Nearly 50% of people diagnosed with PTSD will develop a substance use disorder at some point in their lives, according to the National Center for PTSD. In New Hampshire, where the opioid crisis has reshaped communities and veteran populations face compounding stressors, that overlap is not a coincidence , it is a pattern that demands a specific kind of treatment. This guide covers everything you need to understand about PTSD and substance abuse treatment in New Hampshire: why these conditions interlock, what integrated care actually looks like, which therapies work, how to navigate insurance, and what to do next.
The link between PTSD and substance abuse in new hampshire
The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that between 30% and 60% of people seeking substance use disorder treatment meet diagnostic criteria for PTSD. That is not a coincidence , it is a clinical reality that changes how treatment needs to work. In New Hampshire, where the opioid epidemic has driven the state’s drug overdose death rate to among the highest in the nation and where rural communities face limited access to mental health services, the combination of unaddressed trauma and substance use is the most common presentation, not the exception.
Understanding this connection matters because most treatment systems were built to handle these conditions separately. When you treat addiction without addressing the underlying trauma, the psychological pain that drove substance use in the first place remains untouched. Relapse rates reflect that gap. Effective treatment here means addressing both conditions simultaneously, inside the same program, with clinicians trained in both domains.
Why PTSD and addiction occur together
A landmark 2018 study published in the journal Psychological Trauma analyzed data from over 36,000 adults and confirmed what clinicians had long observed: trauma exposure significantly increases the probability of developing a substance use disorder, with PTSD functioning as the key mediating variable. The relationship is not random. PTSD produces specific neurological and psychological states , hyperarousal, intrusive memory, emotional numbing , that substances temporarily relieve. Once that relief becomes the primary coping mechanism, a feedback loop forms that is genuinely difficult to break without clinical intervention.
The self-medication cycle
Here is the mechanism in plain terms. A trauma survivor experiences intrusive memories, hypervigilance, or an inability to sleep. Alcohol reduces that hyperarousal acutely; opioids blunt emotional pain; benzodiazepines quiet the nervous system. The brain registers the relief, and the behavior is reinforced. The catch is that regular substance use changes how the brain regulates stress hormones, particularly cortisol and norepinephrine, which are already dysregulated by PTSD. When substances are removed, the rebound effect intensifies PTSD symptoms beyond their baseline , more anxiety, more hyperarousal, worse sleep , which triggers the urge to use again. That cycle is the reason treating addiction alone, without addressing trauma, produces such high relapse rates. A 2019 study in Drug and Alcohol Dependence found that PTSD symptom severity was the single strongest predictor of relapse within 90 days of discharge from a substance use treatment program.
Common substances used to cope with PTSD in new hampshire
Alcohol is the most commonly used substance among people with PTSD, partly because of its availability and partly because it reduces limbic system hyperactivity quickly. In New Hampshire, alcohol use disorder remains the most prevalent substance use condition, according to SAMHSA’s National Survey on Drug Use and Health. Opioids, particularly fentanyl and prescription opioids, are the second most significant concern in the state. New Hampshire’s overdose death rate from synthetic opioids has consistently ranked among the top five nationally, and trauma exposure is a documented predictor of opioid misuse escalation.
Benzodiazepines present a specific risk for people with PTSD because they are frequently prescribed for anxiety, which is often the presenting complaint rather than the underlying trauma. They work short-term, but tolerance builds rapidly and withdrawal from benzodiazepines when PTSD is present is medically complex , rebound anxiety in a hyperaroused nervous system can be severe. Stimulants, including cocaine and amphetamines, are used by some trauma survivors who present with emotional numbing or dissociation rather than hyperarousal. The stimulant temporarily restores a sense of presence or energy, but it compounds anxiety over time and disrupts sleep, which is already fragile in PTSD.
Recognizing co-occurring PTSD and substance use disorder
The diagnostic challenge with co-occurring PTSD and substance use disorder is that the symptoms of each condition mask or mirror the other. Emotional numbness, sleep disruption, concentration problems, and irritability appear in both PTSD and substance withdrawal. That overlap leads to underdiagnosis of PTSD in addiction treatment settings , and underdiagnosis of addiction in mental health settings.
