NIDA-funded researcher has developed an innovative treatment program to meet the special needs of drug-abusing women who also are diagnosed with posttraumatic stress disorder (PTSD), a disorder often associated with physical, sexual, or other abuse during childhood. PTSD victims re-experience their trauma, sometimes years later, through unexpected and recurring flashbacks or nightmares. The trauma that sparks PTSD may range from battlefield shock or childhood sexual molestation to violence related to drug dealing.
PTSD symptoms include "avoidant" behavior, which may be marked by loss of interest in favorite activities, avoidance or suppression of thoughts or emotions, feelings of detachment, or difficulty thinking about the distant future. PTSD victims may suffer increased arousal or anxiety, as shown in extra vigilance against perceived dangers, trouble concentrating, exaggerated responses to being startled, and outbursts of anger.
PTSD combined with drug abuse can be devastating for women struggling to survive in the street drug culture. One study, which evaluated women crack cocaine abusers with PTSD in New York City's Harlem, found that they are forced into vicious cycles in which they use crack to counteract the distress of trauma, suffer more drug-related trauma, and then turn to crack again.
Development of new treatment strategies for drug abusers with coexisting PTSD, especially women, should be a high priority, says Dr. Lisa M. Najavits of Harvard Medical School, who conducted a NIDA-funded review of research focusing on women with these problems. Treatments developed either for PTSD or substance abuse alone may not be sufficient, she says. Further, existing treatments for men with PTSD and drug abuse may not be directly applicable to women, she adds.
Dr. Najavits developed an innovative treatment program called "Seeking Safety" that consists of 24 sessions that teach women new coping skills to manage both disorders at once. Patients learn how to ask for help, set boundaries in relationships, nurture themselves, and fight cues and urges to relapse to drug use.
The safety theme is emphasized as the key to recovery from both PTSD and drug abuse.
"Safety" in this situation means abstaining from drugs and alcohol, reducing self-destructive behavior, establishing a network of supportive people, and guarding against the dangers associated with both disorders, such as HIV and domestic violence.
Of 27 women enrolled in the "Seeking Safety" program, 17 completed treatment. After treatment, these women showed significant reductions in drug use, trauma-related symptoms, suicide risk, and suicidal thoughts. They showed improvements in social adjustment, family functioning, problem solving, depression, and thoughts about substance abuse, according to Dr. Najavits. "While this is a small sample, an uncontrolled pilot study, the data indicate that, when provided with treatment tailored to their needs, these difficult-to-treat women appear highly responsive and show improvements in both of their diagnoses," she says.
Her treatment design is now undergoing further evaluation in three demonstrations where it is being compared to usual treatment regimens.
- Fullilove, M.T.; Fullilove, R.E.; Smith, M.; et al. Violence, trauma, and post-traumatic stress disorder among women drug users. Journal of Traumatic Stress 6(4):533-543, 1993.
- Najavits, L.M.; Weiss, R.D.; and Liese, B.S. Group cognitive-behavior therapy for women with PTSD and substance use disorder. Journal of Substance Abuse Treatment 13:13-22, 1996.
- Najavits, L.M.; Weiss, R.D.; and Shaw, S.R. The link between substance abuse and posttraumatic stress disorder in women: A research review. American Journal on Addictions 6(4):273-283, 1997.
- Najavits, L.M.; Weiss, R.D.; Shaw, S.R.; and Muenz, L.R. Seeking Safety: Outcome of a new cognitive psychotherapy for women with posttraumatic stress disorder and substance dependence. Journal of Traumatic Stress, in press.