ABSTRACT
Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are complex psychiatric conditions that commonly co-occur (McCauley, Killeen, Gros, Brady, & Back, 2012), presenting a significant challenge to clinical scientists and practitioners. The development of a deeper understanding of this comorbidity is critical, as the co-occurrence of PTSD and SUD presents a clinical and public health concern. The comorbidity is challenging, difficult to treat, and marked by a more costly and chronic clinical course when compared to either disorder alone (McCauley et al., 2012; Mills Teesson, Ross, & Peters, 2006; Schäfer & Najavits, 2007). Individuals with PTSD/SUD comorbidity, relative to those with either disorder alone, tend to manifest worse treatment adherence, less improvement in symptomatology during treatment, more legal problems, increased risk for experiencing violence, poorer social functioning, more severe physical health problems, and higher rates of suicide attempts (Foa & Williams, 2010; McCauley et al., 2012). Moreover, PTSD, including subclinical PTSD (Norman, Tate, Anderson, & Brown, 2007), is associated with strong drug cravings (Coffey et al., 2002; Saladin et al., 2003) and withdrawal symptoms (Boden, Babson, Vujanovic, Short, & Bonn-Miller, 2013), as well as a greater tendency to use substances to alleviate negative mood states (Back, Brady, Jaanimägi, & Jackson, 2006; Chilcoat & Breslau, 1998; Jacobsen, Southwick, & Kosten, 2001).
