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Gender and the co-morbidity of PTSD with substance use disorders

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Abstract

The major purpose of this chapter is to examine gender as a potentially important individual-difference variable with respect to the co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs). We begin with a review of studies that have examined comorbidity rates in both general and patient populations to demonstrate that PTSD-SUD comorbidity is an important issue in both nonclinical and clinical samples of both genders. We then examine similarities and differences in the predictors of comorbidity in male and female samples. We review the research examining potential functional relations between these two forms of behavioral pathology to determine whether there may be gender differences in the ways that PTSD and SUDs are interrelated. For example, we look at evidence suggesting that women may be more susceptible than men to a form of comorbidity in which the PTSD precedes the development of the SUD. We present new data from treatment-seeking men and women with SUDs to demonstrate that gender moderates PTSD status effects on aspects of service utilization and treatment course. We conclude with a section on the implications of observed gender differences for the treatment of women versus men with comorbid PTSD-SUDs. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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... On observe également la présence d'autres troubles de l'axe I et II, avec majoritairement des troubles thymiques se manifestant par de la dépression majeure, des tentatives de suicide ou de l'automutilation (Cohen & Hien, 2006;Hien et al., 2000;Mills et al., 2005). Ces patients présentent aussi une dépendance plus sévère (polyconsommation, consommation plus élevée et plus fréquente) (Brown, 2000;Hien et al., 2000;Kubiak, 2004;Stewart et al., 2002). Cette comorbidité est aussi associée à des hospitalisations plus fréquentes (Brown et al., 1995), avec un risque accru de rechute, un abandon précoce du traitement et des périodes d'abstinence plus courtes à la suite du traitement comparativement aux patients TUS non traumatisés (Driessen et al., 2008;Norman et al., 2007Norman et al., , 2012. ...
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Ce projet de thèse vise à étudier la pertinence d’utiliser la médiation équine en thérapie, auprès de personnes ayant des troubles addictifs. Dans un premier temps, il s’agira d’étudier l’influence du style d’attachement des patients sur leur niveau d’autonomie ; en s’appuyant sur des modèles théoriques tels que la théorie de l’attachement (Bowlby, 1969-82 ; Hazan, 1987) et la théorie de la motivation autonome (Decy et Ryan, 2000). Dans un deuxième temps, l’objectif sera d’explorer, de décrire et d’évaluer les processus à l’œuvre durant l’intervention à visée thérapeutique avec le cheval. Cette recherche s’inscrit dans le cadre de la compréhension et de l’évaluation des interventions complexes, axe fort de recherche du laboratoire APEMAC. Le questionnement principal de ce projet de thèse est d'interroger la place de la théorie de l’attachement dans les interventions en psychologie de la santé, notamment dans les programmes de prévention de la reconsommation et de la rechute. Quels liens la motivation et l’attachement entretiennent-ils ? En quoi les troubles de l’attachement peuvent-ils entraver le processus de guérison et la tenue de l’abstinence chez ces patients ? L’utilisation du cheval en thérapie peut-elle permettre d’augmenter le sentiment de sécurité interne des personnes et favoriser le développement de leurs compétences d’auto-régulation et de la motivation autonome ? En somme, peut-on augmenter l’autonomie des patients en leur proposant une intervention qui cible les troubles de l’attachement ? Le recueil des données sera réalisé au Centre de Soins de Suite et de Réadaptation en Addictologie « la Fontenelle ». Tout au long de cette recherche, nous prévoyons d’effectuer différentes évaluations quantitatives à l’aide d’outils psychométriques. Nous utiliserons également des méthodes qualitatives en réalisant des entretiens cliniques.
... However, this trend does not necessarily hold in traumaexposed samples. Despite gender differences in trauma type (e.g., men are more likely to experience combat trauma and women are more likely to experience sexual victimization), studies have failed to show gender differences with respect to PTSD prevalence in comorbid SUD samples (Stewart et al., 2002). Additional research is needed to confirm our findings across gender identities, though given the research referenced above, we might expect to see similar findings in more heavily male-identified samples. ...
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Researchers (Van Minnen et al., 2015) have examined the relationship between posttraumatic stress disorder (PTSD) and substance use. Yet, this scholarship is often focused on explicit use and does not account for underlying personality variables that might impact the bidirectional relationship between PTSD and substance use (McCauley et al., 2012). In addition, self-compassion has shown relationships to both disorders, but has not been investigated with both as constructs of interest. Therefore, the purpose of this study was to examine the relationships between personality traits, self-compassion, PTSD symptom severity, and substance use in a PTSD Partial Hospitalization Program (PHP) sample (n = 200). To investigate the hypothesized relationships between variables, we ran descriptive analyses, bivariate correlations, and a series of regression models. Results showed that alcohol and drug problem scales on the Personality Assessment Inventory were not positively correlated with PTSD symptoms nor posttraumatic cognitions, while self-reported alcohol abuse did show a significant negative correlation with self-compassion. However, an Addiction-Related Personality Trait Index derived from the Personality Assessment Inventory, as well as reported alcohol abuse, showed positive correlations on PTSD symptom severity and posttraumatic cognitions, and negative correlations on self-compassion. Overall, personality factors and reported rates of alcohol use explain a significant amount of the variance in PTSD severity and other relevant treatment target variables. Based on these findings, it may be helpful to adapt treatment to include an assessment of, and focus on, the personality traits contributing to and maintaining both substance abuse and PTSD.
