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PTSD/Substance Use Disorder Comorbidity: Treatment Options and Public Health Needs

  • Substance Use Disorders (FG Moeller, Section Editor)
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Abstract

Purpose of review

Posttraumatic stress disorder (PTSD) commonly co-occurs with substance use disorder (SUD) and is challenging to treat. We review all behavioral therapy models with at least one randomized controlled trial in a current PTSD/SUD population. We identify factors in selecting a model for clinical use, emphasizing a public health framework that balances the need for evidence with the need for feasibility in frontline settings.

Recent findings

Seven published models and 6 unpublished models are reviewed. Public health considerations for choosing a model include the following: whether it has been studied across a broad range of SUDs and in complex SUD patients; whether it can be conducted in group modality; its appeal to patients and providers; its cost; workforce requirements; and its ability to reduce substance use in addition to PTSD.

Summary

There are two broad types of models: those that originated in the PTSD field versus the SUD field. Overall, the latter are stronger on public health factors and more feasible in SUD settings. Published models in this category include Relapse Prevention, BRENDA, and Seeking Safety. PTSD/SUD research is at an early stage and there is a need for methodology that quantifies “level of burden” (patients’ socioeconomic disadvantages) across trials.

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Notes

  1. PE is also listed on that website but was not analyzed distinct from various other CBT models.

  2. “Complexity” is sometimes used to describe these disadvantages, but we prefer “level of burden” as it keeps the focus on patients’ experience of hardship rather than the provider-centric concept of “complexity.”

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Acknowledgments

Mark McGovern, PhD, is thanked for his personal communications relevant to this paper.

Funding

This paper was supported by the following grants (Principal Investigator: Dr. Najavits): R44DA041949 and R44DA042640 from the National Institute on Drug Abuse and R44AA026746 from the National Institute on Alcohol and Alcoholism.

Author information

Authors and Affiliations

  1. University of Massachusetts Medical School, Worcester, MA, USA

    Lisa M. Najavits PhD

  2. Santa Clara University, Santa Clara, CA, USA

    H. Westley Clark M.D., J.D., M.P.H., CAS, FASAM

  3. University of Maryland, Baltimore County, MD, USA

    Carlo C. DiClemente

  4. Departments of Psychiatry, Child Study and Neuroscience, Yale University School of Medicine, New Haven, CT, USA

    Marc N. Potenza MD, PhD

  5. Division on Addiction, Harvard Medical School, Boston, MA, USA

    Howard J. Shaffer PhD

  6. Department of Psychiatry and Behavioral Sciences, University of California at San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA

    James L. Sorensen PhD

  7. University of Toledo, Toledo, OH, USA

    Matthew T. Tull PhD

  8. Columbia University School of Social Work, New York, NY, USA

    Allen Zweben PhD

  9. University of California, Veterans Affairs Medical Center, San Francisco, CA, USA

    Joan E. Zweben PhD

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  1. Lisa M. Najavits PhD
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Correspondence to Lisa M. Najavits PhD.

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Conflict of Interest

Dr. Najavits is the director of Treatment Innovations, which receives research grants and provides training, consultation, and materials related to psychotherapy, including the Seeking Safety and creating change models that she developed. She also receives royalties from Guilford Press.

All other authors declare that they have no conflict of interest (Drs. Clark, DiClemente, Potenza, Shaffer, Sorensen, Tull, A. Zweben, J. Zweben).

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Najavits, L.M., Clark, H.W., DiClemente, C.C. et al. PTSD/Substance Use Disorder Comorbidity: Treatment Options and Public Health Needs. Curr Treat Options Psych 7, 544–558 (2020). https://doi.org/10.1007/s40501-020-00234-8

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