Treatment of PTSD and Addiction in Traumatised Adults Mirjana - - PowerPoint PPT Presentation

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Treatment of PTSD and Addiction in Traumatised Adults Mirjana - - PowerPoint PPT Presentation

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ANSA Conference, Cairns 24-25 August 2019 Treatment of PTSD and Addiction in Traumatised Adults Mirjana Askovic, ANFI, STARTTS https://poweredtemplate.com/02777/0/index.html Outline PTSD and substance use disorder/addiction: Epidemiology

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Treatment of PTSD and Addiction in Traumatised Adults

Mirjana Askovic, ANFI, STARTTS

https://poweredtemplate.com/02777/0/index.html

ANSA Conference, Cairns 24-25 August 2019

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PTSD and substance use disorder/addiction: Epidemiology Refugee trauma Relationship between PTSD and addiction EEG phenotypes and neurofeedback treatment Integrative approach to treatment of trauma and addiction Role of neurofeedback Role of therapist

Outline

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  • The estimated lifetime prevalence of PTSD in the Australian population is 12.2%.

Prevalence of PTSD in refugee population is 30% (Still, at al. 2009)

  • Psychiatric comorbidity, particularly depression, anxiety and substance use

disorders commonly occur with PTSD (Gradus, et.al. 2015)

  • People who suffer from PTSD are between two and four times more likely to also

suffer from addiction compared to the general population (Gradus, et. al, 2017)

  • Among individuals seeking treatment for SUDs, approximately 36% to 50% meet

criteria for lifetime PTSD (Brady et.al.2004) Epidemiology of PTSD and addiction

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Refugee trauma, PTSD and addiction

1000 2000 3000 4000 5000 6000 7000 8000 Sub.Ab/Add NO YES

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Refugee trauma and addiction

10 20 30 40 50 60 70 80 90 100

Moderate-severe symptoms

Substance abuse - YES Substance abuse NO

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Comorbidity between PTSD and addiction is likely to reflect overlapping environmental, genetic and neurobiological factors.

Relationship between PTSD and addiction

Environment Genetics

Gene/ Environment Interaction

www.addiction.med.usyd.edu.au

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  • Jay Gunkelman AND Curtis Cripe looked at the divergent EEG patterns (phenotypes) in

addiction (N=30)

  • Two different neural factors underlie the prevalence of addiction cases, likely

representing separate pathophysiologic drives for addictive behaviours: (a) CNS over-arousal (n = 21) (b) cingulate issues/obsessive-compulsive (n = 9) EEG phenotypes and addiction

Gunkelman, J. & Cripe, C (2008)

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CNS over-arousal based drives were attributed to the following phenotypes:

  • low-voltage fast EEG phenotype (SMR and A/T training);
  • faster alpha frequencies (A/T training);
  • beta spindle (SMR and then A/T).

Cingulate-based obsession-and-compulsion–based drives were attributed to anterior midline divergences (Fz supress protocol):

  • Supress Alpha
  • Supress Slow (theta)
  • Supress Beta spindling

EEG phenotypes and addiction

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Additional EEG patterns and addiction

  • Third neural factors that underlies the prevalence of addiction cases, likely

represents a separate pathophysiologic drive for addictive behaviours related to the addiction to stimulants and compulsive gambling.

  • Impulsivity has been recognized as a characteristic of individuals addicted to

drugs, along with sensation seeking and poor decision making (Ersche et al., 2010)

  • Neural correlates include amygdala over-responsiveness to reward (Kasanetz et

al., 2010) and weakened control of the reflective VMPC (Volkow et al., 2004)

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Additional EEG patterns and addiction cont.

  • EEG in gambling disorder clients with high impulsivity score showed decreased

theta absolute power, and decreased alpha and beta absolute power in the left, right, particularly midline frontocentral regions ( Lee et al., 2017).

  • Neurofeedback protocols focused on midline Fz, Fz-Cz – inhibit slow and reward

12-15hz and higher.

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Integrated Treatment Approaches

Addiction Mental Health

Integrated treatment approaches

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Trauma processing Contract and committment Stabilisation and affect regulation Family system/ deeper issues Values,beliefs and meaning Closure Relapse prevention

Integrative approach to trauma and addiction Integrative approach to trauma and addiction

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TREATMENT PLAN DENIAL

  • I don’t drink that much
  • Dope is good for your health

COMMITMENT

  • Regular attendance
  • Communication with D&A
  • Building therapeutic alliance

RECOGNITION

  • Acceptance of the problem
  • Psychoeducation
  • Referral to D&A
  • Detox

Contract and commitment Contract and commitment

  • Client’s expectations
  • Treatment goals
  • Timeline
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Stabilisation and affect regulation Frequently used protocols: C4-A2 Cz-A2/A1 C3-C4 T3-T4 T4-P4 T5-T6 FPO2 Fz-A1

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Outline

Trauma processing/addiction recovery Alpha/Theta training (Pz-A2)

