Addictions are a major public health issue in American society. Approximately 50% of individuals presenting to mental health clinicians have problems with either their own alcoholism or that of a family member. In addition, 24 million Americans are users of illicit drugs. For many individuals, substance use and compulsive behaviors have become a way to manage untreated mental health issues. Undiagnosed trauma and post-traumatic stress disorder are present at much higher rates in those with addictions than in the general population. Alcohol, cannabis and cocaine are the substances that are most frequently used by individuals to self-medicate.
Treatment for clients with addiction and mental health problems has suffered due to a lack of integrated services. Historically, addiction professionals focused solely on helping the clients deal with substance abuse and addiction issues without considering psychological disorders. Mental health clinicians restricted their attention to trauma, depression, anxiety or other psychological problems without considering the potential contribution of substance abuse and/or addiction. Clients were left seeing different treatment professionals concurrently for different disorders or seeking treatment for one disorder first and delaying treatment of the other.
Although this seems to be changing, clients often experience difficulty with getting both addiction and mental health issues addressed simultaneously by one clinician. The lack of integrated services can impede a client’s recovery. If two clinicians are involved, one may not know what the other is doing unless there is very conscious coordination of care. Effective communication between providers may not happen as frequently as necessary due to time constraints or other barriers. Clients may avoid dealing with pertinent issues with one or both of the therapists, leading to problems maintaining sobriety and/or difficulty with stabilizing mental health symptoms.
We (Nancy Abel and John O’Brien) are therapists who specialize in dealing with both trauma and addiction. We feel that both disorders should be dealt with concurrently, although this involves complex clinical decisions about when to intervene. Eye movement desensitization and reprocessing (EMDR) therapy has been proven to be an effective treatment for PTSD and it is one of the front line treatments recommended by trauma experts. EMDR therapy is now is being applied to treatment of addiction and is being integrated with standard addiction treatment to address the underlying trauma found in many addicts. But how and when to apply EMDR therapy to those trying to become and remain sober involves important clinical decision-making.
We wrote our book, Treating Addiction Using EMDR and the Stages of Change, partly due to the fact that we believe strongly that care should be integrated. We believe that treatment is most effective if one clinician can work with both PTSD and addiction. Neither diagnosis should be ignored! Treatment should be as individualized and innovative as possible. And EMDR allows that kind of innovation when dealing with trauma and addiction. We hope that you will find our book to be an integration of the art and science of treatment for addiction and trauma.