Treating PTSD and Cannabis Dependence Together After Sexual Assault

Case series of three emerging adult women (ages 19–25) who experienced recent sexual assault and met criteria for PTSD and problematic cannabis use. Treatment: STEPS protocol combining Written Exposure Therapy with cognitive-behavioral substance use skills training. No control group or comparison condition.

Sexual assault is one of the most common causes of PTSD, and cannabis use disorder frequently co-occurs with trauma in young adults. Most treatment protocols require addressing one condition before the other, which means patients often fall through the cracks. An integrated, brief approach that works soon after trauma could fill a significant gap—but this case series is only the very first step toward testing that idea.

This sits within the broader PTSD-cannabis literature that includes RTHC-00125 (cannabis and trauma exposure in veterans) and RTHC-00127 (PTSD as a predictor of cannabis use disorder). The self-medication hypothesis—that people use cannabis to manage trauma symptoms—is well-documented but creates a clinical paradox: the substance that provides short-term relief may worsen long-term outcomes. Integrated treatments that address both simultaneously could break this cycle.

Three participants with no control group—this is hypothesis-generating, not evidence of efficacy. No long-term follow-up reported. All participants were young women after sexual assault; results may not generalize to other trauma types, demographics, or genders. The improvements could reflect natural recovery, placebo effects, or regression to the mean.