PTSD symptoms that drive substance use
A 2020 study in the Journal of Anxiety Disorders examined 1,400 adults with PTSD and found that three symptom clusters most strongly predicted substance use escalation: hyperarousal (racing heart, exaggerated startle response, chronic tension), emotional detachment (feeling cut off from people and feelings), and avoidance behaviors (deliberately steering away from memories, places, or people connected to the trauma). Flashbacks and intrusive memories played a role, but it was the persistent physiological dysregulation and emotional disconnection that most reliably drove people toward substances as a management strategy.
If you experience any combination of those symptoms alongside increasing substance use, especially use that has escalated in frequency or amount without a clear external trigger, the pattern warrants a dual diagnosis evaluation rather than just an addiction assessment.
When to seek dual diagnosis treatment
The threshold is functional impairment, not symptom count. If PTSD symptoms are disrupting your sleep consistently, straining your close relationships, making it difficult to maintain employment, or causing you to avoid situations necessary for daily life, and if substance use has become part of how you manage any of those disruptions, professional dual diagnosis treatment is the appropriate response. Self-management at this level of co-occurring severity does not work. The neurobiology makes it structurally difficult: the same systems damaged by trauma are the ones needed to regulate behavior and sustain motivation for change. Professional intervention is not a last resort , it is the correct first step.
The state of PTSD and substance abuse in new hampshire
New Hampshire’s 2023 drug overdose data from the NH Department of Health and Human Services reported 486 drug overdose deaths, with fentanyl involved in the overwhelming majority. That number places New Hampshire among the states with the highest per-capita overdose mortality, even as the opioid crisis has shifted in nature over the past decade. What the raw numbers do not capture is the trauma infrastructure underneath those deaths. Rural counties in northern New Hampshire, including Grafton County, face particular vulnerability: geographic isolation, lower rates of mental health provider access, and a large veteran and first responder population that carries disproportionate trauma burden.
New hampshire’s opioid crisis and trauma connection
The opioid epidemic and the trauma epidemic in New Hampshire are not parallel problems , they are the same problem viewed from different angles. A 2021 analysis by the NH Fiscal Policy Institute found that communities with higher rates of adverse childhood experiences (ACEs) also showed higher rates of opioid misuse and overdose. Childhood trauma, interpersonal violence, and community-level trauma (including the losses produced by the overdose crisis itself, which creates grief and secondary trauma in survivors and families) all feed into the cycle. Treating opioid use disorder without addressing the trauma history that preceded and sustains it is like treating a wound without removing what caused it.
Veterans, first responders, and PTSD in new hampshire
The Department of Veterans Affairs estimates that PTSD affects between 11% and 20% of veterans who served in Operation Iraqi Freedom or Operation Enduring Freedom, and up to 30% of Vietnam-era veterans. New Hampshire has a veteran population of approximately 100,000, with notable concentration in northern counties. First responders , police officers, firefighters, paramedics , face a parallel burden. A 2018 study by the Ruderman Family Foundation found that first responders are more likely to die by suicide than in the line of duty, with PTSD and substance use disorder as the primary contributing factors.
Veterans and first responders face specific barriers to treatment beyond geography: stigma within professional culture, concern about security clearances or employment consequences, and the perception that seeking help signals weakness. Tricare coverage for dual diagnosis treatment is available and often covers residential programs, which removes at least the financial barrier if you know how to use it. The cultural barriers require treatment environments that understand and respect these identities , not just clinical competence in PTSD and addiction, but genuine familiarity with military and first responder culture.
What dual diagnosis treatment actually looks like
SAMHSA’s 2020 Treatment Improvement Protocol (TIP) 42 reviewed evidence across thousands of treatment outcome studies and reached a clear conclusion: integrated treatment for co-occurring PTSD and substance use disorder produces significantly better outcomes than sequential or parallel treatment. Sequential treatment means treating addiction first, then PTSD , or the reverse. Parallel treatment means treating both simultaneously but in separate, unconnected programs. Integrated treatment means both conditions addressed together, by a coordinated clinical team, within the same program. The difference in relapse rates and long-term recovery outcomes between integrated and non-integrated approaches is substantial. Understanding what integrated dual diagnosis care involves before entering treatment helps you evaluate whether a program is actually equipped to deliver it.
In practice, an integrated dual diagnosis program looks like this: medical detox when physical dependence is present, followed by residential or intensive outpatient programming where individual therapy, group therapy, medication management, and skill-building are all oriented around both the trauma and the addiction simultaneously. No siloing. The same clinical team that addresses your substance use also addresses your PTSD, so the treatment plan reflects how those conditions interact in your specific case.
