ABSTRACT
Research findings on trauma and substance abuse have led researchers to conclude that trauma, especially childhood trauma, is an important risk factor for the development of substance use disorders (SUD; Cottler, Compton, Mager, Spitznagel, & Janca, 1992; Miller, Downs & Testa, 1993). Comorbidity research indicates that posttraumatic stress disorder (PTSD) and SUD co-occur at high rates (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Rosenberg et al., 2001; Stewart, 1996). Nevertheless, there is continuing debate on how the relationship between trauma and SUD operates. Some argue that PTSD causes the SUD while others suggest that SUD increases the risk for trauma and thus PTSD (Chilcoat & Breslau, 1998; Chilcoat & Menard, 2003; Stewart, Pihl, Conrod, & Dongier, 1998). It has also been suggested that once the disorder develops, the symptoms of one disorder maintain the symptoms of the other (Stewart, 1996). Although most agree that both the PTSD and SUD warrant treatment, there is debate on both the timing (sequential vs. integrated) and type of treatment (Najavits, 2003). In any case, it is essential that practitioners assess clients who abuse substances on their history of traumatic experiences and provide appropriate interventions or referrals to them. Even though it is clear that there are links between trauma and SUD, most addiction treatment programs do not provide assessment or treatment for trauma or PTSD. Consequently, addicted clients are often left with a significant component of their problem unacldressed. Failure to appropriately address the impact of clients' trauma histories has been cited as a factor that contributes to relapse (Brown, 2000; Evans & Sullivan, 1995).
