove
to be more efficient.
(Brady, K.T., et al. Exposure therapy in the treatment of PTSD
among cocaine-dependent individuals: Preliminary findings. Journal
of Substance Abuse Treatment 21(1):47-54, 2001).
The Maternal Substance Abuse and Child Development Project is funded in part by the Georgia Department of Human Resources Division of Public Health.
The Maternal Substance Abuse and Child Development
Study is under the direction of Claire D. Coles Ph.D., with the
Department of Psychiatry and Behavioral Science, Emory University
School of Medicine. For more information, please contact: Claire
D. Coles: firstname.lastname@example.org
Karen K. Howell: email@example.com