A Case Study of Prolonged Exposure for Posttraumatic Stress Disorder With a Latino Male with Polysubstance Use, Severe Depression, and Anger in a Residential Substance Use Treatment Program

Substance use disorders and post-traumatic stress disorder (PTSD) often co-occur, along with depression and anger. Despite evidence that Prolonged Exposure Therapy is effective for individuals with co-occurring PTSD and SUD when PE is implemented alongside SUD treatment, clinicians have been reluctant to offer PE or other trauma-focused therapies to individuals with co-occurring PTSD and SUD because of the belief that increased emotional distress would be counter-therapeutic for individuals in early recovery. A widely held explanation for the high degree of comorbidity is that individuals with PTSD use substances to reduce or avoid painful and disturbing PTSD symptoms. This case study describes the implementation and outcome of PE therapy with a 32-year-old man who had been admitted to a residential substance use treatment program for Latino males. The client had a long history of polysubstance use and severe PTSD. The client was homeless and reported significant depressive and anger symptoms. Assessment of PTSD revealed that he was using heroin and cocaine to avoid painful memories of a traumatic event that had occurred several years prior to his admission to this treatment program. Because the client reported using these substances to reduce emotional distress, PE was chosen as the PTSD intervention. During PE Therapy the client reported no thoughts or urges to use substances and at discharge from residential treatment he reported no problems with PTSD or depression. The client maintained all gains at 1-year follow-up, when he also reported that he was working full time and had remained abstinent since he completed treatment.

The double burden of treating traumatic stress in low-resource communities: experiences and perspectives of non-specialist health workers in South Africa

Considering the global trend towards the dissemination and implementation of trauma-focused treatments in the majority of the world, it is imperative to ascertain the contextual factors which affect the treatment of traumatic stress, especially in low- and middle-income countries characterised by ongoing adversity such as poverty and increased levels of trauma exposure. We explored the experiences of non-specialist health workers whose work involved providing trauma-focused services in low-resource communities in South Africa. Participants ( n = 18) worked at four non-governmental organisations in the Eastern Cape and Western Cape of South Africa. Semi-structured individual interviews were conducted and analysed using a phenomenologically informed thematic analysis. Two superordinate themes were identified, namely, adjusting to trauma-focused work and trauma in the social context. Five themes that made up the superordinate themes were Encountering Trauma Narratives, Support and Resilience, Going the Extra Mile, Helplessness, and Social Factors. The findings are not only in keeping with the psychological risks of trauma-focused work (e.g., vicarious traumatisation) but also highlighting the impact of the social context on the provision of trauma-focused work. Participants reported experiencing an added burden of helplessness due to social factors, such as poverty and high levels of trauma exposure, which affect the process of treating traumatic stress in low-resource settings. We discuss how these findings can contribute to efforts to implement trauma-focused services in low- and middle-income countries.