Journal of Contemporary Psychotherapy

, Volume 47, Issue 1, pp 41–50 | Cite as

Relationship-Based Recovery Case Study: An Interpersonally-Empowering Approach to Recovery from Substance Use Disorder and PTSD

  • Sonya G. Wanklyn
  • Andrew E. Brankley
  • Gab Laurence
  • Candice M. Monson
  • Jeremiah A. Schumm
Original Paper



Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) are prevalent and pernicious disorders that are commonly comorbid. Though promising findings have been documented for psychotherapies addressing PTSD/SUD, this is a relatively new area of inquiry.


To (a) describe relationship-based recovery (RBR), a recently developed cognitive-behavioural treatment for comorbid PTSD and SUD, and (b) explore how RBR might facilitate reduction of PTSD and substance use problems.


This study used a single case design, with assessments occurring at baseline, post-treatment, and 3-month follow-up.


Clinically significant reductions in PTSD and SUD, as well as increased satisfaction with interpersonal relationships, were found at post-treatment and 3-month follow-up. Following treatment, the patient no longer met diagnostic criteria for disorders identified at pre-treatment.


The patient appeared to benefit from the treatment. Research investigating RBR as a potential treatment for PTSD/SUD is warranted.


Posttraumatic stress disorder Substance use disorder Individual CBT Interpersonal 



