Clinical Challenges in the Treatment of Patients With Posttraumatic Stress Disorder and Substance Abuse

Ingo Schäfer; Lisa M. Najavits


Curr Opin Psychiatry. 2007;20(6):614-618. 

In This Article

Psychotherapy Treatment

A variety of psychotherapy treatments have been developed for PTSD/SUD. Here we cover only those with at least one published study; that is, at least at the level of a pilot (no case reports). Also, we address only those specifically designed for the dual diagnosis (not models for one or the other diagnosis that have been tested in PTSD/SUD samples). For a detailed description of the models and their studies, see Najavits[35**] and Najavits et al.[45]

Seeking Safety

The seeking safety model is a present-focused model that offers 25 topics to teach coping skills for PTSD and SUD in four domains: cognitive, behavioral, interpersonal, and case management. The treatment was designed for both sexes, all types of trauma and substance abuse, and group or individual modality. It is the only model thus far established as effective for the dual diagnosis, with consistent positive findings in 16 studies including randomized controlled trials and multisite studies.[49,50] It has a variety of dissemination materials including a website (, training videos, and foreign-language translation.

Concurrent Treatment of Posttraumatic Stress Disorder and Cocaine Dependence

This 16-session individual therapy[51,52] combines existing therapies that had already been established as effective separately for PTSD and SUD [e.g. cognitive behavioral therapy (CBT) for substance abuse and exposure therapy for PTSD]. An uncontrolled pilot study indicates positive outcomes.[52]


Transcend is an integrated 12-week partial hospitalization program for military veterans. It combines CBT, constructivist, psychodynamic, and 12-step models. An uncontrolled pilot[53] found positive results on a sample of clients who entered with 30 days of abstinence.

Substance Dependence Posttraumatic Stress Disorder Therapy

This 40-session individual therapy,[54] later renamed assisted recovery from trauma and substances (ARTS), combines existing therapies that were already established as effective for PTSD and SUD separately (e.g. CBT for substance use and stress-inoculation training for PTSD). A pilot study[55] compared it with 12-step facilitation treatment, but found no outcome differences and thus combined data across the models (thus making it difficult to determine results for substance dependence PTSD therapy itself).

Collaborative Care

Collaborative care is a prevention model rather than a treatment model, designed for medically injured trauma survivors at risk for developing PTSD and alcohol-use disorder. It combines existing models for the disorders (e.g. motivational interviewing, CBT, case management) with dose and treatments varying by clients' presentation. It has one study,[56] a comparison with treatment as usual, with positive results.


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