Overview of Posttraumatic Stress Disorder and Opioid Use Disorder
Posttraumatic stress disorder (PTSD) is a mental health condition that can develop after a person experiences or witnesses a distressing or dangerous life event such as sexual or physical assault, an accident, or other severe events. Symptoms typically appear within three months of the event and may include repeated flashbacks, memories or dreams of the event, avoidance of people, places or activities that are reminders of the event, sleep or concentration difficulties, strong startle responses, loss of interest in former activities, and ongoing negative emotions such as fear or shame. Opioid use disorder (OUD) is a type of substance use disorder that involves a pattern of opioid (e.g., prescription opioids, heroin, fentanyl) use that is difficult to stop despite a desire to cut down or regulate use, and negatively impacts one’s physical and emotional health, relationships and daily functioning. Symptoms may also include using opioids in larger amounts or for longer than intended; spending a great deal of time obtaining, using or recovering from the effects of opioids; craving; failure to fulfill major obligations; reducing or stopping other activities; using opioids in situations where it is unsafe; opioid tolerance; and withdrawal symptoms when stopping opioid use.
Epidemiology of PTSD and OUD
It is well-established that the prevalence of PTSD is substantially higher in individuals with OUD than in the general population. In fact, almost all patients with OUD report experiencing traumatic events and up to one-third meet criteria at some point during their lives for a diagnosis of PTSD.1-3 For example, 94% of patients in Vermont’s largest opioid treatment program reported at least one clinically significant PTSD symptom, and 61% had experienced or witnessed a traumatic event in the past month alone.
OUD Treatment Outcomes
Patients with co-occurring OUD and PTSD generally experience more severe mental health and psychosocial problems than individuals with OUD alone.4 Furthermore, some individuals may use opioids and other substances to reduce the severity of PTSD symptoms.5 Although medications for OUD (MOUD; e.g., methadone, buprenorphine) are the most efficacious treatments for OUD,6 patients with co-occurring PTSD may be more likely to discontinue MOUD treatment and resume nonprescribed opioid use.7, 8 These findings highlight the importance of screening and assessing for PTSD in OUD treatment settings.
Treatments for PTSD and Limited Access in Rural Communities
Fortunately, there are well-established and effective treatments for PTSD (e.g., prolonged exposure therapy and cognitive processing therapy)9, 10 that are widely available for use. Recent research indicates that these treatments are efficacious for improving PTSD severity in individuals receiving treatment for co-occurring OUD, may be associated with better MOUD treatment retention, and do not exacerbate substance use.11-17
Unfortunately, only half of individuals with OUD and a concurrent mental health condition received past-year mental health treatment, and the strongest predictor of this unmet need was rurality.18-21 In addition, poverty, workforce shortages, and lack of reliable transportation present significant barriers to mental health treatment in rural areas.22-24 This translates to significant gaps in access to PTSD treatment among patients living in rural communities. The goal of this University of Vermont Center on Rural Addiction (UVM CORA) toolkit is to provide a number of evidence-based PTSD assessment instruments, treatment manuals, training opportunities, and educational resources to treatment providers and staff who are providing care to people with OUD in rural communities.