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Experimental studies exploring functional relations between posttraumatic stress disorder and substance use disorder.

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Reviews experimental studies exploring functional relations between posttraumatic stress disorder (PTSD) and substance use disorder. Specifically, this chapter reviews relevant laboratory findings, presents a model for understanding the mechanisms of action of drugs of abuse on PTSD symptoms, points out gaps in the literature to date, and makes suggestions for future laboratory-based experimental research. Review of several studies that used experimental methods to identify biological factors and brain structures that are implicated in the etiology of PTSD also shed light on the mechanisms of action of drugs that are often abused by individuals with PTSD (i.e., alcohol, benzodiazepines, and opioids). The model presented in this chapter also provided a framework for understanding how the use of alcohol and prescription depressant drugs could interfere with recovery from PTSD by interfering with the integration of the traumatic event into a contextually based system of memories and beliefs. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Substance use disorder (SUD) and posttraumatic stress disorder (PTSD) are highly comorbid: adults with SUDs are 2.6 to 10.8 times more likely to have PTSD than those without one [1][2][3][4]. The prevalence of experiencing at least one traumatic event in people seeking treatment for substance use is approximately 90%, and most have been exposed to multiple traumas [5,6]. ...
... Some staff (n = 5), but not clients, additionally spoke about the relationship between trauma and substance use where PTSD has caused further substance use, substance use leading to exposure to dangerous environments and substance use exacerbating PTSD symptoms [2,4,45]. ...
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Introduction: Comorbid posttraumatic stress disorder (PTSD) is prevalent among people seeking residential treatment for substance use disorders (SUD). We examined client and staff perceptions of the relationship between trauma and SUDs, and the integration of trauma-informed care (TIC) and specialist-delivered treatment for PTSD in residential alcohol and other drug (AOD) treatment facilities. Methods: Individual semi-structured interviews were conducted with frontline staff (n = 20) and clients (n = 18) in two residential AOD treatment facilities in Queensland, Australia. Interviews were audio recorded, transcribed and shared client and staff data was analysed using thematic analysis. Results: Major staff and client themes emerged: PTSD was perceived as an underlying cause of SUD, where AOD is used to cope with and avoid PTSD and related symptoms (Theme 1). Residential facilities were perceived to provide a safe and supportive environment for clients (Theme 2). Psychoeducation on SUD and PTSD was also highlighted to normalise experiences associated with comorbid SUD/PTSD and promote help-seeking pathways for specialist PTSD treatment. Concurrent treatment of SUD and PTSD in the residential setting was sought after and was perceived to enhance treatment outcomes (Theme 3). Staff saw the need for implementing TIC into the organisation and perceived TIC as a multi-faceted and consistent approach of service delivery. Discussion and conclusions: Both clients and staff perceive comorbid SUD/PTSD as a challenge in residential treatment, that may be overcome through integrating TIC and PTSD treatment in residential treatment facilitates for substance use. Organisational and practical implications are discussed.
... Алкоголь сприймається як копінг для подолання негативних емоцій [7; 30]. Тривожність визначає чутливість до анксіолітичного ефекту алкоголю, шляхом модуляції рецепторів гама-аміномасляної кислоти (ГАМК) [8]. Подальші дослідження також вказали на зв'язок тривожності та зловживання канабісом [17]. ...
... Імпульсивність повязана з ризиком розвитку залежності у підлітковому віці [24]. Вираженість імпульсивності асоціюють з діяльністью серотонінової системи 5-HT, що забезпечує процеси саморегуляції [8]. ...
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У статті представлені результати перекладу та адаптації методики SURPS «Шкала ризику розвитку залежності від психоактивних речовин» російською мовою. Чотири субшкали методики, що відповідають чотирьом добре теоретично обґрунтованим конструктам — «депресивність», «тривожність», «імпульсивність», «пошук стимуляції». Вираженість цих рис на особистісному рівні асоційована з ризиком розвитку залежності від психоактивних речовин та прогнозує можливий вибір психоактивної речовини та етіологію залежності, спираючись на наявну особистісну мотивацію. Представлені кофіцієнти надійності для шкал за методами Альфа Кронбаха та Лямбда 2. За допомогою методу xi-квадрат на результатах вибірки проілюстрована можливість окремих питань-індикаторів передбачити приналежність досліджуваних до когорти без діагностованої залежності або до когорти з діагностованою залежністю. Відповідність оригінальної факторної моделі шкали SURPS емпірично виявленим на російськомовних досліджуваних закономірностям встановлена та модифікована за допомогою методу конфірматорного факторного аналізу.
... Recent laboratory-based work supports and extends those findings, demonstrating that trauma-relevant cues (e.g., via script-driven imagery) not only reliably elicit physiological reactivity, but also an increased desire to drink alcohol (Chaplin, Hong, Bergquist, & Sinha, 2008;Chaplin et al., 2010;Coffey et al., 2002;Coffey, Staiewicz, Hughes, & Brimo, 2006;Coffey et. al, 2010;Conrod & Stewart, 2003;Saladin et al., 2003;Sinha et al., 2009). However, much of the research evaluating the influence of trauma cues on desire to drink has utilized guided-or script-driven imagery (e.g., Coffey et al., 2010;Pitman, Orr, & Steketee, 1989). ...
