Acceptance and commitment therapy for co-occurring PTSD and substance use: A manual development study

We present the theoretical rationale for addressing comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) with Acceptance and Commitment Therapy (ACT). We then describe the development of a treatment manual of ACT for PTSD/SUD and the subsequent refinement to this manual following a feasibility study with a small sample of veterans. Treatment retention was similar to what has been observed in studies of other integrated treatments for PTSD/SUD. Overall treatment satisfaction was positive. Pilot outcomes are presented for descriptive purposes. We describe changes we made to the initial manual following the trial to bolster retention and improve the intervention. Revisions were based on feedback from therapists, consultants, and participants and examination of pilot outcome data. Additional strategies for adapting ACT to this challenging clinical presentation are offered.