A number of psychotherapeutic interventions have been developed for the treatment of co-occurring PTSD and AOD use, and an increasing number are undergoing evaluation. Although there is some contention regarding the naming conventions, existing approaches may be divided into two types: i) past-/trauma-focused therapies; and ii) present-/non-trauma-focused therapies [1304–1306]. The main distinction is that the former involves the revisiting of trauma memories and their meaning, while the latter focus on the development of coping skills in the present.
Several reviews have concluded that there is support for individual past-/trauma-focused psychological interventions that utilise exposure-based approaches, particularly in relation to PTSD outcomes, but that there is very little evidence to support the use of non-trauma-focused individual or group-based interventions over treatment as usual for AOD use [739, 1296, 1307, 1308].
It should be noted that there are diverging views as to whether or not psychotherapy for PTSD, and complex PTSD in particular, should be undertaken using a phase-based approach [1309]. A phase-based approach proposes that it is necessary for a person to undertake interventions that focus on stabilisation in the first phase of treatment (i.e., establishing safety, symptom management, improving emotion regulation and addressing current stressors) prior to moving on to processing the trauma memory, followed by reintegration (i.e., re-establishing social and cultural connection and addressing personal quality of life) [1310]. However, the evidence to date suggests that this approach is neither necessary nor recommended, as it may lead to unnecessary delays or restrictions in access to effective past-/trauma-focused therapy [1309, 1311, 1312]. Indeed, studies comparing the efficacy of a phased-based approach relative to past-/trauma-focused treatment have found that recovery may be faster for those who receive past-/trauma-focused treatment [1311, 1312]. That is not to say that the components incorporated in phase one are not important, but rather, that they can be integrated throughout the treatment process alongside the past-/trauma-focused work [1313]. The vast majority of past-/trauma-focused therapies described in this chapter incorporate phase one components in their programs.