Current Treatment Options in Psychiatry

, Volume 6, Issue 3, pp 188–197 | Cite as

Dealing With Complexity and Comorbidity: Comorbid PTSD and Substance Use Disorders

  • Jessica C. TrippEmail author
  • Jennifer L. Jones
  • Sudie E. Back
  • Sonya B. Norman
PTSD (S Creech and L Sippel, Section Editors)


Purpose of review

Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are highly comorbid, and the presence of both disorders is associated with lower treatment effect sizes and higher dropout from treatment than one disorder alone. This review examines recent research on treatments for patients with comorbid PTSD/SUD, as well as recent work on psychological mechanisms that may contribute to both disorders.

Recent findings

Several studies have shown that trauma-focused treatments, such as Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE), are effective for reducing PTSD and do not cause exacerbation of substance use in patients with comorbid SUD. A few studies have examined pharmacotherapies for PTSD/SUD, but to date there is not one medication that appears to have clear efficacy for individuals with PTSD/SUD. Several mechanisms such as anxiety sensitivity, trauma-related cognitions, and pain may contribute to both PTSD and SUD.


Although trauma-focused treatments show promising results for PTSD/SUD, preconceptions regarding potential concurrent treatment risks influence provider adoption. Because many patients do not have a goal of total abstinence from substances, future research on the impact of continued use on trauma-focused treatment outcomes is needed. Additional trials of medications in conjunction with psychotherapy are indicated.


PTSD Substance use disorder Comorbidity Treatment 


Compliance with ethical standards

Conflict of interest

Sudie E. Back received grants from NIDA, DoD/VA, and from Oxford University Press.

Jessica C. Tripp, Jennifer L. Jones, and Sonya B. Norman declare no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance••Of major importance

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Jessica C. Tripp
    • 1
    • 2
    Email author
  • Jennifer L. Jones
    • 3
  • Sudie E. Back
    • 3
    • 4
  • Sonya B. Norman
    • 1
    • 2
    • 5
    • 6
  1. 1.VA San Diego Healthcare SystemSan DiegoUSA
  2. 2.University of California, San Diego, School of MedicineSan DiegoUSA
  3. 3.Medical University of South CarolinaCharlestonUSA
  4. 4.Ralph H. Johnson VA Medical CenterCharlestonUSA
  5. 5.National Center for PTSDHartfordUSA
  6. 6.VA Center of Excellence for Stress and Mental HealthSan DiegoUSA

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