By Sara Robinson, Adriane Apicelli, and Kerry Nolte, Photo: Leigh Prather, Psychiatric Times, March 21, 2022
The experience of trauma is common for US adults and even more pervasive for patients presenting in psychiatric settings. Estimates of previous experience of traumatic events is 51% to 84% in the general adult population and 76% to 91% in those seen in psychiatric settings. The most prevalent comorbid disorders among adults with serious mental illness (SMI) are substance use disorders (SUDs). Despite trauma symptoms often being underreported, 30% to 60% of individuals seeking treatment for SUD also meet criteria for posttraumatic stress disorder (PTSD). Acknowledgment of “dual diagnosis dates back decades, into the early 1980s; however, the classification of PTSD and SUD as psychiatric comorbidities is inadequate to capture the range of symptoms and impairments of this diverse patient population. Greater understanding of approaches to SUD and related support services may help psychiatric providers provide multifaceted, comprehensive support to patients with SMI, PTSD, and SUD.
Evidence-based treatments exist for both PTSD and SUD; however, the approaches are rarely integrated, despite recognition of frequent cooccurrence. There are trends to further integrate trauma-informed care (TIC) in both SUD and psychiatric settings, but these services are seldom cohesive. To combat the SUD epidemic, availability of medication-assisted treatment/recovery has focused on primary care and the treatment of SUD as a chronic health condition. There is also greater opportunity for psychiatric providers to strengthen their care of patients with comorbid SMI, PTSD, and SUD by continually linking emergent evidence with clinical care. As the SUD epidemic has further intensified during the COVID-19 pandemic, the need for trauma-informed psychiatric care addressing SMI and SUD is even greater.
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