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Introduction Alcohol consumption on college campuses is a major public health concern. Extant literature has identified trauma exposure as a robust risk factors for problematic alcohol use in this at-risk population. However, the mechanisms underlying this association are less well-studied. Research indicates that bodily arousal is a fundamental feature of trauma exposure, and posits that internal stimuli (e.g., heart pounding) at the time of trauma may manifest into conditioned cues that can trigger posttraumatic responding and related symptomatology, including alcohol use. However, past work supporting these assertions have used paradigms purposefully designed to evoke memories of the trauma, making it difficult to ascertain whether the mechanism driving subsequent alcohol craving is the explicit memory cue or the associated bodily arousal. Methods The current study examined whether an implicit, trauma-relevant cue of bodily arousal (via voluntary hyperventilation) – independent of any explicit memory cue – would elicit increased desire to drink among 104 (Mage = 20.30; 61.5% female) trauma-exposed undergraduates. Results Results found no statistically significant difference in change in alcohol craving between the hyperventilation and control tasks. However, secondary analyses indicated that trauma type (i.e., interpersonal/non-interpersonal) may play an influential role this relationship; more specifically, individuals reporting interpersonal trauma as their most traumatic event evidenced a significantly greater increase in desire to drink following hyperventilation compared to the non-interpersonal index trauma group. Discussion Generally, these findings suggests that bodily arousal may only serve as an implicit, trauma-relevant interoceptive cue that increases desire to drink within a specific subset of trauma-exposed college students (i.e., individuals indexing interpersonal trauma). Replication and extension are needed to further understand the influence of bodily arousal on subsequent alcohol use behavior, which will be critical to PTSD-alcohol use modeling and, ultimately, help in informing prevention- and treatment-oriented intervention efforts aimed at reducing problematic alcohol use on college campuses.
... There is evidence that compared to those with SUD only, patients with a dual diagnosis of SUD and PTSD are at higher risk of developing additional psychological problems (depression, anxiety) and neuropsychological impairments (Blanco et al., 2013). This comorbidity is also associated with poorer treatment outcomes, suicidality, longer duration of substance use and more episodes of treatment (Bowe and Rosenheck, 2015;Flanagan et al., 2016;Kaier et al., 2014;Ouimette et al., 1998) Several hypotheses have been put forward to explain the mechanisms that underlie the frequent comorbidity (Conrod and Stewart, 2003;Kramer et al., 2013). Probably the most seminal theoretical account for this phenomenon has been self-medication hypothesis (SMH) according to which individuals with PTSD symptoms use addictive substances to cope with their distress arriving from PTSD symptoms (Khantzian, 1997). ...
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Background Substance use disorder (SUD) and posttraumatic stress disorder (PTSD) are highly comorbid. Self-medication hypothesis (SMH) is a seminal theory aiming to account for the relationship between these disorders. The current study examined hypotheses based on SMH in SUD patients during the very first days of detoxification. Based on SMH we expected a positive association between PTSD and craving concurrently as well as on each following day. Methods A time series with 108 SUD patients used daily self-report questionnaires assessing PTSD symptom severity (PCL-5) and craving (MaCs) for six consecutive days. Daily associations between PTSD symptom severity and craving on the same and on the following day during the first week of detoxification were estimated using linear mixed models. Results There was a significant decrease in PTSD symptom severity during detoxification (ß = -2.06, p < 0.001). Further, PTSD symptom severity predicted craving on the same day (ß = 0.36, p < 0.001) but did not predict craving on the next day (ß = -0.01, p = 0.82). Conclusion Results of the current study only partially support assumptions based on SMH, and points towards a more complex and reciprocal relationship between PTSD and SUD.
... However, dysfunctional coping strategies, experienced workrelated trauma, and self-efficacy were the most robust and strongest predictors for PTSS across most professions. A large body of previous research has reported an increase in the use of alcohol as a coping strategy to forget traumatic events in individuals exposed to disasters (40)(41)(42). Conrod and Stewart (42) suggest that PTSD and alcohol use/abuse appears to be related through a self-medication process. Thus, alcohol dampens the physiological stress response and emotional memory, and thus, has a short-term arousal-and anxietyreducing effect, which is used for the management of PTSS, particularly for hyper-arousal and intrusion symptoms (43). ...
