ABSTRACT
Substance use disorders (SUD) commonly co-occur with posttraumatic stress disorder (PTSD) in both the general population (Pietrzak, Goldstein, Southwick, & Grant, 2011) and veteran population (Fuehrlein et al. 2016; Seal et al., 2011), with especially high PTSD prevalence rates (i.e., 30–60%) among those seeking SUD treatment (Back et al., 2000; Brady, Back, & Coffey, 2004; Brady, McCauley, & Back, 2015; Brown, Stout, & Mueller, 1999; Clark, Masson, Delucchi, Hall, & Sees, 2001; Dansky, Brady, & Roberts, 1994; Jacobsen, Southwick, & Kosten, 2001; Triffleman, Marmar, Delucchi, & Ronfeldt, 1995). Individuals with co-occurring PTSD/SUD have higher rates of homelessness, physical health problems, psychiatric comorbidities, and psychosocial impairment compared to individuals with a single disorder (Back et al., 2000; Bowe & Rosenheck, 2015; Hoge, Terhakopian, Castro, Messer, & Engel, 2007; Ouimette, Goodwin, & Brown, 2006). Importantly, PTSD/SUD comorbidity is also associated with stronger alcohol and drug cravings (Coffey et al., 2002) and poor treatment retention (Shaefer & Najavits, 2007; Tull, Gratz, Coffey, Weiss, & McDermott, 2013). Some evidence also suggests that PTSD may be related to worse substance use treatment outcomes, including poor response to treatment and briefer abstinence periods after treatment (Brown et al., 1999; Driessen et al., 2008), although a recent review of 22 treatment outcome studies (Hildebrand, Behrendt, & Hoyer, 2015) concluded that the effect of comorbid PTSD on SUD treatment outcomes was inconsistent.