  • Guided relaxation
  • Visualisation of desired
  • utcomes
  • 40 min A/T
  • Body scan
  • Processing of experience
  • Grounding

Role of therapist

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Outline

Management of relapse

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Outline

Work with family system/deeper issues

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sense of belonging re- connection

  • rientation

towards future

Values, beliefs and meaning

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STRESS MANAGEMENT MEANINGFUL ACTIVITIES SLEEP DIET EXERCISE SOCIAL CONNECTIONS

Relapse prevention and closure

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Conclusion

Relationship between PTSD and addiction Integrated approach to treatment Role of neurofeedback and neuroscience driven approaches Role of psychotherapy/trauma informed therapy

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Questions ? ? ? ? ? ?

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References

  • 1. Steel Z, Chey T, Silove D et al. Association of torture and other potentially traumatic events with mental health
  • utcomes among populations exposed to mass conflict and displacement. JAMA: 302(5), 537‐492 (2009).
  • 2. McCauley, J. L., Killeen, T., Gros, D. F., Brady, K. T., & Back, S. E. Posttraumatic Stress Disorder and Co-Occurring

Substance Use Disorders: Advances in Assessment and Treatment. Clinical psychology : a publication of the Division

  • f Clinical Psychology of the American Psychological Association, 19(3), (2012).
  • 3. Gradus, J.L., Antonsen, S., Svensson, E., Lash, T.L., Resick, P.A. and Hansen, J.G. Trauma, comorbidity, and

mortality following diagnoses of severe stress and adjustment disorders: a nationwide cohort study. American Journal

  • f epidemiology, 182(5), 451-458 (2015).
  • 4. Gradus, J.L., Prevalence and prognosis of stress disorders: a review of the epidemiologic literature. Clinical

epidemiology, 3 (9), 251-260 (2017).

  • 5. Brady, K.T., Back S.E. & Coffey S.F. Substance abuse and post traumatic stress disorder. Current direction in

psychological science. 13(5), 206-209 (2004).

  • 6. Rehm, J., Gmel Sr, G.E., Gmel, G., Hasan, O.S., Imtiaz, S., Popova, S., Probst, C., Roerecke, M., Room, R.,

Samokhvalov, A.V. and Shield, K.D., The relationship between different dimensions of alcohol use and the burden of disease—an update. Addiction, 112(6), 968-1001 (2017).

  • 7. Lopez‐Quintero, C., Hasin, D.S., De Los Cobos, J.P., Pines, A., Wang, S., Grant, B.F. and Blanco, C., Probability and

predictors of remission from life‐time nicotine, alcohol, cannabis or cocaine dependence: Results from the national epidemiologic survey on alcohol and related conditions. Addiction, 106(3), 657-669 (2011).

  • 8. Drgon T, D’Addario C, Uhl GR. Linkage disequilibrium, haplotype and association studies of a chromosome 4 GABA

receptor gene cluster: candidate gene variants for addictions. Am. J. Med. Genet. B. Neuropsychiatr. Genet, 141B, 854–860 (2006).

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References

  • 9. Gunkelman, J. & Cripe, C. (Clinical Outcomes in Addiction: A Neurofeedback Case Series, Biofeedback, 36 (4), 152–

156 (2008).

  • 10. Ersche K.D., Turton A.J., Pradhan S., Bullmore E.T. & Robbins T.W. Drug addiction endophenotypes: impulsive versus

sensation-seeking personality traits. Biol Psychiatry. 68(8), 770-3 (2010).

  • 11. Kasanetz F., Deroche-Gamonet V., Berson N., Balado E., Lafourcade M., Manzoni O. & Piazza V.P. Transition to

addiction is associated with a persistent impairment in synaptic plasticity. Science, 328(5986), 1709-12 (2010).

  • 12. Volkow N.D., Fowler J.S., Wang G.J. & Swanson J.M. Dopamine in drug abuse and addiction: results from imaging

studies and treatment implications. Mol Psychiatry, 9(6), 557-69 (2004).

  • 13. Lee J.Y., et al. Resting-state EEG activity related to impulsivity in gambling disorder. J Behav Addict, 6(3), 387–395

(2017).

  • 14. Ford J.D. & Russo E. Trauma-Focused, Present-Centered, Emotional Self-Regulation Approach to Integrated Treatment

for Posttraumatic Stress and Addiction: Trauma Adaptive Recovery Group Education and Therapy (TARGET). American Journal of Psychotherapy, 60 (4), 335-355 (2006).

  • 15. Covington S.S. Women and Addiction: A Trauma-Informed Approach, Journal of Psychoactive Drugs, 40(5), 377-385

(2008).

  • 16. Killeen, T. K., Back, S. E., & Brady, K. T. Implementation of integrated therapies for comorbid post-traumatic stress

disorder and substance use disorders in community substance abuse treatment programs. Drug and alcohol review, 34(3), 234–241 (2015).