Theoretical perspective on posttraumatic stress disorder and substance use disorder

Abstract

This paper reviews theoretical considerations in the treatment of patients with the dual diagnosis of posttraumatic stress disorder (PTSD) and substance use disorder (SUD). This dual diagnosis is shown to have features that are similar to other dual diagnoses, but also differences in some important areas. For example, in contrast to some other mental health diagnoses, PTSD may worsen with abstinence from substances; it is unique in potentially evoking symptoms of the disorder in the clinician; it may be easier to diagnose in the context of SUD; it may be more disavowed and underdiagnosed; it may require stage-based treatment; it may have more likelihood of recovery; and legal issues may be more prominent. Key themes of therapy for the dual diagnosis are described, as well as specific psychotherapies that have published empirical results. The need for more empirical research on the dual diagnosis is emphasised.

Acknowledgement

Preparation of this paper was supported by grant K02 DA-00400 from the National Institute on Drug Abuse and the Dr Ralph and Marian C. Falk Medical Research Trust. The section on specific therapies in this paper is adapted with permission from the Center for Substance Abuse Treatment (in press).