The Use of Exposure-Based Treatment Among Individuals With PTSD and Co-occurring Substance Use Disorders: Clinical Considerations

Abstract

Integrative treatments for co-occurring posttraumatic stress (PTSD) and substance use disorders have been shown to be safe and effective. Improvement in PTSD symptoms can positively impact substance use outcomes. Interventions that include exposure-based techniques, which are considered the treatment of choice for PTSD, have not been well studied in substance-abusing populations. Concurrent treatment of PTSD and Substance Use Disorders with Prolonged Exposure (COPE) is a manualized psychotherapy that combines both imaginal and in vivo exposure techniques for PTSD with cognitive behavioral techniques for substance use disorders. Preliminary studies using COPE demonstrate promise and feasibility. In this article the authors explore the clinical considerations when implementing exposure-based therapy for PTSD in substance-abusing individuals.

Keywords:

• posttraumatic stress disorder
• substance use disorder
• prolonged exposure

ACKNOWLEDGMENTS

This report was sponsored by a grant from the National Institute of Drug Abuse R01 DA030143 (Back, PI). The authors would like to thank Dr. Edna Foa for her significant contributions to the development and modification of the COPE manual. The authors would also like to thank Dr. Denise Hien, Dr. Katherine Mills, Dr. Maree Teesson, and their team of therapists for implementing and investigating the safety and effectiveness of COPE in civilian populations.

Notes

Note. IES = Impact of Event Scale; CAPS = Clinician Administered PTSD Scale; MISS = Mississippi Scale for PTSD; BDI = Beck Depression Inventory; ASI = Addiction Severity Index.

^a N = 15.