Trauma and Substance Abuse: Causes, Consequences, and Treatment of Comorbid Disorders

310 Pages·2003·18.72 MB·English

by  Paige Ouimette

Trauma
and
Substance
Abuse
Mlra uma
and
Substance
Abuse
Causes, Consequences,
and Treatment of
Cornorbid Disorders
Edited by
PAIGEO UIMETTE
AND
PAMELJ.A B ROWN
American Psychological Association
Washington, DC
Copyright 0 2003 by the American Psychological Association. All rights reserved.
Except as permitted under the United States Copyright Act of 1976, no part of this
publication may be reproduced or distributed in any form or by any means, or stored in a
database or retrieval system, without the prior written permission of the publisher.
Published by
American Psychological Association
750 First Street, NE
Washington, 20002
DC
www.apa.org
To order In the U.K., Europe, Aftica, and the Middle
APA Order Department East, copies may be ordered from
P.O. Box 92984 American Psychological Association
Washington, DC 20090-2984 3 Henrietta Street
Tel: [phone] Covent Garden, London
Direct: (202) 336-55 10 WC2E 8LU England
Fa: [phone]
TDD/TTY: [phone]
Online: www.apa.or&ooks/
Email: [email protected]
Typeset in Goudy by World Composition Services, Inc., Sterling, VA
Printer: United Book Press, Inc., Baltimore, MD
Cover Designer: Naylor Design, Washington,
DC
Technical/Production Editor: Jennifer L. Zale
The opinions and statements published are the responsibility of the authors, and such
opinions and statements do not necessarily represent the policies of the American
Psychological Association.
Library of Congress Cataloging-in-Publication Data
Trauma and substance abuse : causes, consequences, and treatment of
comorbid disorders / edited by Paige Ouimette and Pamela J. Brown
p. cm.
Includes bibliographical references and index.
ISBN 1-55798-938-9
1. Post-traumatic stress disorder-Patients-Rehabilitation. 2.
Substance abuse-Patients-Rehabilitation. 3. Comorbidity. 4.
Psychiatry. I. Ouimette, Paige. 11. Brown, Pamela J.
RC489.C63 T72 2003
616.85’2 1-dc2 1 2002008422
British Library Cataloguing&-Publication Data
A CIP record is available from the British Library.
Printed in the United States of America
First Edition
CONTENTS
.............................................................................................
Contributors ix
Foreword ................................................................................................... xi
Donald Meichenbaum
Introduction ............................................................................................... 3
Pamela J. Brown and Paige Ouimette
I. Epidemiology and Etiological Issues ...................................................... 7
Chapter 1. Epidemiological Investigations: Comorbidity
of Posttraumatic Stress Disorder and Substance
.....................................................................
Use Disorder 9
Howard D. Chilcoat and Christian Menard
Chapter 2. Psychosocial Models of Functional Associations
Between Posttraumatic Stress Disorder and
Substance Use Disorder ................................................. 29
Sherry H. Stewart and Patriciuj. Conrod
Chapter 3. Experimental Studies Exploring Functional
Relations Between Posttraumatic Stress Disorder
and Substance Use Disorder .......................................... 57
Patricia j. Conrod and Sherry H. Stewart
Chapter Childhood Trauma, Posttraumatic Stress Disorder,
4.
Substance Abuse, and Violence .................................... 73
David Lisak and Paul M. Miller
v
11. Assessment and Treatment ................................................................ 89
Chapter 5. Substance Use Disorder-Posttraumatic Stress
Disorder Comorbidity: A Survey of Treatments
and Proposed Practice Guidelines ................................. 91
Paige Ouimette, Rudolf H. Moos, and Pamela J. Brown
Chapter 6. Assessment of Comorbid Substance Use Disorder
and Posttraumatic Stress Disorder .............................. 111
Jennifer P. Read, Andreas R. Bollinger, and Erica
Sharkunsky
Chapter 7. Exposure-Based, Trauma-Focused Therapy for
Comorbid Posttraumatic Stress Disorder-Substance
Use Disorder ................................................................. 127
Scott F. Coffer, Bonnie S. Dansky, and
Kathleen T. Brady
Chapter 8. Seeking Safety: A New Psychotherapy for
Posttraumatic Stress Disorder and Substance
Use Disorder ................................................................. 147
Lisa M. Najavits
Chapter 9. Comorbid Posttraumatic Stress Disorder and
Substance Use Disorders: Treatment Outcomes
and the Role of Coping ............................................... 171
Pamela J. Brown, Jennifer P. Read, and
Christopher W. Kahler
111. Specific Populations ......................................................................... 189
Chapter 10. Concurrent Posttraumatic Stress Disorder and
Substance Use Disorder Among Veterans:
...................................
Evidence and Treatment Issues 191
Josef I. Ruzek
Chapter 11. Posttraumatic Stress Disorder and Substance
Use Disorder Among Incarcerated Women ............... 209
Cynthia L. Battle, Caron Zlotnick, Lisa M. Najavits,
Marysol Gutierrez, and Celia Winsor
Chapter 12. Comorbidity of Substance Use Disorders and
Posttraumatic Stress Disorder in Adolescents ............ 227
Rose M. Giaconia, Helen 2. Reinherz,
Angela D. Paradis, and Cecilia K. Stashwick
Epilogue: Future Directions ................................................................... 243