Evidence-based therapies for PTSD and addiction
The therapies with the strongest research base for co-occurring PTSD and substance use disorder are not experimental. They are well-validated, widely endorsed by the VA and NIDA, and teachable within a structured residential or outpatient program.
Cognitive processing therapy (CPT)
CPT was developed by Dr. Patricia Resick and has been extensively validated for PTSD, with the VA formally endorsing it as a first-line treatment. A 2017 meta-analysis of 26 randomized controlled trials found CPT produced large reductions in PTSD symptom severity. The mechanism is specific: CPT targets “stuck points” , distorted beliefs formed as a result of trauma, such as “I am permanently damaged” or “nowhere is safe.” Those beliefs do not just fuel PTSD. They directly sustain substance use by reinforcing hopelessness and reducing motivation for recovery. CPT does not require you to narrate the trauma in detail; it works at the level of meaning rather than memory.
Seeking safety
Seeking Safety, developed by Dr. Lisa Najavits at Harvard Medical School and first published in 1998, remains the most researched and replicated integrated treatment model specifically designed for co-occurring PTSD and substance use disorder. The original trial demonstrated significant reductions in both PTSD symptoms and substance use, and replication studies across diverse populations have been consistent. A Seeking Safety session is structured around one of 25 topics that bridge safety, coping, and healing , covering themes like detaching from emotional pain, taking good care of yourself, and setting limits. The approach is present-focused, which makes it accessible early in recovery before trauma processing is clinically appropriate.
EMDR and trauma-focused CBT
Eye Movement Desensitization and Reprocessing (EMDR) has strong evidence for PTSD across multiple meta-analyses, including a 2013 WHO guideline that listed it as a recommended first-line treatment. EMDR works by having you recall traumatic memories while engaging in bilateral stimulation (typically guided eye movements), which appears to reduce the emotional charge of the memory during reprocessing. For people with co-occurring substance use disorder, EMDR is typically introduced after a period of stabilization rather than in early detox. Trauma-focused CBT addresses the cognitive distortions and avoidance behaviors that maintain both PTSD and addiction, making it applicable across the full treatment continuum.
Medication-assisted treatment and PTSD
Medication-assisted treatment (MAT) with buprenorphine or naltrexone is not in competition with trauma therapy , it is the stabilization that makes trauma therapy possible. For opioid use disorder, buprenorphine reduces cravings and withdrawal symptoms enough to allow cognitive engagement in therapeutic work. Naltrexone blocks opioid receptors and is also FDA-approved for alcohol use disorder. A 2020 study in JAMA Psychiatry found that buprenorphine-maintained patients showed significantly greater engagement with PTSD-focused therapy than patients who were not on MAT, with correspondingly better outcomes on both PTSD and substance use measures.
On the PTSD medication side, SSRIs (sertraline and paroxetine are FDA-approved for PTSD) reduce symptom burden but do not resolve trauma. Prazosin, an alpha-1 blocker, has evidence for reducing trauma-related nightmares specifically. The sequencing principle is: use medication to establish enough stability that the person can tolerate and engage with trauma-focused therapy, then build the therapeutic work on that stable foundation.
The role of medical detox in dual diagnosis care
When physical dependence is present , particularly to alcohol, benzodiazepines, or opioids , medically supervised detox is not optional. It is the necessary first step before any meaningful therapeutic work can begin. Alcohol and benzodiazepine withdrawal carry specific dangers when PTSD is co-occurring: the rebound hyperarousal of withdrawal is dramatically amplified in a nervous system already dysregulated by trauma. Seizure risk is real, and the severity of anxiety and agitation during withdrawal is substantially greater in people with PTSD than in those without it. Attempting to withdraw from alcohol or benzodiazepines at home, without medical monitoring, is genuinely dangerous in this population. Residential detox provides 24-hour medical monitoring, medication protocols to manage withdrawal safely, and the clinical environment to begin stabilization before formal trauma-focused therapy starts.
Levels of care for PTSD and substance abuse treatment in new hampshire
The American Society of Addiction Medicine (ASAM) criteria provide a framework for matching treatment intensity to clinical need. For co-occurring PTSD and substance use disorder, the right level of care depends on the severity of both conditions, the presence of physical dependence, and the stability of your living situation and social support.
