Treating trauma at the same time as comorbid substance abuse may sound pretty obvious. Both treatments at the same time – duh! But it is not historically practiced that way. Luckily, a growing understanding about how PTSD and substance abuse influence each other has yielded effective methods to treat both.
For a long time, treating comorbid PTSD and substance abuse created quite a dilemma. Therapy often is not effective if someone is actively using or even intoxicated in sessions. So treatment usually requires clients to quit substances and then return to therapy for effective PTSD treatment.
However, effective treatments for PTSD require active engagement with trauma content (e.g., memories, triggers, strong emotions like anxiety or shame). So once treatment commences, clients are likely to return to substances as their primary method of coping with difficult triggers. Relapse is exceedingly common. This creates a real catch-22 for treatment.
Clients usually understand the relationship between trauma and substance abuse, but that interaction is still extremely difficult to manage. Luckily, successful efforts in the past decade combine trauma and substance abuse treatment into one simultaneous treatment.
The COPE model (“Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure”) utilizes a simultaneous approach with the same therapist. This approach uses prolonged exposure therapy along with psychoeducation about the interaction of trauma and substance abuse. COPE also teaches clients effective tools to manage substance cravings in the moment. Tools for effective emotion regulation help clients deal with life stressors and prevent substance abuse relapse.
COPE has been shown to be effective in clinical trials. The VA also effectively uses similar methods with prolonged exposure therapy or cognitive processing therapy (CPT) in outpatient or residential treatment formats.
More good news: there are multiple ways to learn to conduct COPE with clients. There are good trainings therapists can take to learn to use the COPE method. Therapist resources are also available in the form of a therapist guide to treatment and a client workbook.
Comorbid PTSD and substance abuse has traditionally created a difficulty for therapists. But new and exciting advances make it possible for therapists to effectively treat trauma and substance abuse at the same time. Now our efforts make more sense!
