Co-occurring posttraumatic stress disorder and substance use disorder (PTSD/SUD) is a serious public health issue affecting millions. Compared to White people, people of color endure more chronic and severe cases of PTSD/SUD due to their heightened exposure to common risk factors (i.e., interpersonal violence) and to unique risk factors (i.e., racial discrimination) associated with the disorder. Despite this, they are significantly and systematically underrepresented in PTSD/SUD clinical research. There is also a lack of research on culturally tailored treatments for people of color and on addressing their unique issues. Consequently, current treatments may not meet their needs, which may explain their high treatment dissatisfaction and dropout rates. This qualitative study sought to address this gap by determining whether and how race and gender matters are relevant to PTSD/SUD and how clinics and clinicians' handling of these matters impact people of color’s therapeutic experience. We found that oppression significantly contributes to PTSD/SUD incidence, exposure to discrimination exacerbates PTSD/SUD symptoms, and people of color wanted to address these issues in therapy. We also found that people of color seldom noted visible representation of staff of color in clinics and encountered discrimination from clinic staff. This made them feel unwelcome in clinics. Further, when people of color attempted to address matters of oppression and discrimination in therapy, clinicians invalidated their experiences or were underprepared to address them. This ruptured the client-therapist therapeutic alliance and made people of color either seek a new therapist or terminate treatment altogether. Our findings demonstrate the necessity of fostering a health equity focus in PTSD/SUD research so clinics and clinicians can address matters of oppression and discrimination appropriately.
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