Treating Comorbid Posttraumatic Stress Disorder and Substance Use Disorder

This chapter aims to provide an overview of co-occurring posttraumatic stress disorder and substance use disorder (PTSD-SUD). We review the prevalence of PTSD-SUD; history of treatment approaches; overview of current treatment modalities for PTSD-alone, SUD-alone, and co-occurring PTSD-SUD treatment; and clinical considerations. A primary focus of this chapter is to provide a summary and critical analysis of sequential and integrated treatments for PTSD-SUD. In particular, sequential treatments covered in this chapter include Relapse Prevention, Contingency Management, Prolonged Exposure, and Cognitive Processing Therapy. Integrated treatments discussed include Seeking Safety, Concurrent Treatment of PTSD and SUD Using Prolonged Exposure, Integrated Cognitive Behavioral Therapies, and pharmacological SUD interventions in combination with behavioral PTSD therapies. Further, this chapter provides clinical guidelines for treatment selection, managing complex trauma, and considerations for common clinical difficulties such as low motivation, attendance, and treatment nonadherence. The chapter concludes with a clinical vignette to illustrate a PTSD-SUD case utilizing an integrated approach.