... Future work should consider use of structured interviews for PTSD and coping strategies, as well as established timeline follow-back procedures for substance use. Third, given the focus of the current study on comprehensively evaluating coping strategy utilization, other variables that may impact PTSD symptom-substance use patterns were not examined (e.g., biological sex, race/ethnicity; Dansky et al., 1996;Stewart, Ouimette, & Brown, 2002). Future work should consider evaluating of these sociodemographic constructs in their modeling. ...
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Objective: There is a lack of research on primary prevention of posttraumatic stress disorder (PTSD) symptoms and substance use among trauma-exposed populations. To guide the development of more effective prevention efforts, the current study sought to identify underlying coping mechanisms that impact PTSD-substance use co-occurrence. Method: A person-centered analytic approach (latent class analysis) examined PTSD-substance use co-occurrence typologies (classes) and identified theoretically adaptive (e.g., active coping) and maladaptive (e.g., denial) coping strategies that differentiated between classes among a sample of 1,270 trauma-exposed participants (Mage = 20.71, 73.5% female, 45.7% White). Results: Latent class analysis identified five distinct typologies, reflective of extant epidemiological and etiological work. Generally, behavioral disengagement and self-blame coping increased the likelihood of being in more severe PTSD-illicit substance use (e.g., cocaine) comorbidity classes. Positive reframing and planning differentiated between low and moderate illicit substance typologies with moderate PTSD severity. Venting, acceptance, and self-distraction differentiated between asymptomatic and moderate PTSD severity typologies with low illicit substance use. Conclusions: Findings identify general coping strategies associated with increased likelihood of being in more severe comorbidity typologies, as well as several unique coping strategies associated with risk of transitioning between low/moderate PTSD and illicit substance use classes. Relevant interventions (e.g., trauma psychoeducation, guilt-reduction therapy, psychological first aid) that may be targets for future prevention-oriented work are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... Of the 4.4 million Veterans receiving VA disability benefits for military-related disorders in 2016, almost 20% were indemnified for PTSD (Veterans Benefits Administration, 2016). On one hand, one might expect SUD prevalence to be especially elevated in this subgroup, because comorbid PTSD/SUD is associated with greater PTSD chronicity (Zlotnick et al., 1999), more medical and psychiatric comorbidities (Stewart et al., 2002), poorer perceptions of health and life opportunities (Najavits et al., 1999) and poorer response to PTSD treatment (Perconte & Griger, 1991) than PTSD alone. Further, in two small samples of treatment-seeking civilians, Riggs and colleagues (2003) showed that those seeking integrated treatment for PTSD/SUD had lower incomes and higher unemployment than those seeking treatment only for PTSD. ...
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Background: Posttraumatic stress disorder (PTSD) that is comorbid with substance use disorders (SUDs) has been associated with poorer mental health outcomes compared to when SUD is not present. Objectives: To identify the prevalence of SUDs in Veterans who have applied for PTSD disability benefits and, within this subgroup, examine the effect of a SUD diagnosis on PTSD symptom severity, functioning, and economic outcomes approximately 2 years later. Method: Retrospective, gender-stratified cohort study of 4,918 representatively sampled Veterans who applied for Department of Veterans’ Affairs (VA) PTSD disability benefits between 1994 and 1998. We used medical administrative data to determine if a SUD diagnosis was present when Veterans’ disability claims were adjudicated. PTSD symptom severity; work, role, and social functioning; physical functioning; working for pay; and low income were assessed by mailed survey approximately 2 years later. Results: 3,337 (68%) Veterans returned surveys. Among respondents, men were more likely than women to have any SUD diagnosis at the time of their claims’ adjudication (25.6% v. 17.6%, p < 0.001). Regardless of gender, Veterans with a SUD diagnosis had clinically meaningful and statistically significantly severer PTSD symptoms and poorer functioning approximately 2 years after their claim was adjudicated than did Veterans without SUD (ps < 0.001). Work, role, and social functioning was also statistically significantly worse for men and women with a SUD diagnosis (ps < 0.001). In terms of economic outcomes, men and women with a SUD diagnosis at the time their claim was adjudicated were 50-60% less likely to report working for pay two years later and 40%-100% more likely to report low income compared to respondents without a SUD diagnosis (ps < 0.001). Conclusions: Although a substantial fraction of respondents were diagnosed with a SUD at the time their claim was adjudicated, the proportion of men with a SUD was similar to that reported for other clinical samples with PTSD; it was actually lower among the women compared to other clinical samples. A SUD diagnosis was a poor prognostic factor for the Veterans in this sample, associated with severer PTSD, poorer functioning, and poorer economic outcomes.
