Co-occurring Posttraumatic Stress Disorder and Substance Use Disorder: Recommendations for Management and Implementation in the Department of Veterans Affairs

Abstract

The recently revised Department of Veterans Affairs (VA) and Department of Defense Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder (PTSD) offers guidance to treat co-occurring PTSD and substance use disorder. The release of the guideline occurred at a time of cultural shifts in recognizing and managing substance use disorders and when major changes were made in the VA to address co-occurring PTSD and substance use disorders. The release also coincided with an increasing number of veterans returning from the wars in Afghanistan and Iraq who were coming to the VA for PTSD treatment. A key augmentation in mental health staffing has brought many new clinicians to the VA and has made it more feasible to address the two disorders in a coordinated way. In this article the authors describe the recommendations in the revised 2010 PTSD clinical practice guideline to address co-occurring PTSD and substance use disorder, review the supporting research evidence behind the recommendations, and examine methods of new VA programs to address the two disorders. A description of what is working and where obstacles still exist is provided. The new recommendations have moved the field forward by offering clinical guidance to practitioners who are working with patients with the commonly observed co-occurring PTSD and substance use disorder.

Keywords:

• co-occurring disorders
• posttraumatic stress disorder
• substance use disorder
• implementation

ACKNOWLEDGMENTS

The authors wish to acknowledge the support of Dr. Antonette Zeiss, Dr. John Allen, Dr. Jennifer Burden, and the panel of experts and work group who were key to the clinical guidance developed in the recommendations to the field and in the new PTSD clinical practice guideline. Dr. Carol Malte is acknowledged for providing the substance use disorder/PTSD specialist data from the Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Healthcare System.

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