ChapterPDF Available

Relations among Trauma, PTSD, and Substance Misuse: The Scope of the Problem

Authors:

Abstract

Although previous reviews have established strong co-occurrences between both trauma and posttraumatic stress disorder (PTSD) with substance use disorders (SUDs; e.g., Stewart, 1996), research on this issue has dramatically increased over the past 2 decades. This chapter provides an up-to-date review of the extant literature that establishes these relationships across general population and treatment-seeking samples, gender, and developmental stage. We specifically examine the evidence for relations between trauma exposure, PTSD, and SUDs by trauma type (e.g., disaster vs. combat) and by substance (e.g., alcohol vs. cannabis) in an attempt to determine whether the relations are specific or general across traumata and drug type. The intent of this opening chapter is to set the stage for the chapters that follow by establishing the scope of the problem. We conclude with a consideration of possible directions for future research on the epidemiology of this form of comorbidity. (PsycINFO Database Record (c) 2015 APA, all rights reserved)
A preview of the PDF is not available
... However, alcohol problems are often comorbid with symptoms of posttraumatic stress disorder (PTSD; Debell et al., 2014). Such comorbidity presents unique challenges for treatment, as individuals with these co-occurring mental health conditions show greater symptom severity, poorer social functioning, more functional health problems, less improvement over the course of treatment, earlier treatment dropout, and greater relapse relative to either condition alone (Bailey & Stewart, 2013;McCarthy & Petrakis, 2010;McCauley et al., 2012;Read et al., 2014;Stewart, 1996). Research dedicated to understanding the nature of comorbid PTSD-alcohol problems remains an important priority, with potential implications for the development and tailoring of effective interventions. ...
Article
Full-text available
A behavioral economic reinforcer pathology model theorizes that alcohol problems are influenced by steep delay discounting, overvaluation of alcohol reinforcement, and low reinforcement from alcohol-free activities. Extending this account to the comorbidity of alcohol problems and posttraumatic stress disorder (PTSD), the present study tested the hypothesis that alcohol problems and PTSD symptom severity would interact and be positively associated with indicators from these three domains. High-risk emerging adults from North America (Study 1, n = 1,311, Mage = 22.13) and general community adults from Canada (Study 2, n = 1,506, Mage = 36.80) completed measures of alcohol problems, PTSD symptoms, delay discounting, alcohol demand, and proportionate alcohol-related reinforcement. Across studies, regression analyses revealed significant main effects of alcohol problems and PTSD symptoms in relation to selected reinforcer pathology indicators, but no significant interactions were present for delay discounting or proportionate alcohol-related reinforcement. Interactions were observed for alcohol consumption at $0 (intensity) and the rate of change in consumption across the demand curve (elasticity; Study 1) and for elasticity and maximum alcohol expenditure (Omax; Study 2), but not in the predicted directions. Higher synergistic severity was associated with lower alcohol reinforcing value in each case. These findings reveal expected relations between reinforcer pathology indicators and both alcohol problems and PTSD symptomatology in general but did not support the hypothesized synergistic relationship. The relation between alcohol problems and PTSD is more complex than predicted by existing extensions of the reinforcer pathology model, warranting further investigation.
... Trauma exposure increases the risk of misusing alcohol and substances, often used to cope with trauma [18]. Women have a greater risk of developing a co-occurring disorder, meaning the coexistence of both substance use and mental health problems [19,20]. ...
Article
Full-text available
African American women have a higher likelihood of experiencing lifetime trauma compared to other racial/ethnic groups. Trauma exposure may be associated with higher substance misuse and greater adverse sexual and mental health outcomes. This study expands upon previous empirical findings to characterize the effect of trauma history on substance use, sexual health, and mental health among young African American women. This study included 560 African American women aged 18–24 years in Atlanta, Georgia. Trauma history was defined as having ever experienced a traumatic event based on the Traumatic Events Screening Inventory (TESI). Relative to women not reporting a trauma history and controlling for age, education, and employment, women who experienced trauma were over 2.5 and 2.3 times, respectively, more likely to report alcohol misuse and marijuana misuse. They were 3.0 times more likely to experience peer normative pressure for substance use. Women who experienced trauma were 2.1 times more likely to have multiple sex partners, 2.9 times more likely to have peer norms for risky sex, 1.8 times more likely to perceive barriers to using condoms with sex partners, 2.1 times more likely to report lower communication frequency about sex, 2.0 times more likely to report lower self-efficacy for refusing sex, and 1.9 times more likely to report less relationship control. Women with a trauma history were also 5.0 times more likely to have experienced intimate partner violence, 2.1 times more likely to report high depression symptomatology, 4.0 times more likely to report high overall stress, 3.2 times more likely to have worse coping skills, and 1.8 times more likely to have poor emotional regulation. Findings suggest that trauma history may increase myriad adverse psychosocial health outcomes. Screening for trauma history may help inform the provision of services. Intensified TESI screenings may help identify a history of trauma and assist in identifying adverse health outcomes.
