Motion: 'not everybody who has experienced trauma needs or wishes to have trauma treatment'

For...

You need to establish rapport before you can talk about the substance use and its treatment. If there is no rapport then there is no point to any kind of intervention; service users will not take in anything that is said to them, they will probably dislike their practitioner, and are likely to drop out.

Against...

Establishing rapport is important and needs to be part of dealing with the problem the service user wants help with. It is no good wasting time just trying to strike up some rapport. Service users want to know that they are going to get the help they need and that their practitioner has that as their focus.

For... Some individuals are resilient to trauma and do not develop PTSD and some are content with their ability to cope. Combined trauma and substance use treatment requires well qualified staff who are fully supported by their organisation with training and supervision. It can be damaging to embark on exploring trauma where the requisite conditions are not in place. Against... A significant number of service users have experienced trauma and developed PTSD. Many state a preference for both addiction and PTSD to be treated concurrently and by a single practitioner. Where the two conditions are treated together, outcomes for both are improved. It is incumbent on organisations wishing to offer specialist addiction interventions to provide the required resources. This summary of a research article should help you clarify your thoughts on the issues raised by the debate… Integrated Therapy There is a high prevalence of co-occurring PTSD and substance use disorders in addiction help-seeking populations. Treatment protocols and manuals are available, but rates of implementation are low; efficacy and effectiveness vary. It may be that practitioners are careful not to get involved in interventions where they lack the training and support to be sure that they do no harm. Practice can be safe and improve both PTSD and SUD outcomes, but is challenging in deciding delivery sequencing of target behaviours and in the effects on practitioners. Service users have shown a preference for integrated treatment and should be given a choice of treatment methods; CBT and exposure treatment are necessary components and are both preferred. Organisations need to make significant resources available in order to deliver safe and cost effective treatment: training, supervision and opportunities for peer group support and sharing of experiences. Find the full text of the article here… Killeen TK et al (2016) Implementation of integrated therapies for comorbid post-traumatic stress disorder and substance use disorders in community substance abuse treatment programs. Drug Alcohol Review 34: 234–241 doi:10.1111/dar.12229 Decide which side of the debate you support and then Make Your Own Case