Co-occurring issues for PTSD and Substance Dependence Disorders
-By Timothy Lyons
I am a firm believer in screening for mental health disorders when a person comes in for treatment of a substance use disorder. This is known as screening for dual diagnosis. I think this should be done in all cases when a person decides to get sober or clean. This is especially true in cases where a person suffers from post-traumatic stress disorder (PTSD)
The reasons for screening for dual diagnosis are that in many cases persons who suffer from mental illness represent a disproportionate amount of the drug abusing population. Nearly 41% of persons who have been diagnosed with a substance abuse disorder have been diagnosed with a mental illness. This is a cautious number because there are many rehabilitation facilities that do not treat for illnesses like PTSD.
With Post Traumatic Stress Disorder
PTSD cases are seen in over 30% of persons who have exposure to severe trauma and about 10% of persons who are exposed to moderate trauma suffer from PTSD. In the case of co-occurring diagnosis for substance abuse and PTSD the rate of success is far less than persons who are diagnosed without an additional mental illness. It is important to perform screening for dual diagnosis. PTSD is correlated with an increase in diagnosis of substance abuse disorder. It is thought that the one of the ways in which persons with PTSD deal with their PTSD is through the use of substances. In this way persons who suffer from PTSD are far more likely to end up with a substance use disorder.
Since 33% of persons who have reported having been diagnosed with PTSD also report a concurrent problem with substance abuse, it would seem that there is a very high amount of persons with substance issues who are comorbid for PTSD specifically in relation to other mental illness. This is troubling in that this information comes from self-reports. It is possible that the numbers are even higher as self-reports tend to have bias from the reporter so that they will not be looked at from the perspective of having a mental illness. It would be more acceptable for the person to have a substance use disorder than a mental illness.
Screening for dual diagnosis
The one troubling aspect of co-occurring treatment will be the large numbers of veterans that come home from combat situations with PTSD that will need some form of treatment for both problems. With the length of the current conflicts and the amount of soldiers that are being diagnosed with PTSD, the problems that they will be experiencing will be lifelong. More than ever we should be screening for dual diagnosis
The treatment efforts will have to continue for years to come. There will be a huge amount of manpower and effort put forth to try and stem the tide of these co-occurring issues. So far the cost of these problems are in the billions and will continue to rise. There will be a huge opportunity for persons who wish to work in the area of dual diagnosis. There is so much work to be done.
Dual diagnosis as one of the most important things that we can do for our clients. Close to 89 percent of the dually diagnosed do not receive treatment for both disorders. This lack of treatment for the comorbid disorder is setting up a relapse. The impetus is on the part of the counselor to ask themselves why they got into the field. They should not shrug off the extra work involved with co-occurring issues. They should really leave no stone unturned when it comes to saving lives. All facilities that deal with substance abuse should connect clients to treatments for both issues because even if they are not dually diagnosed, it’s the safer bet.
References
“A Counselors Perspective: Dual Diagnosis” by David Skonezny, CADC-2, ICADC. Counselor Magazine, pp10-11. Volume 16, No.4 August 2015 ed.