... Trauma can influence the initiation of substance use behavior and the development and course of SUD, including relapse following treatment. Although trauma can lead to dysfunction at any stage of development, childhood trauma is especially important in setting the stage for SUD that is often chronic and severe (Bailey & Stewart, 2014). Stress, especially chronic, uncontrollable, or high-intensity traumatic stress that occurs early in life, may interact with social, personality, and genetic or biological variables to influence an individual's vulnerability to develop SUD (Brady, Killeen, Brewerton, & Lucerini, 2000;Cleck & Blendy, 2008;De Bellis, 2002;Enoch, 2011;Enoch et al., 2010;Goeders, 2004;Hyman & Sinha, 2009;Sinha, 2008Sinha, , 2009). ...
... Research consistently demonstrates high substance use disorder (SUD) rates among trauma-exposed populations with or without posttraumatic stress disorder (PTSD) [1][2][3]. However, few studies analyze associations with specific PTSD symptoms (PTSSs). ...
Article
Full-text available
Background: Trauma is commonly associated with substance-related problems, yet associations between specific substances and specific posttraumatic stress disorder symptoms (PTSSs) are understudied. We hypothesized that substance-related problems are associated with PTSS severities, interpersonal traumas, and benzodiazepine prescriptions. Methods: Using a cross-sectional survey methodology in a consecutive sample of adult outpatients with trauma histories (n = 472), we used logistic regression to examine substance-related problems in general (primary, confirmatory analysis), as well as alcohol, tobacco, and illicit drug problems specifically (secondary, exploratory analyses) in relation to demographics, trauma type, PTSSs, and benzodiazepine prescriptions. Results: After adjusting for multiple testing, several factors were significantly associated with substance-related problems, particularly benzodiazepines (AOR = 2.78; 1.99 for alcohol, 2.42 for tobacco, 8.02 for illicit drugs), DSM-5 PTSD diagnosis (AOR = 1.92; 2.38 for alcohol, 2.00 for tobacco, 2.14 for illicit drugs), most PTSSs (especially negative beliefs, recklessness, and avoidance), and interpersonal traumas (e.g., assaults and child abuse). Conclusion: In this clinical sample, there were consistent and strong associations between several trauma-related variables and substance-related problems, consistent with our hypotheses. We discuss possible explanations and implications of these findings, which we hope will stimulate further research, and improve screening and treatment.
... Epidemiological data also demonstrate that individuals with PTSD are 4.6 times more likely to develop AUD than those without PTSD (Hofmann, Richey, Kashdan, & McKnight, 2009). Rates of PTSD and AUD comorbidity are high in community samples, yet they are even higher among military personnel and veterans (Bailey & Stewart, 2014). A national study showed that 63% of Iraq and Afghanistan combat veterans with AUD also had PTSD (Seal et al., 2010). ...
