Home > Psychosocial support to tackle trauma-related symptoms and related substance use disorders.

Schäfer, Ingo and Lotzin, Annett (2019) Psychosocial support to tackle trauma-related symptoms and related substance use disorders. Strasbourg: Council of Europe.

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Approximately 60%-70% of the general population will experience a traumatic event at some point in their lifetime, which can include forms of violence, abuse, neglect and war. Post-traumatic Stress Disorder (PTSD) and Substance Use Disorders (SUD) are often concurrent and develop as a result of a person being exposed to a traumatic event. In clinical populations (focusing on either disorder), about 25–50% have a lifetime dual diagnosis of PTSD and SUD. Patients with this dual diagnosis have a more severe clinical profile and are more difficult to treat than patients with solely one of the conditions.


Part of providing adequate health service is addressing and responding correctly to the effects of trauma. Given that the dual diagnosis of PTSD and SUD is frequent and causes significant social disabilities, special measures to prevent and treat these disorders need to be taken. There are programs in place to help prevent primary and secondary versions of these disorders, however, more research needs to be conducted on the effectiveness of these programs. Patients with PTSD and SUD should be encouraged to attend interventions that deal with their diagnoses. Further research is needed to evaluate the existing treatment models and to assess patient and clinical acceptability of the various approaches in European countries.


The systematic assessment of trauma exposure, PTSD and SUD is highly recommended in both settings. Health care professionals should have knowledge and skills in the field of trauma inquiry, however, there is a lack of training methods. At present, the limited training available to practitioners is the main barrier to adopting evidence-based treatments for co-occurring PTSD and SUD.


Forced migrants have experiences of trauma and poor mental health that are associated with substance use. However, there is no sound evidence on the prevalence of SUD among refugees in European countries to date. There is a lack of studies examining interventions to prevent or treat both SUD in general, and SUD related to post-traumatic disorders in refugee populations. The existing evidence suggests that interventions to address SUD have to be integrated with interventions addressing other consequences of trauma in refugee populations.


Another group with special treatment needs are veterans from armed conflict, as substance use disorders and PTSD are more frequent among these populations. The social stigma associated with mental illness within military communities veterans is a barrier for veterans receiving appropriate treatment. Trauma-focused therapies for PTSD are effective for veterans, however services that integrate both SUD and PTSD treatment while considering specific war-related traumas should be established for veteran populations.


Given the high prevalence of trauma victims in all social, legal, and health-related services, a trauma-informed approach is required to appropriately respond to the needs of individuals. To be trauma-informed means to recognize that trauma is common, to understand its impact and to respond appropriately to affected people, including referral to trauma-specific interventions for those who need it. Trauma-informed care is an important framework to supporting consumers with PTSD and SUD, however more research on the dissemination of trauma-informed care concepts in Europe is needed.

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