People with co-occurring PTSD and AOD use can benefit from a variety of treatments. It is important to emphasise that while there is a strong evidence base for certain treatments, the need for individualising a treatment plan to suit the particular client is of paramount importance.
Due to the inter-relatedness of PTSD and AOD use, experts recommend that these conditions be treated in an integrated fashion [102, 141, 739, 1295, 1296]. Some clinicians maintain the view that the AOD use must be treated first, 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 [1297]. Moreover, clients express a preference for integrated interventions that treat both disorders concurrently [141, 1298]. Ongoing AOD use may impede therapy, but it is not necessary to achieve abstinence before the commencement of PTSD treatment [1299]. Improvements can be obtained even in the presence of continued substance use [1300, 1301].
There are several 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.
As complex PTSD is a new diagnosis there is no direct evidence about how to treat it; however, given the high prevalence of complex PTSD [1286], it is likely that a high proportion of participants in the PTSD treatment trials described in this section were experiencing PTSD in its complex form. A meta-analysis that retrospectively assessed PTSD psychotherapy trials to determine if they included patients with complex PTSD has also found beneficial effects of standard trauma-focused treatments in reducing PTSD symptoms as well as some symptoms specific to complex PTSD (i.e., negative self-concept, disturbances in relationships) [1302]. Given that complex PTSD is comprised of a greater number and diversity of symptoms, its treatment may nonetheless require additional treatments and/or treatment of a longer duration compared to those with PTSD [1303].