Consequences of the comorbidity of disorders related to substance use and post-traumatic stress on treatment
Over the past 15 years, the high prevalence of the comorbidity of “substance use disorders/post-traumatic stress disorder” has brought a growing number of researchers to look at the consequences of this dual diagnosis on treatment. The empirical data from these studies demonstrates that the clinical profile of persons who consult for alcoholism and drug addiction is more deteriorated when the substance use disorder is combined with a post-traumatic stress disorder. Moreover, these persons usually derive less benefit from the addiction treatment. Integrated treatment programs seem promising in treating both disorders but do not appear to rule out the dropout problem. Even though no study has been specifically designed to identify the factors involved in the process, a review of the literature reveals many cues which suggest three hypotheses : self-medication, the weakness of the therapeutic alliance and lack of social support not to mention the potential contribution of practical obstacles such as the lack of transportation and financial constraints. These hypotheses should orient future research in order to determine the essential elements in designing treatment programs that are better adapted to the reality of trauma survivors.