Interdisciplinary Issues at the Intersection of Assessing and Treating Substance Use Disorders and Post Traumatic Stress Disorder: Clinical Social Work and Clinical Behavioral Analysis with Veterans


  • Monica M. Matthieu Saint Louis University
  • Alyssa Wilson
  • Robert W. Casner



Post traumatic stress disorder, substance-related disorders, gambling, veteran, United States Department of Veterans Affairs, social work, behavioral disciplines and activities


Veterans and military personnel may be at higher risk for developing addictions due to increased prevalence rates of co-occurring mental health disorders including posttraumatic stress and substance abuse disorders. However, clinicians may feel unprepared to assess and to treat these co-occurring disorders, especially when it includes a behavioral addiction such as gambling. Clinical social work and clinical behavior analysis are two fields with complementary interdisciplinary approaches that can lead to improved client-centered outcomes. Yet, limited evidence exists to guide interdisciplinary treatment teams in effective treatment of gambling addictions and Post Traumatic Stress Disorder (PTSD). The current article provides an interdisciplinary treatment model to assist clinicians in selecting appropriate evidence-based assessments and treatments. A case example focuses on the use of assessment tools and treatment approaches drawn from recommendations from best practice guidelines for veterans. Finally, resources related trauma and addictions are presented.

Author Biography

Monica M. Matthieu, Saint Louis University

Assistant Profesor, School of Social Work, College for Public Health and Social Justice, Saint Louis University and Research Social Worker, Mental Health Service, Central Arkansas VA Healthcare System.


American Psychiatric Association [APA]. (2015). Diagnostic and statistical manual of mental disorders (6th ed.). Washington, DC: Author.

Association for Behavior Analysis International. (2017). What is Behavioral Analysis? Retrieved from:

Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C.A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behavior Research and Therapy, 34, 669-673

Bolen, D. W, & Boyd, W. H. (1968). Gambling and the gambler: A review and preliminary findings. Archives of General Psychiatry, 18, 617-630. doi:

Bush K., Kivlahan, D. R., McDonell M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Archives of Internal Medicine, 158, 1789-1795. doi:

Casey, L. M., Oei, T. P., Raylu, N., Horrigan, K., Day, J., Ireland, M., & Clough, B. A. (2017). Internet-based delivery of cognitive behaviour therapy compared to monitoring, feedback and support for problem gambling: A randomised controlled trial. Journal of Gambling Studies [online], 1-18. doi:

Cowlishaw, S., Merkouris, S., Dowling, N., Anderson, C., Jackson, A., & Thomas, S. (2012). Psychological therapies for pathological and problem gambling. The Cochrane Database of Systematic Reviews, 11CD008937. doi:

Department of Veterans Affairs, Department of Defense [DVA/DoD]. (2015). DVA/DoD Clinical Practice Guideline for Management of Substance Use Disorder: Guideline Summary (ver.3.0). Office of Quality and Performance. Washington DC: Author.

Department of Veterans Affairs, Department of Defense [DVA/DoD]. (2017). DVA/DoD Clinical Practice Guideline for Post Traumatic Stress Disorder and Acute Stress Reaction. (ver. 3.0). Office of Quality and Performance. Washington DC: Author.

Dixon, M. R., & Johnson, T. E. (2007). The gambling functional assessment (GFA): An assessment device for identification of the maintaining variables of pathological gambling. Analysis of Gambling Behavior, 1(1), 44-49.

Dixon, M. R., Wilson, A. N., & Habib, R. (2016). Empirical research: Neurological evidence of acceptance and commitment therapy effectiveness in college-age gamblers. Journal of Contextual Behavioral Science, 5(2), 580-588. doi:

Dixon, M. R., Wilson, A. N., Belisle, J., & Schreiber, J. (under review). Assessing the construct validity of the gambling functional assessment. The Psychological Record.

Edens, E., & Rosenheck, R. (2012). Rates and correlates of pathological gambling among VA mental health service users. Journal of Gambling Studies, 28(1), 1-11. doi:

Emshoff, J., Gilmore, D., & Zorland, J. (2010). Veterans and problem gambling: A review of the literature. Georgia State University. Retrieved from

Gebauer, L., LaBrie, R. A., & Shaffer, H. J. (2010). Optimizing DSM-IV-TR classification accuracy: A brief bio-social screen for detecting current gambling disorders among gamblers in the general household population. Canadian Journal of Psychiatry, 55(2), 82-90. doi:

Gooding P.A. & Terrier. N., (2009). A systematic review and meta-analysis of cognitive-behavioural interventions to reduce problem gambling: Hedging our bets? Behaviour Research and Therapy, 47, 592-607 doi:

Karlin, B. E., Ruzek., J. I., Chard, K. M., Eftekhari, A., Monson, C. M., Hembree, E. A., . . . Foa, E. B. (2010). Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration. Journal of Traumatic Stress, 23, 663-673. doi:

