What treatments are used for people with PTSD and substance use problems?

People who have PTSD are more likely than those who do not to have problems with drugs and alcohol.

When someone has PTSD it's common for them to have other related problems. The relationship between PTSD and substance use problems is bi-directional. This means that people with PTSD have more problems with drugs and alcohol both before and after they develop PTSD. For example:
  • If someone uses drugs and alcohol in ways that impact their life, they are at risk for the types of traumatic events that could lead to PTSD.
  • When someone goes through a traumatic event, they may try to use drugs or alcohol to manage their stress reactions or PTSD symptoms.
Those who have both PTSD and substance use disorders face more challenges in treatment, with other health problems, and in managing daily life (such as financial and social challenges). We know from research that we can treat someone for PTSD and substance use problems at the same time.  

“I kicked my drugs. And this is all from the treatment I have been given.”
              Craig "Stu" Shipley, U.S. Marine Corps, 1964 - 1968

How many studies look at treating PTSD and substance use problems at the same time?
There are 27 studies focused on treating PTSD and substance use problems in the PTSD Repository. This is 5% of studies. 

What substances are people using in studies that focus on treating PTSD and substance use?
Of the studies that focus on treating PTSD and substance use, participants may have problems with alcohol, drugs, or both. Most studies, 12 in total, have samples in which participants used both alcohol and drugs. In 8 of the studies, all of the participants used alcohol. Of studies focused on drug use, 4 had participants who all used nicotine and 1 had participants who all used any number of drugs.

What types of treatments are being studied for treating PTSD and substance use problems?

We know that trauma-focused talk therapies are the most effective treatment for PTSD and research shows that they are safe and effective for people who also have substance use problems. In some cases the treatments being tested are primarily PTSD treatments with the expectation that they will also reduce the substance use.  In other cases the treatments are specifically designed to treat both disorders (PTSD and substance use) – these are called integrated treatments.

Integrated treatment for PTSD+SUD
Integrated treatments for PTSD and substance disorders use strategies for improving both problems in one treatment and are delivered by one provider. The most commonly studied integrated treatment for people who have PTSD and substance use problems is Concurrent Treatment for PTSD (COPE). This treatment combines Prolonged Exposure for PTSD--a trauma-focused talk therapy--with relapse prevention for substance use.
Non-integrated treatments would include 2 treatments delivered by different providers during the same time period. For example, a patient would receive one treatment for PTSD and another for substance use. Or, non-integrated treatments can be "phased," meaning that one condition is treated before the other. 
As shown in the bar chart, research is focused on testing integrated treatments to best support those who have PTSD and substance use problems. 

For more information about problems with alcohol and drugs for those with PTSD, please see PTSD and Substance Misuse on the National Center for PTSD website.