Residential treatment
Residential treatment is the appropriate starting point for moderate-to-severe co-occurring presentations. Living on-site means 24-hour clinical support, a structured daily schedule that replaces the chaos of active addiction, and removal from the environmental triggers , people, places, and situations , that activate both PTSD symptoms and substance cravings. For people whose home environment is unsafe, unsupportive, or itself a source of trauma exposure, residential care is not just preferable, it is required. New Hampshire Detox Center in Bethlehem provides residential care that integrates PTSD and substance use treatment from day one rather than treating the addiction first and the trauma later.
Partial hospitalization programs (PHP)
PHP operates typically five to six hours per day, five days per week, with clients returning home or to sober living in the evenings. It is appropriate for people who have completed residential treatment and have a stable living environment, or for those whose symptom severity does not require round-the-clock supervision but exceeds what standard outpatient can address. PHP maintains intensive clinical contact while allowing more independence, which is a meaningful step in rebuilding functional life skills alongside continued trauma-focused work.
Intensive outpatient programs (IOP)
IOP involves roughly nine or more hours of structured treatment per week, typically spread across three sessions. For people managing work or family responsibilities, IOP provides enough clinical intensity to address co-occurring conditions while accommodating outside obligations. It functions as the bridge between PHP and standard outpatient care, maintaining therapeutic momentum while reintegrating daily responsibilities. If you are exploring options across the region, understanding how anxiety, trauma, and substance use are treated in integrated outpatient settings in Grafton County can help you compare what local programs actually offer.
Outpatient and aftercare
Standard outpatient care , typically one to two sessions per week , is appropriate as a step-down after more intensive treatment. Aftercare is not optional, and the data on this is unambiguous: a 2017 study in the Journal of Substance Abuse Treatment found that clients who engaged in continuing care after residential treatment had relapse rates 40% lower than those who did not. Aftercare includes individual therapy, medication management if applicable, peer support, and a specific relapse prevention plan oriented around PTSD triggers.
How to choose the right PTSD and substance abuse treatment program in new hampshire
Not every program that lists “dual diagnosis” on its website actually provides integrated treatment for PTSD and substance use disorder. The term is widely used and inconsistently applied. The practical question is whether the program simultaneously treats both conditions with evidence-based protocols, or whether it treats addiction and refers out for mental health, or treats symptoms without addressing underlying trauma. The distinction matters enormously for outcomes.
Questions to ask before entering treatment
Ask directly: does the program treat PTSD and substance use disorder simultaneously within the same clinical team, or are they addressed in separate tracks? What specific trauma therapies are used , CPT, EMDR, Seeking Safety, or trauma-focused CBT? Are all of these facilitated by clinicians credentialed in trauma treatment, not just general counseling? What is the staff-to-client ratio? Is medication management available on-site, including MAT and psychiatric medication? Is the detox medically supervised, and is the medical team experienced with the complexities of withdrawal in PTSD populations? What is the program’s accreditation status? Programs accredited by The Joint Commission or CARF have met documented standards for clinical quality and safety.
Understanding insurance coverage for dual diagnosis treatment in NH
Commercial insurers including Aetna, Anthem, Cigna, Harvard Pilgrim, and Tufts all cover residential and outpatient dual diagnosis treatment under the Mental Health Parity and Addiction Equity Act, which requires that mental health and substance use disorder benefits be no more restrictive than medical benefits. The practical implication is that residential treatment for co-occurring PTSD and SUD must be covered at the same level as a medical admission of equivalent severity. Tricare covers dual diagnosis residential treatment for eligible veterans and military family members; confirm whether the program is Tricare-authorized before admission.
New Hampshire Medicaid options including WellSense, AmeriHealth Caritas, and Granite State Health Plan all cover substance use disorder and co-occurring mental health treatment. Coverage details vary by plan. To verify your specific coverage, contact your insurer directly with the program’s name, NPI number, and the procedure codes for the level of care you are considering. Reputable programs will assist with benefits verification before admission. If you need help understanding how benefits apply specifically to co-occurring disorders in New Hampshire, the resource at co-occurring disorder treatment options across the state covers the landscape in more detail.
What to expect when you enter treatment
Fear of the unknown is one of the most consistent barriers to treatment entry. Knowing what actually happens during admission and the early days of residential care does not make the process easier emotionally, but it removes the layer of anxiety that comes from imagining a process you have never seen.