We wish to extend our gratitude to the client who participated in this study. The views expressed in this article are those of the authors and do not necessarily reflect those of the U.S. Government or the Department of Veterans Affairs.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders 4th ed. text revision. Washington, DC: American Psychiatric Association. (Author).Google Scholar
  2. Back, S. E., Foa, E. B., Killeen, T., Mills, K., Teesson, M., Carroll, K., et al. (2014). Concurrent treatment of PTSD and substance use disorders using prolonged exposure (COPE).Therapist manual. Oxford: Oxford University Press.CrossRefGoogle Scholar
  3. Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., et al. (1995). The development of a clinician-administered PTSD scale. J Trauma Stress, 8, 75–90. doi: 10.1002/jts.2490080106.CrossRefPubMedGoogle Scholar
  4. Blanco, C., Xu, Y., Brady, K., Pérez-Fuentes, G., Okuda, M., & Wang, S. (2013). Comorbidity of posttraumatic stress disorder with alcohol dependence among US adults: results from National Epidemiological Survey on alcohol and related conditions. Drug Alcohol Depend, 132, 630–638. doi: 10.1016/j.drugalcdep.2013.04.016.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Brady, K. T., Back, S. E., & Coffey, S. F. (2004). Substance abuse and posttraumatic stress disorder. Curr Dir Psychol Sci, 13, 206–209. doi: 10.1111/j.0963-7214.2004.00309.x.CrossRefGoogle Scholar
  6. Brady, K. T., Dansky, B. S., Back, S. E., Foa, E. B., & Carroll, K. M. (2001). Exposure therapy in the treatment of PTSD among cocaine-dependent individuals: preliminary findings. J Subst Abuse Treat, 21, 47–54.CrossRefPubMedGoogle Scholar
  7. Brady, K. T., & Sinha, R. (2005). Co-occurring mental and substance use disorders: the neurobiological effects of chronic stress. Am J Psychiatry, 162, 1483–1493. doi: 10.1176/appi.ajp.162.8.1483.CrossRefPubMedGoogle Scholar
  8. Bremner, J. D., Southwick, S. M., Darnell, A., & Charney, D. S. (1996). Chronic PTSD in Vietnam combat veterans: course of illness and substance abuse. Am J Psychiatry, 153, 369–375.CrossRefPubMedGoogle Scholar
  9. Brewin, C., Andrews, B., & Valentine, J. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol, 68, 748–766. doi: 10.1037/0022-006X.68.5.748.CrossRefPubMedGoogle Scholar
  10. Cohen, S., & Hoberman, H. (1983). Positive events and social supports as buffers of life change stress. J Appl Soc Psychol, 13, 99–125.CrossRefGoogle Scholar
  11. Hersen, M., & Barlow, D. H. (1984). Single case experimental designs: strategies for studying behavior change (2nd ed.). New York: Pergamon Press.Google Scholar
  12. Lecrubier, Y., Sheehan, D. V., Weiller, E., Amorim, P., Sheehan, K. H., Janavs, J., et al. (1997). The mini international neuropsychiatric interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry, 12, 224–231. doi: 10.1016/S0924-9338(97)83296-8.CrossRefGoogle Scholar
  13. Mills, K. L., Teesson, M., Back, S. E., Brady, K. T., Baker, A. L., Hopwood, S., et al. (2012). Integrated exposure-based therapy for co-occurring posttraumatic stress disorder and substance dependence: a randomized controlled trial. J Am Med Assoc, 308, 690–699.Google Scholar
  14. Monson, C. M., & Fredman, S. J. (2012). Cognitive-behavioral conjoint therapy for posttraumatic stress disorder: therapist’s manual. New York: Guilford Press.Google Scholar
  15. Monson, C. M., Fredman, S. J., & Dekel, R. (2010). Posttraumatic stress disorder in an interpersonal context. In J. G. Beck (Ed.), Interpersonal processes in the anxiety disorders: implications for understanding psychopathology and treatment (pp. 179–208). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  16. Monson, C. M., Fredman, S. J., Macdonald, A., Pukay-Martin, N. D., Resick, P. A., & Schnurr, P. P. (2012). Effect of cognitive-behavioral couple therapy for PTSD: a randomized controlled trial. J Am Med Assoc, 308, 700–709. doi: 10.1001/jama.2012.9307.CrossRefGoogle Scholar
  17. Norman, S. B., Tate, S. R., Anderson, K. G., & Brown, S. A. (2007). Do trauma history and PTSD symptoms influence addiction relapse context? Drug Alcohol Depend, 90, 89–96. doi: 10.1016/j.drugalcdep.2007.03.002.CrossRefPubMedGoogle Scholar
  18. O’Farrell, T. J., & Fals-Stewart, W. (2006). Behavioral couples therapy for alcoholism and drug abuse. New York: Guilford Press.Google Scholar
  19. Powers, M., Vedel, E., & Emmelkamp, P. (2008). Behavioral couples therapy (BCT) for alcohol and drug use disorders: a meta-analysis. Clin Psychol Rev, 28, 952–962.CrossRefPubMedGoogle Scholar
  20. Rothbaum, B. O., Foa, E. B., Riggs, D. S., Murdock, T., & Walsh, W. (1992). A prospective examination of post-traumatic stress disorder in rape victims. Journal of Traumatic Stress, 5, 455–475. doi: 10.1007/BF00977239.CrossRefGoogle Scholar
  21. Schumm, J. A., & Gore, W. L. (2016). Simultaneous treatment of co-occurring posttraumatic stress disorder and substance use disorder. Curr Treat Options Psychiatry, 3, 28–36. doi: 10.1007/s40501-016-0071-z.CrossRefGoogle Scholar
  22. Schumm, J. A., Wanklyn, S. G., & Monson, C. M. (2014). Relationship-based recovery: an interpersonally-empowering approach to recovery from substance use disorder and PTSD—therapist manual. (Unpublished workbook).Google Scholar
  23. Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Janavs, J., Weiller, E., Keskiner, A., et al. (1997). The validity of the mini international neuropsychiatric interview (MINI) according to the SCID-P and its reliability. Eur Psychiatry, 12, 232–241.CrossRefGoogle Scholar
  24. Sobell, L. C., & Sobell, M. B. (1995). Alcohol timeline followback users’ manual. Toronto: Addiction Research Foundation.Google Scholar
  25. Stewart, S. H. (1996). Alcohol abuse in individuals exposed to trauma: a critical review. Psychol Bull, 120, 83–112. doi: 10.1037/0033-2909.120.1.83.CrossRefPubMedGoogle Scholar
  26. Tonigan, J. S., & Miller, W. R. (2002). The inventory of drug use consequences (InDUC): test-retest stability and sensitivity to detect change. Psychol Addict Behav, 16, 165–168. doi: 10.1037//0893-164x.16.2.165.CrossRefPubMedGoogle Scholar
  27. van Dam, D., Vedel, E., Ehring, T., & Emmelkamp, P. M. G. (2012). Psychological treatments for concurrent posttraumatic stress disorder and substance use disorder: a systematic review. Clin Psychol Rev, 32, 202–214. doi: 10.1016/j.cpr.2012.01.004.CrossRefPubMedGoogle Scholar
  28. Weathers, F. W., Keane, T. M., & Davidson, J. R. (2001). Clinician-administered PTSD scale: a review of the first ten years of research. Depress Anxiety, 13, 132–156. doi: 10.1002/da.1029.CrossRefPubMedGoogle Scholar
  29. Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD checklist: reliability, validity and diagnostic utility. Proceedings of the 9th Annual Conference of the International Society for Traumatic Stress Studies (ISTSS). San Antonio: ISTSS.Google Scholar
  30. Whisman, M. A., Uebelacker, L. A., & Bruce, M. L. (2006). Longitudinal association between marital discord and alcohol use disorders in a community sample. J Fam Psychol, 20, 164–167. doi: 10.1037/0893-3200.20.1.164.CrossRefPubMedGoogle Scholar
  31. Yin, R. K. (2013). Case study research (5th ed.). Thousand Oaks: Sage Publications.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Sonya G. Wanklyn
    • 1
    • 5
  • Andrew E. Brankley
    • 1
  • Gab Laurence
    • 2
  • Candice M. Monson
    • 1
  • Jeremiah A. Schumm
    • 3
    • 4
    • 6
  1. 1.Department of PsychologyRyerson UniversityTorontoCanada
  2. 2.St. Stephen’s Community HouseTorontoCanada
  3. 3.Cincinnati VA Medical CenterCincinnatiUSA
  4. 4.University of CincinnatiCincinnatiUSA
  5. 5.Centre for Addiction and Mental HealthTorontoCanada
  6. 6.School of Professional Psychology, Wright State UniversityEllis Human Development InstituteDaytonUSA

Personalised recommendations