Trauma focused forms of treatment aim to focus on, process, and identify the meaning of the traumatic experience of the individual while concurrently addressing needs of comorbid SUD. A modified version of seeking safety, seeking safety plus exposure therapy revised, incorporates imagined exposure to the traumatic event into the seeking safety treatment protocol. Concurrent treatment of PTSD and cocaine dependence (CTPCD), also referred to as concurrent treatment of PTSD and substance use disorders with prolonged exposure (COPE), merges typical prolonged exposure protocol for the treatment of PTSD with CBT protocol for SUD. Symptom outcomes have shown improvement in the assessment of the efficacy of trauma-focused treatments for both PTSD and SUD, however effects of the treatment have been small, and they have not evidenced ability to treat both disorders over and above the treatment of either PTSD or SUD alone. Of note, research has conveyed that exposure-based treatments for individuals with PTSD and SUD see high dropout rates, with rates typically peaking around the session that introduces exposure of trauma-based memories to the client. This has created impediments for assessing the efficacy of trauma-focused therapies for people with both SUD and PTSD compared to assessing the efficacy of treating PTSD and SUD separately.