Article
Full-text available
Despite high rates of comorbid hazardous alcohol use and posttraumatic stress disorder (PTSD), the nature of the functional relationship between these problems is not fully understood. Insufficient evidence exists to fully support models commonly used to explain the relationship between hazardous alcohol use and PTSD including the self-medication hypothesis and the mutual maintenance model. Ecological momentary assessment (EMA) can monitor within-day fluctuations of symptoms and drinking to provide novel information regarding potential functional relationships and symptom interactions. This study aimed to model the daily course of alcohol use and PTSD symptoms and to test theory-based moderators, including avoidance coping and self-efficacy to resist drinking. A total of 143 recent combat veterans with PTSD symptoms and hazardous drinking completed brief assessments of alcohol use, PTSD symptoms, mood, coping, and self-efficacy 4 times daily for 28 days. Our results support the finding that increases in PTSD are associated with more drinking within the same 3-hr time block, but not more drinking within the following time block. Support for moderators was found: Avoidance coping strengthened the relationship between PTSD and later drinking, while self-efficacy to resist drinking weakened the relationship between PTSD and later drinking. An exploratory analysis revealed support for self-medication occurring in certain times of the day: Increased PTSD severity in the evening predicted more drinking overnight. Overall, our results provide mixed support for the self-medication hypothesis. Also, interventions that seek to reduce avoidance coping and increase patient self-efficacy may help veterans with PTSD decrease drinking. (PsycINFO Database Record
Article
Full-text available
Background Why do potentially traumatic events (PTEs) and substance use (SU) so commonly co‐occur during adolescence? Causal hypotheses developed from the study of posttraumatic stress disorder (PTSD) and substance use disorder (SUD) among adults have not yet been subject to rigorous theoretical analysis or empirical tests among adolescents with the precursors to these disorders: PTEs and SU. Establishing causality demands accounting for various factors (e.g. genetics, parent education, race/ethnicity) that distinguish youth endorsing PTEs and SU from those who do not, a step often overlooked in previous research. Methods We leveraged nationwide data from a sociodemographically diverse sample of youth (N = 11,468) in the Adolescent Brain and Cognitive Development Study. PTEs and substance use prevalence were assessed annually. To account for the many pre‐existing differences between youth with and without PTE/SU (i.e. confounding bias) and provide rigorous tests of causal hypotheses, we linked within‐person changes in PTEs and SU (alcohol, cannabis, nicotine) across repeated measurements and adjusted for time‐varying factors (e.g. age, internalizing symptoms, externalizing symptoms, and friends' use of substances). Results Before adjusting for confounding using within‐person modeling, PTEs and SU exhibited significant concurrent associations (βs = .46–1.26, ps < .05) and PTEs prospectively predicted greater SU (βs = .55–1.43, ps < .05) but not vice versa. After adjustment for confounding, the PTEs exhibited significant concurrent associations for alcohol (βs = .14–.23, ps < .05) and nicotine (βs = .16, ps < .05) but not cannabis (βs = ‐.01, ps > .05) and PTEs prospectively predicted greater SU (βs = .28–.55, ps > .05) but not vice versa. Conclusions When tested rigorously in a nationwide sample of adolescents, we find support for a model in which PTEs are followed by SU but not for a model in which SU is followed by PTEs. Explanations for why PTSD and SUD co‐occur in adults may need further theoretical analysis and adaptation before extension to adolescents.
Article
Substance use disorders and post-traumatic stress disorder (PTSD) often co-occur, along with depression and anger. Despite evidence that Prolonged Exposure Therapy is effective for individuals with co-occurring PTSD and SUD when PE is implemented alongside SUD treatment, clinicians have been reluctant to offer PE or other trauma-focused therapies to individuals with co-occurring PTSD and SUD because of the belief that increased emotional distress would be counter-therapeutic for individuals in early recovery. A widely held explanation for the high degree of comorbidity is that individuals with PTSD use substances to reduce or avoid painful and disturbing PTSD symptoms. This case study describes the implementation and outcome of PE therapy with a 32-year-old man who had been admitted to a residential substance use treatment program for Latino males. The client had a long history of polysubstance use and severe PTSD. The client was homeless and reported significant depressive and anger symptoms. Assessment of PTSD revealed that he was using heroin and cocaine to avoid painful memories of a traumatic event that had occurred several years prior to his admission to this treatment program. Because the client reported using these substances to reduce emotional distress, PE was chosen as the PTSD intervention. During PE Therapy the client reported no thoughts or urges to use substances and at discharge from residential treatment he reported no problems with PTSD or depression. The client maintained all gains at 1-year follow-up, when he also reported that he was working full time and had remained abstinent since he completed treatment.
Article
The objective of the present study was to examine how symptoms of posttraumatic stress disorder (PTSD) may confer drinking risk as students with trauma histories complete college and move toward independent adulthood. Students (N = 283) completed assessments of trauma, posttraumatic stress, and alcohol use and consequences at four time points during the year following their fourth year of college. Some students had transitioned out of the college environment, whereas others had not. We examined how transition status moderated within-person associations between changes in PTSD and corresponding changes in alcohol outcomes over time. Using multilevel modeling, we examined differences in within-person PTSD-alcohol associations comparing students who were (1) continuing as fifth-year seniors, (2) graduated and pursuing graduate education, and (3) graduated and left the university setting. Alcohol use and consequences tended to decline on average from the fourth to fifth year post-matriculation. Yet, within-person increases in posttraumatic stress symptomatology across the fifth year were associated with greater alcohol consequences, but only for those students who had left the university setting. These data suggest that the transition out of college may be an important developmental context that is associated with increased vulnerability for negative consequences from stress-related drinking. Findings may have important implications for campus-based prevention efforts geared toward the facilitation of a successful transition into independent adulthood.
ResearchGate has not been able to resolve any references for this publication.