The initial assessment and treatment planning process
Admission begins with a comprehensive dual diagnosis assessment. This covers your full trauma history , including childhood adverse experiences, adult trauma exposure, and trauma type , your substance use history including what you use, frequency, quantity, and last use date, a medical evaluation that identifies physical dependence and any co-occurring medical conditions, and mental health screening that assesses PTSD, depression, anxiety, and any other psychiatric presentations. The assessment informs an individualized treatment plan that identifies your specific PTSD symptom clusters, your primary substances and the withdrawal risks involved, and the sequence of interventions appropriate for your situation. Nothing about the plan is generic. The combination of trauma history, substances, and individual circumstances is specific to you, and the treatment plan reflects that.
Building coping skills without substances
Before trauma processing begins in earnest, treatment focuses on building the distress tolerance and emotional regulation skills that will make trauma work possible and safe. Dialectical Behavior Therapy (DBT) skills , particularly distress tolerance techniques such as TIPP (temperature, intense exercise, paced breathing, paired muscle relaxation) and grounding exercises , give you concrete tools to manage acute emotional distress without substances. CPT introduces the concept of noticing and challenging stuck points without requiring full trauma narrative early in treatment. These are not preliminary steps before the “real” treatment starts. They are the foundation that makes everything else work.
Family involvement in dual diagnosis recovery
A 2019 meta-analysis in Family Process analyzing 22 studies found that family involvement in addiction treatment significantly improved both retention and long-term recovery outcomes, with the strongest effect for people with co-occurring mental health conditions. Family members carry secondary trauma from living with someone whose PTSD and substance use have shaped the household. Family therapy and education groups help family members understand how PTSD drives substance use, recognize their own enabling or avoidance patterns without self-blame, and rebuild communication in ways that support rather than undermine recovery. Family involvement is not about fixing blame , it is about making the recovery environment functional enough that it sustains rather than triggers relapse.
Long-term recovery from PTSD and substance abuse
A 2020 longitudinal study in Psychiatric Services followed 800 adults with co-occurring PTSD and substance use disorder over three years. Among those who received integrated treatment, 62% showed clinically significant improvement in both PTSD symptoms and substance use at the three-year mark. Among those who received treatment for one condition only, the improvement rate was 29%. Recovery from co-occurring PTSD and substance use is real and measurable , but it takes integrated treatment and sustained aftercare to achieve.
Recovery is not defined only by abstinence. The functional markers that matter are: sleeping without being regularly disrupted by nightmares or hyperarousal, engaging in relationships without the emotional detachment or irritability that alienates people, maintaining employment or educational involvement, and managing stressful situations without substance use or PTSD symptom escalation. Those are achievable outcomes. They take time and clinical support, but they are the norm for people who access adequate integrated treatment.
Relapse prevention for co-occurring PTSD and SUD
The relapse triggers for people with co-occurring PTSD are more specific and more predictable than generic “high-risk situations.” Trauma anniversaries , dates associated with the traumatic event , reliably increase PTSD symptom intensity and substance craving. Sensory cues that mirror the trauma environment (a smell, a sound, a visual similarity) can activate the trauma response before conscious recognition occurs. Interpersonal conflict, particularly conflict that involves loss of control or perceived threat, activates hyperarousal that closely mirrors the original trauma state.
The early warning signs of PTSD symptom escalation that precede substance use relapse include increased nightmare frequency, sleep disruption returning after a period of stability, emotional withdrawal from close relationships, and the return of hypervigilance in situations that had previously become manageable. Identify your personal early warning signs in treatment and create a specific written plan for what you do when they appear , who you contact, what skills you use, and at what point you re-engage with a clinical provider. That plan is the one concrete relapse prevention action to complete before leaving any level of care.
Peer support and community resources in new hampshire
NAMI New Hampshire offers peer-to-peer support, education programs, and connection to local resources across the state, including northern counties. The NH Recovery Hub connects people in recovery with peer support specialists, recovery coaches, and community programs organized by county. For veterans, the NH Office of Veterans Services coordinates with VA-affiliated peer support programs specifically designed for veterans in recovery from PTSD and substance use disorder. Peer support specialists with lived experience of co-occurring conditions are meaningfully different from general case managers: they know the terrain from the inside and provide a kind of credibility that clinical support alone cannot offer.
