Stress syndrome, addictions have common treatments: 11/16

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Stress syndrome, addictions have common treatments

by Dawn Brazell
Public Relations

Close to half of those with post-traumatic stress syndrome (PTSD) also suffer from substance use disorders. That's why MUSC researchers Kathleen Brady, M.D., Ph.D., and Sudie Back, Ph.D., hope to educate therapists and the public about an influential change in how to best treat this population. Brady and Back are faculty members in the Department of Psychiatry and Behavioral Sciences.

Dr.
Brady Dr. Kathleen Brady with her latest manual on PTSD.

These MUSC researchers collaborated with colleagues in Australia to test exposure therapy, an evidence-based cognitive-behavioral treatment for PTSD and addiction developed by the MUSC research group, in the treatment of individuals with co-occurring PTSD and addictions. The study was conducted in Sydney, Australia in collaboration with investigators from the University of New South Wales.

Brady said that she wasn't surprised by the findings, published in the Journal of the American Medical Association, that this patient population could be treated for their PTSD without worsening symptoms of addiction. (Read the abstract here at http://jama.jamanetwork.com/article.aspx?articleid=1346186)

"Because this was almost an heretical idea in terms of how the treatment for this difficult portion of the population had been, it really has opened up a new avenue for treatment of people with co-occurring PTSD and stress disorders and addictions that is much more efficacious and more humane."

The fact that these findings set a new standard for handling treatment is exciting to Brady, a longtime researcher in this area. "This is an incredibly common problem and so pertinent today because we have so many veterans returning from our recent wars with problems related to PTSD and addictions. Therapists need effective tools to address these problems."

Another aspect that made this study interesting is the collaboration with MUSC and University of New South Wales researchers, who used the manual "Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE)" that was developed based on work by Brady and colleagues.

"We have been working in PTSD for a long time. We were the first group who conducted trials exploring medication treatments for this comorbidity and have been involved in neurobiologic exploration of the stress response in individuals who have co-occurring disorders," she said, adding that it's one reason MUSC has become a specialty center for PTSD treatment.

"Once you get a critical mass in an area, it becomes a magnet for new trainees and more experienced colleagues who want to collaborate and be part of the excitement of new discovery."

Colleagues in Australia read about the manual and asked to collaborate on a study. Brady said they've developed a close partnership, and it was helpful to conduct the research there given funding was easier to obtain and the timeframe for the completion of the study could be shorter. "It's such a rich experience to interact with others who come from a different perspective."

For the study, researchers enrolled 103 participants, who met the diagnostic criteria for both PTSD and substance dependence. The subjects were randomly selected to either receive both prolonged exposure therapy and treatment for substance dependence or to only receive treatment for substance dependence.

Those participants involved with the integrated approach spent the first few sessions learning cognitive behavioral therapy strategies to deal with substance abuse, and then they were treated for their PTSD symptoms. Brady said they focused on teaching the patients the relationship between their trauma and their addictions and how the conditions are in a 'feed-forward, vicious cycle.'

At a nine-month follow-up visit, both groups experienced reductions in PTSD symptoms, but subjects in the integrated group also showed a reduction in the severity of their PTSD symptoms without any increase in the severity of their substance use.

Brady said they've had good experience with the integrated approach so far. "We were true believers that this works. We think this study will change the way clinicians approach this particular population, which is a substantial number of people with addictions. This will improve their treatment and relieve their suffering more rapidly than anything that has been used before."

Beyond the scope of the study is a bigger message. Brady wants to see the moralistic thinking about addictions change. It's not just a fault of willpower or a societal issue to be resolved by throwing people with addictions into jail, one of the most costly and least effective ways of treating addictions, she said.

"The message I'd like to get out to the lay public is that addictive disorders are treatable disorders. There's a neurobiology to these disorders and there are effective treatments. We need to support that. There are a significant number of people in this country and throughout the world who can live much happier lives and make much greater contributions. Why have people suffer with addictions, waste their lives and drain the resources of our society when a relatively small investment in treatment can lead to incredible gains at the individual and societal level."

Friday, Nov. 16, 2012

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