ABSTRACT
Although comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD), or PTSD/SUD, present a pressing public health concern, most people with PTSD/SUD do not receive effective treatment. A substantial minority of those with PTSD or SUD will never seek treatment (Wang et al., 2005), and of those who do, evidence-based psychotherapy is often not offered. Even when PTSD/SUD clients access treatment, this comorbidity is associated with low likelihood of ongoing engagement (Simpson, Lehavot, & Petraskis, 2016). Many factors contribute to these low rates of treatment access and engagement, including limited local availability of mental health treatment providers (Kazdin & Blase, 2011), slow progress in the dissemination and implementation of evidence-based treatments to community providers (McHugh & Barlow, 2010), stigma associated with seeking mental health treatment (Corrigan, 2004), and logistical challenges related to attending appointments (e.g., transportation, childcare). High cost of care is also a treatment barrier for many with psychiatric conditions, and given the higher treatment costs associated with PTSD/SUD (Ouimette, Brown, & Najavits, 1998), this barrier may be particularly salient. In addition, many of these barriers disproportionately impact rural communities (Smalley et al., 2010).
