Psychological treatment of PTSD with comorbid substance use disorder (SUD): expert recommendations of the European Society for Traumatic Stress Studies (ESTSS)

Background: Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) are often comorbid and difficult to treat.The availability of evidence-based treatment guidelines is very limited and there is significant uncertainty about what best practice looks like.Objective: This paper describes the methodology used to develop expert recommendations for the assessment and psychological treatment of PTSD and comorbid SUD and presents the final recommendations.Methodology: A small committee of experts in the field of PTSD and SUD was formed on behalf of the European Society for Traumatic Stress Studies (ESTSS) Board.The committee developed recommendations based on a two-stage process.In the first stage a systematic review of randomised controlled trials of psychological interventions aimed at treating PTSD-SUD comorbidity was completed, and other recent relevant reviews systematic were also considered.To complement the recommendations based on systematic review, the second stage involved the review and collation of existing guidance, good practice and consensus recommendations made in methodologically rigorous clinical practice guidelines.Results: The two-stage process resulted in 9 recommendations related to assessment and 21 recommendations related to treatment planning and delivery.Conclusions: To our knowledge, this is the first attempt to provide expert recommendations based on a systematic review of the literature and through collation of guidance provided in other authoritative and reliable sources.These expert recommendations will provide helpful guidance to clinicians and service providers in both addiction and mental health settings about appropriate clinical care for those with PTSD SUD comorbidity.Tratamiento psicolgico del TEPT con Trastorno por Uso de Sustancias (TUS) comrbido: recomendaciones de expertos de la Sociedad Europea de Estudios de Estrs Traumtico (ESTSS) Antecedentes: El trastorno de estrs postraumtico (TEPT) y el trastorno por uso de sustancias (TUS) suelen ser comrbidos y difciles de tratar.La disponibilidad de pautas de tratamiento basadas en evidencia es muy limitada y existe una incertidumbre significativa sobre cmo son las mejores prcticas.Objetivo: Este artculo describe la metodologa utilizada para desarrollar recomendaciones de expertos para la evaluacin y el tratamiento psicolgico del TEPT y el TUS comrbido y presenta las recomendaciones finales.Metodologa: Se form un pequeo comit de expertos en el campo del TEPT y TUS en nombre del directorio de la Sociedad Europea de Estudios de Estrs Traumtico (ESTSS en su sigla en ingls).El comit desarroll recomendaciones basadas en un proceso de dos etapas.En la primera etapa se complet una revisin sistemtica de ensayos controlados aleatorizadoos de intervenciones psicolgicas destinadas a tratar la comorbilidad TEPT-TUS, y tambin se consideraron otras revisiones sistemticas relevantes recientes.Para complementar las recomendaciones basadas en la revisin sistemtica, la segunda etapa implic la revisin y recopilacin de guas existentes, buenas prcticas y recomendaciones de consenso formuladas en guas de prctica clnica metodolgicamente rigurosas.Resultados: El proceso de dos etapas result en 9 recomendaciones relacionadas con la evaluacin y 21 recomendaciones relacionadas con la planificacin y administracin del tratamiento.