People with co-occurring PTSD and AOD use are often considered more difficult to treat than people with either condition alone [89, 818]. Comorbid PTSD and AOD use is associated with difficulties recruiting and retaining clients in treatment, poor treatment adherence and outcomes, as well as less time spent abstinent post-treatment [89, 819-821].
Due to the inter-relatedness of PTSD and AOD use, experts recommend that these conditions be treated in an integrated fashion [281, 822-824]. Some clinicians maintain the view that the AOD use must be treated first [825, 826], or that abstinence is necessary before PTSD diagnosis and management can be attempted . In practice however, this approach can lead to clients being passed between services with little coordination of care . Ongoing AOD use may impede therapy, but it is not necessary to achieve abstinence before the commencement of PTSD treatment . Improvements can be obtained even in the presence of continued substance use [828, 829].
There are several treatment options available for the treatment of PTSD, including psychotherapy (e.g., past- and present-focused therapies), pharmacotherapy, e-health interventions, physical activity, and complementary and alternative therapies (e.g., yoga). The evidence base surrounding each of these treatments is discussed below.