Clinicians' views on treating posttraumatic stress disorder and substance use disorder.

The dual diagnosis of posttraumatic stress disorder (PTSD) and substance use disorder (SUD) is reported to be both highly prevalent and highly challenging. In this study, 147 clinicians were surveyed on their degree of difficulty and gratification in working with each disorder (PTSD, SUD) and their combination; specific types of difficulties and gratifications; and personal and professional characteristics. The dual diagnosis was perceived as more difficult than either disorder alone; but, interestingly, gratification in the work was higher than its difficulty. Areas of greatest difficulty were clients' self-destructiveness, case management, and dependency; areas of greatest gratification were teaching new coping, developing expertise, and helping clients achieve abstinence. In general, difficulty and gratification appeared to be separate constructs, rather than simply opposites. Those finding the work most difficult were more likely to be in a mental health setting and to have no personal history of trauma. Clinical implications are discussed.