Practical Considerations for Treating Comorbid Posttraumatic Stress Disorder in the Addictions Clinic : Approaches to Clinical Care, Leadership, and Alleviating Shame - 31/08/22

Doi : 10.1016/j.psc.2022.05.003

Benjamin Israel, MD ^a,^⁎ , Alicia E. Wiprovnick, PhD ^b, Annabelle M. Belcher, PhD ^b, Mary B. Kleinman, MS, MPH ^c, Avinash Ramprashad, MD ^b, Max Spaderna, MD ^d, Eric Weintraub, MD ^d
^a Division of Consultation-Liaison Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, 4801 Yellowwood Ave, Ste 2E1, Baltimore, MD 21209, USA
^b Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA
^c Department of Psychology, University of Maryland at College Park, Biology/Psychology Building, 4094 Campus Drive, College Park, MD 20742, USA
^d Division of Addiction Research and Treatment, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA

^∗Corresponding author.

Résumé

A practical, common-sense framework for recognizing and addressing comorbid posttraumatic stress disorder (PTSD) in the substance use disorder (SUD) clinic is outlined. The article focuses on strategies that can help establish trauma-informed care or augment an existing approach. Interventions are organized around the task of ameliorating shame (or shame sensitivity), which represents a transdiagnostic mediator of psychopathology and, potentially, capacity for change. Countershaming strategies can guide a trauma-responsive leadership approach. Considering the striking rate of underdiagnosis of PTSD among patients with SUD, implementing routine systematic PTSD screening likely represents the single most consequential trauma-informed intervention that SUD clinics can adopt.

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Keywords : Trauma, Substance use, PTSD, Shame, Screening, Treatment, Leadership, Burnout