Taking the first step toward treatment in new hampshire
A 2019 study in JAMA Psychiatry found that every month of delay between the onset of a substance use disorder and treatment entry is associated with measurably worse outcomes, including higher severity at presentation and longer time to stable recovery. The research on treatment engagement is unambiguous: earlier entry produces better results. The fear of treatment , fear of withdrawal, fear of confronting trauma, fear of what you will discover about yourself, fear of stigma , is real, but it is not a reason to delay. It is a reason to enter a treatment environment equipped to address those fears clinically.
If you are in northern New Hampshire or traveling from elsewhere in the state, a first step that can happen today is calling for a clinical assessment. That call is not a commitment to admission; it is a conversation that establishes what level of care fits your situation and whether the program is equipped to treat the combination of conditions you are dealing with. If you are reaching out on behalf of a family member, the same call starts the process of understanding what treatment would look like and how to help your loved one access it. For context on how depression and other co-occurring conditions are treated alongside addiction in New Hampshire, that resource covers the broader landscape of integrated care options in the state.
The one action available to you right now: call for a clinical assessment. Not a tour, not a commitment , an assessment. That is the move that begins everything else.
Frequently asked questions
Can PTSD and substance use disorder be treated at the same time, or does one have to come first?
They are treated simultaneously in an integrated program. The old sequential approach , treating addiction first, then PTSD , has been largely replaced by integrated models because treating one without the other dramatically increases relapse risk. PTSD symptoms drive substance use, and substance use amplifies PTSD symptoms. Addressing both within the same treatment plan, with a coordinated clinical team, is the standard of care supported by SAMHSA, NIDA, and the VA.
How long does dual diagnosis residential treatment typically take in new hampshire?
Residential treatment for co-occurring PTSD and substance use disorder typically runs 30 to 90 days, depending on the severity of both conditions, the substances involved, and the complexity of the trauma history. Medical detox, when needed, usually spans five to ten days and precedes formal residential treatment. Many people then step down to PHP or IOP for continued structured support. There is no universal timeline; your treatment plan determines the appropriate length.
Does insurance cover dual diagnosis treatment in new hampshire?
Yes. Under the Mental Health Parity and Addiction Equity Act, commercial insurers , including Aetna, Anthem, Cigna, Harvard Pilgrim, and Tufts , are required to cover dual diagnosis treatment at parity with medical benefits. Tricare covers residential and outpatient dual diagnosis treatment for eligible veterans and military family members. New Hampshire Medicaid plans, including WellSense, AmeriHealth Caritas, and Granite State Health Plan, also cover co-occurring disorder treatment. The specifics of your coverage depend on your plan; call your insurer or ask the treatment program to verify benefits before admission.
What makes dual diagnosis treatment different from standard addiction treatment?
Standard addiction treatment focuses primarily on the substance use: detox, recovery skills, relapse prevention, and peer support. Dual diagnosis treatment adds trauma-specific assessment and therapy , CPT, EMDR, Seeking Safety, trauma-focused CBT , delivered by clinicians credentialed in both addiction and trauma treatment. The clinical team actively coordinates between the psychiatric and addiction dimensions of your care rather than treating them as separate problems. Without that coordination, PTSD symptoms go untreated and become the primary driver of relapse.
Is it safe to go through detox when you also have PTSD?
Medically supervised detox is specifically safer for people with PTSD than attempting withdrawal at home. PTSD dysregulates the same neurological systems , primarily the stress response and the autonomic nervous system , that become severely activated during alcohol and benzodiazepine withdrawal. Medical detox provides 24-hour monitoring, medication protocols to control withdrawal severity and prevent complications, and clinical support to manage the amplified anxiety and hyperarousal that PTSD produces in the withdrawal period. Home withdrawal from alcohol or benzodiazepines when PTSD is present carries genuine medical risk.
How do I know if a treatment program in new hampshire actually specializes in dual diagnosis, not just lists it as a service?
Ask specific questions. Does the program have clinicians credentialed in trauma-focused therapies (CPT, EMDR, Seeking Safety)? Are PTSD and substance use disorder addressed in the same sessions and by the same clinical team, or referred to separate providers? Does the program use a validated trauma assessment tool at intake? What is the staff-to-client ratio for individual therapy? Programs that provide clear, specific answers to those questions are equipped to deliver integrated care. Programs that respond with vague assurances that they treat “the whole person” without naming specific protocols warrant further scrutiny.
