Trauma- and Stressor-Related Disorders

The majority of people presenting to drug and alcohol services are likely to have experienced some traumatic events in their lives.  Many will have ongoing problems from those experiences.  Combat exposure, physical and/or sexual assault, life-threatening accidents, and natural disasters place a person at risk of alcohol use and post-traumatic stress disorder.  As an intervention to organise care - we could find no direct evidence about trauma informed care in drug and alcohol settings but evidence from other settings suggest that it is likely to be beneficial.   

Recommendations for the management of comorbid trauma and post-traumatic stress disorder from the 2013 Australian guidelines for the treatment of adults with acute stress disorder and posttraumatic stress disorder (Australian Centre for Posttraumatic Mental Health (ACPMH), 2013), and the National Comorbidity Guidelines are summarised here and are supported by a high quality Cochrane review.  There is clear evidence that intervention should be individual and not group based and that trauma focused approaches lead to better outcomes than those without a trauma focus.  However as there are relatively few health professionals trained to provide trauma focused psychotherapies, there is a need for significant training and clinical supervision to provide and support workforce capacity. 

Australian PTSD clinical practice guidelines recommend that pharmacotherapies be added to trauma focused CBT if there is not sufficient benefit from CBT alone (Australian Centre for Posttraumatic Mental Health (ACPMH), 2013).  

A systematic review of 18 studies of benzodiazepines for PTSD found worse substance use outcomes with the use of benzodiazepines. From Marel et al’s (2016) review the antidepressants sertraline, desipramine and paroxetine as well as naltrexone and disulfiram have been successfully trialled for comorbid PTSD and substance use disorders. There was insufficient evidence to make any recommendation about the use of the anticonvulsants topiramate and gabapentin for comorbid PTSD and alcohol use disorder.