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This 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 specific units or topics, addressing a range of different cognitive, behavioral, and interpersonal domains. Each topic provides 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, topics can be conducted in any order and in a range of different formats and settings. The volume is designed for maximum ease of use with a large format, lay-flat binding, and helpful reproducible therapist sheets and handouts.