Importance: Trauma-focused treatments are effective for posttraumatic stress disorder (PTSD) but are rarely offered to patients with comorbid substance use disorder. Research suggests gender-based differences in prevalence and treatment needs for these patients, but treatment trials have mainly included men.

Question: Will integrated trauma-focused psychological treatment lead to greater reductions in posttraumatic stress disorder (PTSD) symptom severity and alcohol use than usual treatment for alcohol use disorder (AUD) in women?

Findings: In this randomized clinical trial of 90 women receiving outpatient addiction services, integrated treatment significantly reduced PTSD symptom severity more than relapse prevention (usual treatment for AUD). Self-reported alcohol use also decreased, with no detectable differences between the treatment arms.

Meaning: The findings suggest that PTSD can be safely and effectively treated using integrated treatment in women with AUD and ongoing alcohol use.