This much-needed manual presents the first empirically studied, integrative treatment approach developed specifically for PTSD and substance abuse. For persons with this prevalent and difficult-to-treat dual diagnosis, the most urgent clinical need is to establish safety-to work toward discontinuing substance use, letting go of dangerous relationships, and gaining control over such extreme symptoms as dissociation and self-harm. The manual is divided into 25 topics, each of which forms the basis for one or more sessions. Covering a range of cognitive, behavioral, and interpersonal issues, topics include highly practical tools and techniques to engage patients in treatment; teach "safe coping skills" that apply to both disorders; and restore ideals that have been lost, including respect, care, protection, and healing. Structured yet flexible, sessions can be conducted in any order and in a range of settings. The volume is designed for maximum ease of use with a large-size format and helpful reproducible handouts and forms.