Dealing With Complexity and Comorbidity: Comorbid PTSD and Substance Use Disorders

Purpose of review: Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are highly comorbid, and the presence of both disorders is associated with lower treatment effect sizes and higher dropout from treatment than one disorder alone. This review examines recent research on treatments for patients with comorbid PTSD/SUD, as well as recent work on psychological mechanisms that may contribute to both disorders. Recent findings: Several studies have shown that trauma-focused treatments, such as Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE), are effective for reducing PTSD and do not cause exacerbation of substance use in patients with comorbid SUD. A few studies have examined pharmacotherapies for PTSD/SUD, but to date there is not one medication that appears to have clear efficacy for individuals with PTSD/SUD. Several mechanisms such as anxiety sensitivity, trauma-related cognitions, and pain may contribute to both PTSD and SUD. Summary: Although trauma-focused treatments show promising results for PTSD/SUD, preconceptions regarding potential concurrent treatment risks influence provider adoption. Because many patients do not have a goal of total abstinence from substances, future research on the impact of continued use on trauma-focused treatment outcomes is needed. Additional trials of medications in conjunction with psychotherapy are indicated. © 2019, Springer Nature Switzerland AG.