Paige Ouimette and Pamela J. Brown
vi CONTENTS
References .............................................................................................. 247
Author Index ......................................................................................... 291
Subject Index ......................................................................................... 303
About the Editors .................................................................................. 315
CONTENTS vii
CONTRIBUTORS
Cynthia L. Battle, PhD, Department of Psychiatry and Human
Behavior, Brown University and Butler Hospital, Providence, RI
Andreas R. Bollinger, PhD, VA Boston Healthcare System and Boston
University School of Medicine, Boston
Kathleen T. Brady, MD, PhD, Department of Psychiatry and Behavioral
Sciences, Medical University of South Carolina, Charleston
Pamela J. Brown, PhD, private practice, New Bedford, MA, and
Department of Psychiatry and Human Behavior, Brown University,
Providence, RI
Howard D. Chilcoat, ScD, Department of Mental Hygiene, Johns
Hopkins Bloomberg School of Public Health, Baltimore
Scott F. Coffey, PhD, Department of Psychiatry, State University of
New York at Buffalo
Patricia J. Conrod, PhD, Department of Psychology, University of
British Columbia, Vancouver, British Columbia, Canada
Bonnie S. Dansky, PhD, CB Technologies, Inc., Exton, PA
Rose M. Giaconia, PhD, Graduate School of Social Work, Simmons
College, Boston
Marysol Gutierrez, BA, Butler Hospital, Providence, RI
Christopher W. Kahler, PhD, Center for Alcohol and Addiction
Studies, Brown University, Providence, RI
David Lisak, PhD, Department of Psychology, University of
Massachusetts-Boston
Donald Meichenbaum, PhD, Department of Psychology, Waterloo
University, Waterloo, Ontario, Canada
Christian Menard, MHS, PhD candidate, Department of Mental
Hygiene, Johns Hopkins Bloomberg School of Public Health,
Baltimore
ix
Paul M. Miller, PhD, Department of Psychiatry and Human Behavior,
Brown Medical School, Providence, RI
Rudolf H. Moos, PhD, Center for Health Care Evaluation, VA Palo
Alto Health Care System, Menlo Park, CA, and Department of
Psychiatry, Stanford University School of Medicine, Stanford, CA
Lisa M. Najavits, PhD, Department of Psychiatry, Harvard Medical
School, Boston, and Trauma Research Program, McLean Hospital,
Belmont, MA
Paige Ouimette, PhD, Department of Psychology, Washington State
University, Pullman
Angela D. Paradis, BA, Graduate School of Social Work, Simmons
College, Boston
Jennifer P. Read, PhD, Center for Alcohol and Addiction Studies,
Brown University, Providence, RI
Helen Z. Reinherz, ScD, Graduate School of Social Work, Simmons
College, Boston
Josef I. Ruzek, PhD, Education and Clinical Laboratory Division,
National Center for Post-Traumatic Stress Disorder, VA Palo Alto
Health Care System, Menlo Park, CA
Erica Sharkansky, PhD, Boston VA Medical Center and Women’s
Health Sciences Division, National Center for Post-Traumatic
Stress Disorder, Boston
Cecilia K. Stashwick, BA, Graduate School of Social Work, Simmons
College, Boston
Sherry H. Stewart, PhD, Department of Psychology, Dalhousie
University, Halifax, Nova Scotia, Canada
Celia Winsor, BS, The Providence Center and Rhode Island
Department of Corrections Women’s Facility, Cranston
Caron Zlotnick, PhD, Department of Psychiatry and Human Behavior,
Brown University and Butler Hospital, Providence, RI
X CONTRIBUTORS
FOREWORD
As the adage goes, one of the tasks of science is to “carve nature at its
joints.’’ In the area of developmental psychopathology, this translates into
the need to identify distinct mental disorders and to ascertain how they
may co-occur. Such co-occurrence of mental disorders, or comorbidity, refers
to the presence of independent psychiatric disorders. These disorders may
be present during the same period of time (concurrent comorbidity), or they
may occur during one’s life (lifetime comorbidity), thus taking the forms
of simultaneous or sequential disorders, respectively. Such comorbidity of
mental disorders has been found to be more the rule than the exception,
especially in the case of posttraumatic stress disorder (PTSD) and substance
use disorder (SUD).
The contributors to this edited volume highlight the critical need of
attending to the issue of comorbid PTSD and SUDs. They note the high
incidence of comorbidity of PTSD and SUD. Moreover, patients who evi-
dence comorbid disorders of PTSD and SUDs have more severe levels of
psychopathology, with greater symptomatology for each disorder; more life
stressors (e.g., more medical problems, higher unemployment, higher arrest
records); higher health care utilization; less effective coping strategies; and
poorer response to treatment than do patients with either PTSD or SUD
alone. They are also more likely to experience additional comorbid affective
disorders (panic disorders, major depressive disorders), personality disorders,
and a record of antisocial and violent behaviors.
Even though the prevalence and incidence and the impact of the
comorbid disorders of PTSD and SUD are high, clinicians often fail to
systematically assess for SUDs, exposure to trauma, and PTSD. Few patients
with PTSD and SUDs receive any type of psychiatric treatment. This is
especially troubling when one considers that new innovative integrative
treatments now exist that have led to promising results. The recent work
xi