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Patients with posttraumatic stress disorder (PTSD) and substance abuse (SA–PTSD) diagnoses were compared with patients with only substance use diagnoses (SA only) and those with substance abuse and Axis I psychiatric diagnoses other than PTSD (SA–PSY) on outcomes 1 year after substance abuse treatment. At follow-up, patients with PTSD reported more problems that directly resulted from substance use, had more psychological distress, and reported less support from friends than both SA-only and SA–PSY patients. SA–PTSD patients were less likely to be employed and more likely to be readmitted for inpatient/residential treatment during the follow-up than SA-only patients. The effect of PTSD on 1-year problems from substance use was partially mediated by greater use of emotional discharge coping, having more positive expectancies regarding substance use, and expecting fewer benefits from quitting. Expecting fewer benefits from quitting partially explained the relationship between PTSD and 1-year friend support.