The main goal of this proposal is to develop a psychotherapy treatment manual for the group cognitive-behavioral treatment of women with comorbid substance use disorder (SUD) and post-traumatic stress disorder (PTSD). In addition, the manual will be pilot-tested in a within-subjects group treatment with a total of 24 patients and three therapists. The rationale for targeting this population derives from the relatively high co- occurrence of these two disorders, from research indicating that women in particular have relatively high rates of SUD/PTSD, and from descriptions in the clinical literature of the different clinical presentation and treatment needs of women SUD/PTSD patients in comparison to male SUD/PTSD patients (most of whom are combat veterans). Cognitive-behavioral therapy is suggested as a treatment of choice because it promotes self-control skills to control the overwhelming affects that are a hallmark of this population; it teaches functional behaviors that may have deteriorated or failed to develop as a result of the disorders (relationship skills, self- nurturing, activity planning); and it provides explicit training to prevent relapse, a known danger-for both SUD and PTSD. A group format is recommended for cost-effectiveness and to provide a socially supportive environment considered important for the treatment of these disorders. In developing the treatment manual, considerable emphasis will be placed on making the treatment effective and accessible for this population through the use of several fundamental principles drawn from educational research, including visual aids, education for the patient role, teaching for generalization, emphasis on structured treatment, testing of acquired knowledge of CBT, affectively engaging themes and materials, and memory enhancement devices). The impact of the manual will be tested by a repeated-measures outcome study, assessing patients' satisfaction with the group treatment, knowledge acquisition of the didactic material, reduction in SUD and PTSD symptoms, and level of therapeutic alliance toward the treatment. In addition, therapists' satisfaction with and adherence to the treatment manual will be assessed.
