Service provider perspectives on treating adolescents with co-occurring PTSD and substance use: challenges and rewards Emma Louise Barrett, Zachary W. Adams, Erin V. Kelly, Natalie Peach, Rachel Hopkins, Bronwyn Milne, Sudie E. Back and Katherine L. Mills Abstract Purpose – Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) frequently co-occur (PTSD+SUD). The onset of these disorders often occurs during adolescence. There is limited understanding of the perspectives of service providers working with this population. The purpose of this paper is to identify the practices, attitudes, experiences and training needs of Australian service providers treating adolescents with PTSD+SUD. Design/methodology/approach – Service providers in Australia were invited to complete an anonymous online survey regarding their experiences working with adolescents who have PTSD+SUD. Ninety participants completed the 48-item survey that comprised multiple choice and open-ended questions. Findings – Service providers estimated that up to 60 per cent of their adolescent clients with PTSD also have SUD. They identified case management, engaging with caregivers and difficult client emotions as specific challenges associated with working with this population. Despite this, providers rated treating PTSD+SUD as highly gratifying for reasons such as teaching new coping skills, developing expertise and assisting clients to achieve their goals. There were mixed perspectives on how to best treat adolescents with PTSD+SUD, and all participants identified a need for evidence-based resources specific to this population. Originality/value – This is the first survey of Australian service providers working with adolescents who experience PTSD+SUD. The findings improve our understanding of the challenges and rewards associated with working with this population, and provide valuable information that can enhance clinical training and guide the development of new treatment approaches for this common and debilitating comorbidity. Keywords Alcohol, Adolescents, Substance use disorders, PTSD, Trauma, Drugs Paper type Research paper Introduction The common co-occurrence of post-traumatic stress disorder (PTSD) and substance use disorders (SUD) has been consistently highlighted in epidemiological studies (Goldstein et al., 2016; Kilpatrick et al., 2000; Mills et al., 2006) and studies of clinical samples around the world (Back et al., 2006; Brady et al., 2004; Dore et al., 2012; Ouimette et al., 2010). These debilitating disorders tend to have their onset during adolescence (Ford et al., 2009; Nooner et al., 2012). It is estimated that up to 50 per cent of adolescents with PTSD have co-occurring SUD (Nooner et al., 2012), and among those with SUD, 70 per cent have experienced trauma and 35 per cent have PTSD (Deykin and Buka, 1997; Giaconia et al., 2000; Kilpatrick et al., 2003; Lubman et al., 2007). The common co-occurrence of PTSD and SUD (PTSD+SUD) is of significant concern, given that these disorders are associated with poor clinical and developmental outcomes, including significant functional and structural brain abnormalities during adolescence (Brady and Back, 2012; Hall et al., 2016; Marusak et al., 2015). Adolescents who develop PTSD and/or SUDs exhibit significantly greater internalising and externalising problems including academic and vocational impairment, anxiety, depression, suicidality, poorer physical health, family and social Received 20 July 2019 Revised 10 September 2019 Accepted 11 September 2019 Emma Louise Barrett is based at the University of New South Wales, Sydney, Australia. Zachary W. Adams is based at the Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA. Erin V. Kelly, Natalie Peach and Rachel Hopkins are all based at the University of New South Wales, Sydney, Australia. Bronwyn Milne is based at the Sydney Children’s Hospital Network, Sydney, Australia. Sudie E. Back is based at the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Columbia, South Carolina, USA. Katherine L. Mills is based at the University of New South Wales, Sydney, Australia. DOI 10.1108/ADD-07-2019-0005 VOL. 12 NO. 4 2019, pp. 173-183, © Emerald Publishing Limited, ISSN 1757-0972 j ADVANCES IN DUAL DIAGNOSIS j PAGE 173