Integrated Treatment for Opioid Use Disorder and PTSD

Inclusion Criteria: * Any gender; any race or ethnicity; aged 18-70 years old. * English-speaking * Meet DSM-5 diagnostic criteria for OUD. * Meet DSM-5 diagnostic criteria for PTSD and have some memory of their index traumatic event. * Must be maintained on a stable dose of medication for OUD for at least 1 month. * Participants taking psychotropic medications will be required to be maintained on a stable dose for at least 1 month before study initiation. Exclusion Criteria: * Participants presenting with psychiatric contraindications (e.g., unmanaged psychosis or mania, or bipolar) will be excluded and referred clinically. * Participants considered an immediate suicide risk, with current suicidal ideation and a plan of intent, or displaying other high-risk behaviors (i.e., MOUD refusal, risky fentanyl use, etc.), as determined by the PI and study team. These individuals will complete a safety plan and be referred for treatment. * Participants meeting DSM-5 criteria for a concurrent, non-opioid, substance use disorder and who report that the other substance is their primary substance of use. These participants will be referred clinically for treatment. * Participants enrolled in ongoing evidence-based psychotherapy for substance use disorders or PTSD outside of medications for OUD and standard psychotherapy groups in treatment programs. * Medical problems requiring immediate and intensive treatment, such as unstable or symptomatic end stage liver disease.