Cart before the horse? Psychological treatment of substance using individuals with PTSD

First published: 10 May 2019 | Last updated: 20 May 2019

Authors: Dr Laura Kemmis1, Dr Kim Ehntholt2 and Dr Shamil Wanigaratne3

Early Intervention Service, Newham, East London NHS Foundation Trust
Traumatic Stress Clinic, Camden and Islington NHS Foundation Trust
National Rehabilitation Centre Abu Dhabi and Institute of Psychiatry, King’s College London*

The work was carried out at the South London and Maudsley NHS Foundation Trust and Camden and Islington NHS Foundation Trust


To investigate emotional processing in individuals with Substance Use Disorder and Post Traumatic Stress Disorder.


There are high co-morbidity rates between post-traumatic stress disorder (PTSD) and substance use disorder (SUD). Controversy exists in both the trauma and addiction fields regarding how best to treat co-morbid SUD-PTSD and which disorder to treat first. Current NICE guidelines (UK) for PTSD recommend that for PTSD sufferers with drug or alcohol dependence, healthcare professionals should treat the drug or alcohol problem first. One reason for this guideline possibly stems from an assumption that substance use prevents emotional processing and may exacerbate the PTSD symptoms.


The study used a between group design comparing a substance using group (SU), substance using with PTSD and PTSD only group.


The participants were recruited from substance misuse clinics and traumatic stress clinics


90 patients were recruited to the study of whom, 7 were excluded from the analysis due to incomplete data. Of the remaining 83, 26 were in the SUD group, 21 in the PTSD group and 36 in the SUD + PTSD group. The mean age of participants was 41.1 years range 17- 70 and 61% were male.


Experimental session:

The Brief Symptoms Inventory (BSI); The Maudsley Addiction Profile (MAP); The Posttraumatic Stress Diagnostic Scale (PDS); The Emotional Processing Scale (EPS-25).

Task: International Affective Picture System (IAPS).

Findings and conclusions

Each group indicated evidence of emotional processing dysfunction relative to the normal population. Within the SUD-PTSD group there was significant evidence that the additional impact of trauma increased emotional processing dysfunction but less evidence to suggest that substance use increased emotional processing dysfunction. The present findings serve to question current NICE guidelines for the treatment of co-morbid SUD-PTSD.


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Dr Laura Kemmis