Table 4.

Challenges in treating adolescents with PTSD+SUD

Item	M	SD
Overall difficulty treating
PTSD+SUD dual diagnosis (n=132)	1.44	1.01
SUD alone (n=109)	1.25	1.09
Self-harm behaviors (n=129)	1.09	0.84
Risky sexual behaviors (n=129)	1.04	0.81
PTSD alone (n=128)	0.59	0.77
Depression (n=133)	0.56	0.79
Specific difficulties
Case management	1.24	0.93
Clients’ dependency	1.22	0.84
Clients’ self-harm	1.12	0.81
Working with clients’ parents and families	1.12	0.90
De-escalating clients (e.g., when dissociating or agitated)	1.03	0.80
Clients’ anger	0.99	0.83
Relationship problems	0.92	0.81
Not knowing how to work with these clients	0.90	0.76
Prioritizing treatment components or goals	0.82	0.78
Hearing painful details of trauma	0.81	0.75
Deciding what kind of treatment approach to use	0.79	0.76
HIV/AIDS	0.74	0.86
Counter-transference toward these clients	0.63	0.64
Setting boundaries	0.56	0.70
Clients’ crying/sadness	0.56	0.73

Note. Each item rated on a 0–3 scale: 0=not at all, 1=somewhat, 2=moderately, 3=a great deal.