Questions remain regarding the most ideal form of trauma-focused treatment for patients with PTSD and a substance use disorder. Variant forms of trauma-focused treatment may yield more favorable outcomes based on, for example, the type of trauma or length of time since trauma, and research in this area is needed to help guide treatment decisions. The Hien et al. study delivered Seeking Safety, a cognitive behavior therapy that addresses trauma in the present tense and teaches coping skills to help prevent substance use and manage PTSD symptoms as well as develop effective communication skills. A prior Stage IA trial utilized Prolonged Exposure to address trauma among patients with PTSD and cocaine dependence (6). The findings also demonstrated that integrated treatment leads to significant improvements in PTSD and substance use disorder symptoms as well as depression and psychiatric symptoms. Despite the fact that Prolonged Exposure is the gold standard treatment for PTSD and was the only psychosocial treatment deemed effective by the Institute of Medicine for PTSD (7), it is likely to receive the most resistance from therapists and researchers. Prolonged Exposure is a technique that involves two main treatment components: 1) in vivo exposure, in which patients repeatedly confront anxiogenic situations that are safe but that have been avoided because the situations remind them of the trauma, and 2) imaginal exposure, in which patients repeatedly recount the traumatic event during therapy in order to extinguish conditioned responses of fear. By approaching these avoided people, places, things, and memories, the limitations on patients' lives are substantially lessened (e.g., a patient who experienced a traumatic car accident can now drive again) and patients are not as "undone" by memories of the trauma (e.g., the patient can talk about what happened without becoming overwhelming upset). In addition to the Brady et al. study (6), two small studies have used either in vivo or imaginal exposure techniques to address PTSD among substance use disorder patients, and the results of both studies were positive (8, 9). Also, several randomized clinical trials of an integrated, exposure-based PTSD-substance use disorder psychotherapy called COPE (Concurrent treatment with Prolonged Exposure), which is based on the early work by Brady et al. and uses both in vivo and imaginal exposure, are underway and preliminary results appear promising (10).