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Does Talking About Trauma Trigger Relapse?

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT
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Talking about traumatic events is often considered dangerous territory when treating addiction. Some people believe that cognitive behavioral therapy (CBT) – the gold standard in treating trauma – brings painful memories to the surface. They assert that CBT can be dangerous for people with dual diagnosis – i.e. those both a subtance use disorder (SUD) and post-traumatic stress disorder (PTSD) –  might not have the tools to cope with these memories. Therefore, they theorize, bringin up these memories increases their risk of drug relapse.

According to a June 2020 study from Johns Hopkins University, this line of thinking is incorrect. The study shows that treating PTSD at the same time as SUD didn’t cause drug relapse. In addition, data showed that PTSD severity decreased after just one therapy session.

For the study, the researchers asked participants about drug cravings, number of drug-using days, and other signs of emotional or psychological distress. They found no increase in drug use or stress after PTSD therapy sessions. After nine therapy sessions, the severity of PTSD decreased by 54 percent on average, compared to the first session.

“Now that we have evidence that treating PTSD won’t impact recovery, patients can request therapy, and mental health providers have a duty to make it available to their patients,” said Jessica Peirce, PhD, associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.

The Link Between Substance Abuse and Trauma

Substance abuse and trauma often go together. About 25 percent of people with substance use disorders also suffer from PTSD. Trauma can lead to substance abuse and substance use disorder (addiction), often in an attempt to cope with depression, low self-worth and other PTSD symptoms. Substance abuse can also lead to trauma. In these cases, using drugs or alcohol leads to risky behaviors like driving under the influence, which can increase the risk of trauma.

The link between drug use and trauma is also strong in young people. Research shows:

  • Teens who have experienced physical or sexual abuse are three times more likely to report abusing drugs or alcohol than those without a history of trauma.
  • More than 70% of adolescents receiving treatment for substance abuse had a history of trauma.
  • In a study of severely traumatized people, participants reported high rates of dependence on several drugs (39% alcohol, 34% cocaine and 44% marijuana). They also started using earlier than peers who didn’t have trauma.

At first, drugs and alcohol may seem like a solution to trauma symptoms, but over time they make the problem worse. Recovery is harder after a traumatic event, and some teens develop a second diagnosis – substance use disorder – that also requires treatment. Although these teens need specialized treatment, many don’t receive it.

What Type of Treatment Works for PTSD + Addiction?

The Johns Hopkins study underscores the importance of integrated dual diagnosis treatment for PTSD and substance abuse, which is care for both issues at the same time. Most treatment is compartmentlaized. Participents get either trauma treatment or substance abuse treatment – not both. This type of treatment doesn’t address the underlying issues, which prevents long-term healing and increases the risk of relapse. So, you’ll need to do your research to find the most effective care.

Trauma-informed dual diagnosis treatment is unique in several ways:

  • It’s delivered by clinicians who have training and experience in treating both trauma and addiction.
  • It includes comprehensive assessments that consider trauma history and its relationship to the client’s current methods of coping, like substance abuse.
  • It includes evidence-based interventions such as cognitive behavioral therapy to replace negative patterns of thinking and behaving with healthier ones.
  • Early on in treatment, clinicans focus on developing a sense of safety and avoiding re-traumatization. They often use experiential and nonverbal techniques.
  • Clients practice developing healthy coping mechanisms to replace substance abuse.
  • Clients develop tools to enhance emotional and behavioral regulation.
  • Relapse prevention planning takes into account trauma triggers as well as drug relapse triggers.

With dual diagnosis treatment, teens with dual diagnoses can heal. They can learn to process their sadness, anger and fear in healthy ways. Then, they can then develop coping strategies so they can move forward. They an focus on what really matters during adolescence. In our winds, this means they can who they are and who they want to be. They can experience life – with all its ups and downs – without relying on drugs or alcohol to cope.

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