Kessler, R. C., Hwang, I., Labrie, R., Petukhova, M., Sampson, N. A., Winters, K. C., . . . (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychological Medicine, 38, 1-10. doi:

Ledgerwood, D., & Milosevic, A. (2015). Clinical and personality characteristics associated with post-traumatic stress disorder in problem and pathological gamblers recruited from the community. Journal of Gambling Studies, 31(2), 501-512. doi:

Ledgerwood, D. M., & Petry, N. M. (2006). Posttraumatic stress disorder symptoms in treatment-seeking pathological gamblers. Journal of Traumatic Stress, 19, 411-416. doi:

Lesieur, R., & Blume, S. (1987). The South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers. American Journal of Psychiatry, 144, 1184-1188. doi:

Lopez-Viets, V. C., & Miller, W. R. (1997). Treatment approaches for pathological gamblers. Clinical Psychology Review, 17, 689-702

Maynard, B. R., Wilson, A. N., Labuzienski, E., & Whiting, S. W. (2015). Mindfulness-based approaches in the treatment of disordered gambling: A systematic review and meta-analysis. Research on Social Work Practice [online]. doi:

National Association of Social Workers [NASW]. (1989). NASW Standards for the Practice of Clinical Social Work. Washington, DC: NASW Press.

Newhouse, J. (2013). Vets vulnerable to gambling addictions. Psychology Today. Retrieved from:

Pallesen, S., Mitsem, M., Kvale, G., Johnsen, B., & Molde, H. (2005). Outcome of psychological treatments of pathological gambling: a review and meta-analysis. Addiction, 100, 1412-1422. doi:

Petry, N. M. (2009). Disordered gambling and its treatment. Cognitive and Behavioral Practice, 16(4), 457-446. doi:

Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 66, 564-574. doi:

Petry, N. M., & Steinberg, K. L. (2005). Childhood maltreatment in male and female treatment-seeking pathological gamblers. Psychology of Addictive Behaviors, 19, 226-229. doi:

Prins, A., Ouimette, P., Kimerling, R., Cameron, R. P., Hugelshofer, D. S., Shaw-Hegwer, J…Sheikh, J. I. (2003). The Primary Care PTSD Screen (PC-PTSD): Development and operating characteristics. Primary Care Psychiatry, 9, 9-14. doi:

Prins, A., Bovin, M.J., Smolenski, D.J., Marx, B. P., Kimerling, R., Jenkins-Guarnieri, M. A. . . . Tiet, Q. Q. (2016). The primary care PTSD screen for DSM-5 (PC-PTSD-5): Development and evaluation within a veteran primary care sample. Journal of General Internal Medicine, 31(10), 1206-1211. doi:

Raylu, N., & Oei, T. P. (2002). Pathological gambling. A comprehensive review. Clinical Psychology Review, 22, 1009-1061. doi:

Substance Abuse and Mental Health Services Administration [SAMHSA]. (2016). SBIRT: Screening, brief intervention, and referral to treatment. Retrieved from

SAMHSA-HRSA Center for Integrated Health Solutions. (n.d.). AUDIT-C – Overview. Retrieved from:

SAMHSA-HRSA Center for Integrated Health Solutions. (n.d.). Screening tools: DAST-10. Retrieved from:

Skinner H. (1982). The Drug Abuse Screening Test. Addictive Behaviors, 7, 363-371. doi:

Taber, J. I., McCormick, R. A., & Ramirez, L. F. (1987). The prevalence and impact of major life stressors among pathological gamblers. International Journal of the Addictions, 22, 71-79. doi:

U.S. Department of Veterans Affairs [DVA]. (2008). VHA Handbook 1160.01 Uniform Mental Health Services in VA Medical Centers and Clinics. Washington, D.C.: Author.

U.S. Department of Veteran Affairs: National Center for PTSD [NC-PTSD]. (2016). Primary care PTSD screen (PC-PTSD). Retrieved from

Volberg, R. A., & Williams, R. J. (2011). Developing a brief problem gambling screen using clinically validated samples of at-risk, problem and pathological gamblers. Report to the Alberta Gaming Research Institute. Retrieved from:

Whiting, S. W., Potenza, M. N., Park, C. L., McKee, S. A., Mazure, C. M., & Hoff, R. A. (2016). Investigating veterans’ pre-, peri-, and post-deployment experiences as potential risk factors for problem gambling. Journal of Behavioral Addictions 5(2), 213-220. doi:

Wilson, A. N., & Matthieu, M. M. (2015). Clinical application of behavior analytic social work practice. In H. S. Roane, J. L. Ringdahl, & T. S. Falcomata (Eds.), Clinical and organizational applications for applied behavior analysis (pp. 501-522). London: Elsevier.