Division of Consultation-Liaison Psychiatry, Department of Psychiatry, University of Maryland School of Medicine, 4801 Yellowwood Ave, Ste 2E1, Baltimore, MD 21209, USA.
Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA.
Psychiatr Clin North Am. 2022 Sep;45(3):375-414. doi: 10.1016/j.psc.2022.05.003.
A practical, common-sense framework for recognizing and addressing comorbid posttraumatic stress disorder (PTSD) in the substance use disorder (SUD) clinic is outlined. The article focuses on strategies that can help establish trauma-informed care or augment an existing approach. Interventions are organized around the task of ameliorating shame (or shame sensitivity), which represents a transdiagnostic mediator of psychopathology and, potentially, capacity for change. Countershaming strategies can guide a trauma-responsive leadership approach. Considering the striking rate of underdiagnosis of PTSD among patients with SUD, implementing routine systematic PTSD screening likely represents the single most consequential trauma-informed intervention that SUD clinics can adopt.
本文概述了一种实用且常识性的框架，用于识别和处理物质使用障碍（SUD）诊所中的共病创伤后应激障碍（PTSD）。本文侧重于可以帮助建立创伤知情护理或增强现有方法的策略。干预措施围绕减轻羞耻感（或羞耻感敏感）展开，羞耻感敏感是精神病理学和潜在的改变能力的一种跨诊断中介。反羞耻策略可以指导对创伤反应灵敏的领导方法。考虑到 SUD 患者中 PTSD 的诊断率惊人地低，实施常规系统的 PTSD 筛查可能代表 SUD 诊所可以采用的最具影响力的创伤知情干预措施。
