Integrative treatments for co-occuring posttraumatic stress and substance use disorders have been shown to be safe and effective. Improvement in PTSD symptoms can positively impact substance use outcomes. Interventions that include exposure-based techniques, which are considered the treatment of choice for PTSD, have not been well studied in substance-abusing populations. Concurrent treatment of PTSD and Substance Use Disorders with Prolonged Exposure (COPE) is a manualized psychotherapy that combines both imaginal and in vivo exposure techniques for PTSD with cognitive behavioral techniques for substance use disorders. Preliminary studies using COPE demonstrate promise and feasibility. In this article the authors explore the clinincal considerations when implementing exposure-based therapy for PTSD in substance-abusing individuals.
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