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Brief Treatment and Crisis Intervention Advance Access originally published online on July 12, 2006
Brief Treatment and Crisis Intervention 2006 6(3):248-254; doi:10.1093/brief-treatment/mhl005
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© The Author 2006. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:

Original Article

Present- Versus Past-Focused Therapy for Posttraumatic Stress Disorder/Substance Abuse: A Study of Clinician Preferences

   Lisa M. Najavits, PhD

From the National Center for PTSD, VA Boston Healthcare System, and Boston University School of Medicine

Contact author: Lisa M. Najavits, Research Psychologist, National Center for PTSD, VA Boston Healthcare System (116B-3), 150 South Huntington Avenue, Boston, MA 02130. E-mail: lnajavits{at}

This study explored clinicians' views on present- versus past-focused posttraumatic stress disorder (PTSD) treatments for clients with the dual diagnosis of substance-use disorder (SUD) and PTSD. Clinicians (N = 133) attending a professional workshop were administered a questionnaire on the relative appeal and importance of each type of treatment, parameters for administering them (e.g., group vs. individual format), and whether clients' abstinence from substances was necessary. Clinicians' personal and professional characteristics were also measured and related to their views of the treatments. Results indicated consistently greater endorsement for present- than for past-focused PTSD treatment but clear interest in both modalities and their combination. A majority believed they could treat PTSD/SUD clients but also believed that clients need to be abstinent before engaging in past-focused PTSD treatment. Clinician characteristics associated with lower ratings of past-focused treatment included length of clinical experience, higher degree of burnout, and mental health as a primary work setting. Relatively higher ratings of past-focused treatment were found among clinicians who had a personal history of trauma and/or SUD and were from a substance-abuse primary work setting. Discussion includes methodological limitations of this study and directions for future research.

KEY WORDS: therapy, PTSD, substance abuse, clinician

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