Abstract: Background: The comorbidity of (complex) posttraumatic stress disorder (cPTSD) and substance use disorder offers difficulties in treatment. There is a high comorbidity between both diseases and a high need for treatment with simultaneous treatment being advised. Aim and methods: Basing on clinical experience and a selective review of the current literature we report frequent difficulties in the therapeutical process which are in parts associated with cPTSD and are formed during the course of illness. Results: In detail, these are attachment difficulties facilitated by a history of neglect that need to be addressed during treatment. Other difficulties are regulation of emotions and dissociations, self-medication, victimization, and experiential avoidance. Treatment should address these parts. The main emphasis of this article stresses attachment difficulties and their impact on treatment. In the treatment section proposals for therapy modifications are made.
Bertino et al. (Wed,) studied this question.
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