Dr. James O'Shea:

It is difficult. People with complex trauma and current active addiction will struggle the most in terms of any psychological intervention or trauma intervention. That said, there is a lot of evidence, particularly in the past ten years, to suggest that good addiction treatment stabilises trauma. In this country, we have good addiction treatment right across the public, voluntary and community services. We have increasingly very good and very evidence-based addiction treatments so we probably do not need to invest a lot in the trauma stabilisation programmes. We need to invest in good addiction treatment programmes so that people are able to engage with specific trauma-focused treatment approaches. Historically, what we have done is to try to stabilise the addiction before treating the trauma but obviously, the traumatic symptoms cause people to relapse. I conducted a search of all the international evidence on this last year and it is clear that the gold standard is to treat them together. Addiction workers and mental health workers, with appropriate training, are well able to hold the complexity of that kind of intervention.