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Emergency personnel and rescue workers may be at a risk of posttraumatic stress symptoms (PTSS) due to exposure to trauma and work-related stressors. Though rescuers of different professions are often engaged in the same type of emergency, they have different tasks and responsibilities and receive different training in coping with traumatic events and stress; hence, we speculated that the salience of identified risk factors for PTSS vary across their respective professions. The present cross-sectional survey aimed to identify influencing variables on PTSS, well-being, and suicidal ideation that can act differently across professions of rescue workers and emergency personnel. In this anonymous online study, data from 1,002 rescue workers and emergency personnel in Switzerland, were collected: 499 police officers, 239 firefighters, 97 ambulance personnel, and 85 emergency and 82 psychiatric nurses. PTSS, coping strategies, well-being, suicidal ideation, previously experienced and work-related trauma, and self-efficacy were measured and analyzed using multiple regression and structural equation modeling (SEM). The prevalence of suspected posttraumatic stress disorder varied across the professions, ranged from 8% (firefighters) to 22% (psychiatric nurses), and was associated with psychological strain and suicidal ideation. The SEM showed that dysfunctional coping strategies, self-efficacy, previously experienced and work-related trauma, years on job, and female sex explained up to 78% of PTSS and that PTSS itself explained up to 68% of the psychological strain experienced in the different professions. Independent of the profession, dysfunctional coping such as alcohol use, avoidance, and distraction, as well as work-related trauma were the most robust predictors of PTSS. However, while self-efficacy was a risk factor for police officers, firefighters and ambulance personnel, it was a protective factor for emergency and psychiatric nurses. Furthermore, female sex was only a risk factor for ambulance personnel and emergency nurses. In agreement with prior research, emergency personnel and rescuers exhibited enhanced prevalence of PTSS and suspected PTSD, leading to significant psychological strain and suicidal ideation. However, risk factors varied across the professions. Thus, the development of profession-specific trainings to improve self-efficacy and coping with work-related stressors to reduce PTSS, and enhance quality of life, is needed for individuals in such high-risk professions. Clinical Trial Registration: ClinicalTrials.gov Nr. NCT03842553.
... A significant body of research supports the relationship between PTSD symptom severity and substance use disorder severity (see reviews by Conrad & Stewart, 2003;Jacobsen, Southwick, & Kosten, 2001;Leeies, Pagura, Sareen, & Bolton, 2010). It is essential to improve our understanding of this relationship, as persons with both disorders present with worse psychological functioning and greater psychiatric problems than persons with substance use disorder alone (Flanagan, Korte, Killeen, & Back, 2016). ...
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Objective: Research has demonstrated a cyclical relationship between posttraumatic stress disorder (PTSD) and substance use disorder. Identifying factors that link PTSD symptom clusters and substance use disorder may illuminate mechanisms underlying the PTSD–substance use disorder relationship, better informing interventions that target this comorbidity. The current study of individuals enrolled in an outpatient aftercare chemical dependency program in King County, Washington, assessed whether overall PTSD symptoms and specific PTSD symptom clusters predicted craving depending on individuals identified primary drug of choice (DOC). Methods: Participants eligible for the parent study were at least 18 years of age, fluent in English, medically cleared from substance withdrawal, and able to participate in treatment sessions and agreed to random assignment. Random assignment to either a mindfulness-based relapse prevention group, a standard relapse prevention group, or a treatment as usual group was conducted on a computer randomization program. A secondary analysis of baseline data was employed in the current study to determine which of the PTSD symptom clusters (avoidance, hyperarousal, and intrusion) predicted substance craving. Results: Covarying for severity of dependence, results suggest that overall PTSD scores predicted craving in participants who identified alcohol, stimulants, and opiates as their primary DOC. Further, avoidance-related PTSD symptoms alone predicted a significant proportion of the variability in craving in stimulant users, and hyperarousal symptoms alone predicted a significant proportion of the variability in craving in alcohol users. No specific PTSD cluster significantly predicted a proportion of the variability in craving in marijuana or opiates users. Conclusions: Findings suggest that craving may play a role in maintaining the relationship between specific PTSD symptom clusters and substance use disorder, and the nature of this relationship may differ by primary DOC. The clinical trial on which this secondary analysis of data was conducted is registered as NCT01159535 at www.clinicaltrials.gov. The original trial from which data for this study was drawn was supported by the National Institutes of Health [NIH/NIDA 5 R01 DA025764-02].
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Experiencing a sexual assault can have long-lasting negative consequences including development of posttraumatic stress disorder (PTSD) and alcohol misuse. Intervention provided in the initial weeks following assault can reduce the development of these chronic problems. This study describes the iterative treatment development process for refining a brief intervention targeting PTSD and alcohol misuse for women with recent sexual assault experiences. Experts, treatment providers, and patients provided feedback on the intervention materials and guided the refinement process. Based on principles of cognitive change, the final intervention consists of one in-person session and four coaching calls targeting beliefs about the assault and about drinking behavior. Initial feasibility and acceptability data are presented for patients enrolled in an open trial (N = 6). The intervention was rated as helpful, not distressing, and interesting by patients and all patients completed the entire treatment protocol. A large decrease in PTSD symptoms pre- to post-intervention was observed. A small effect on decreasing alcohol consequences also emerged, although drinks consumed per week showed a slight increase, not a decrease, over the course of the intervention. Applications of this intervention and next steps for testing efficacy are presented.
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