Exposure therapy in the treatment of PTSD among cocaine-dependent individuals: description of procedures

An estimated 30% to 50% of cocaine-dependent individuals meet criteria for lifetime PTSD. This comorbidity has detrimental effects on clinical present ation, and treatment course and outcome. Cocaine dependence is associated w ith increased rates of exposure to trauma, more severe symptoms, higher rat es of treatment attrition and retraumatization, and greater vulnerability t o PTSD when compared to other substance use disorders. These associations u nderscore the need for effective treatments that address issues particular to PTSD in a manner tolerable to cocaine-dependent individuals. This articl e describes a manualized psychotherapy developed specifically for individua ls with PTSD and cocaine dependence. Concurrent Treatment of PTSD and Cocai ne Dependence (CTPCD) provides coping skills training, cognitive restructur ing techniques, and relapse prevention strategies to reduce cocaine use. In -vivo and imaginal exposure therapy techniques are incorporated to reduce P TSD symptom severity. Primary treatment goals include psychoeducation speci fic to the interrelationship between PTSD and cocaine dependence, and clini cally meaningful reductions in cocaine use and PTSD symptomatology. Seconda ry goals include a reduction in HIV high-risk behaviors and improved functi oning in associated areas, such as anger and negative affect management. (C ) 2001 Elsevier Science Inc. All rights reserved.