... Three fourths of the women we interviewed used drugs or alcohol, which is common in traumatized populations, including combat veterans and survivors of sexual and domestic violence (McFarlane, 2001;Norris, Foster & Weishaar, 2002;Stewart, Ouimette, & Brown, 2002). The majority of these women described their substance use as a form of chemical dissociation. ...
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We examined social and physical violence experienced by American Indian/Alaska Native (AI/AN) women in prostitution and their impacts on the mental and physical health of 105 women (81% Anishinaabe, mean age = 35 years) recruited through service agencies in three Minnesota cities. In childhood, abuse, foster care, arrests, and prostitution were typical. Homelessness, rape, assault, racism, and pimping were common. The women's most prevalent physical symptoms included muscle pain, impaired memory or concentration, and headaches. Symptoms of post-traumatic stress disorder and dissociation were common, with more severe psychological symptoms associated with worse health. Most of the women wanted to leave prostitution and they most often identified counseling and peer support as necessary to accomplish this. Most saw colonization and prostitution of AI/AN women as connected.
... Given the absence of research examining the relevance of specific emotional responses to cocaine cravings or cocaine use among SUD patients with PTSD, no specific hypotheses were made with regard to the role of specific negative emotional states in the association between PTSD and cocaine cravings following trauma cue exposure. Finally, given the well-documented gender differences in PTSD-relevant emotional responding (Peirce, Newton, Buckley, & Keane, 2002), the clinical presentation of PTSD-SUD diagnoses (Sonne, Back, Diaz Zuniga, Randall, & Brady, 2003;Stewart, Ouimette, & Brown, 2002), and emotion regulation (Gratz & Roemer, 2004;Nolen-Hoeksema & Aldao, 2011), we explored the moderating role of gender in these associations. ...
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This study examined the effect of personalized trauma cue exposure (relative to neutral cue exposure) on cocaine cravings within a sample of trauma-exposed cocaine dependent patients with and without current PTSD. We also examined the extent to which negative affect (as well as the discrete negative emotional states of anxiety, anger, and shame/guilt) in response to the trauma cue accounted for these cocaine cravings. Sixty cocaine dependent patients in residential substance use treatment (50% with PTSD) were exposed to a personalized trauma and neutral script on separate days. Self-reported cocaine cravings and emotional response prior to and following each script were assessed. PTSD was associated with increased cocaine cravings following a personalized trauma (but not a neutral) script, and, for men specifically, the experience of self-conscious emotions (shame and guilt) to the trauma script mediated the relationship between PTSD and cocaine cravings following trauma script exposure. Treatment implications are discussed.
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Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) is an integrated, evidence-based treatment that results in significant reductions in posttraumatic stress disorder (PTSD) and substance use disorder (SUD) severity. Emotional processing theory suggests that successful prolonged exposure–based treatments should result in more cohesive trauma narratives due to better integration and organization of trauma memory into cognitive conceptualizations of fear. Therefore, we hypothesized that language used by patients would become more cohesive over time and increased language cohesion would be related to larger reductions in PTSD and SUD outcomes. Broadly, language cohesion refers to several linguistic devices that help establish and cohere meaning throughout spoken and written discourse (e.g., increased use of transition words like “and,” “then,” and “but”). This was the first known study to examine changes in language related to both PTSD and SUD severity during COPE treatment. The sample included 28 military veterans with current comorbid PTSD/SUD enrolled in a larger COPE study. A text analysis program, Coh-Metrix, was used to analyze language cohesiveness. No language cohesion variables significantly changed over time. Narrativity levels significantly moderated change in PTSD outcomes, = 0.11. Adversative connectives significantly moderated change in SUD outcomes, = 0.26. The findings illuminate potential processes underlying successful COPE treatment. Less use of language conveying a narrative and more use of contrast-indicative words (e.g., but, whereas) was associated with larger reductions in PTSD and SUD outcomes during treatment. These results contribute to the extant literature on associations between trauma exposure, language, and emotional processing.
Chapter
Law enforcement assessment is a highly specialized area within the field of psychology. The psychologist’s main responsibilities within this domain are twofold: to assess potential police officer candidates and to assess and support officers during their careers. Given the nature of police work, trauma assessments are an integral component of this work. Officers are routinely exposed to life-threatening experiences, as well as vicarious trauma. Furthermore, they may have personal trauma histories. While these experiences may increase their empathy and ability to effectively respond to difficult situations, it can also be detrimental to their objectivity and ability to self-regulate and result in use of maladaptive coping skills. The following chapter describes the nature and function of pre-employment and fitness-for-duty evaluations, as well as best practices for conducting such evaluations. Furthermore, an in-depth discussion on the nature of trauma within law enforcement is provided, along with areas for consideration. In order to provide further context, there is an extensive discussion on the environment of police culture as it contributes to the experience of trauma. Finally, case examples, recommendations, and resources are provided.
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Introduction: Early exposure to experiencing or witnessing sexual violence/trauma disproportionately permeates the lives of young racialized women. In order to interrogate this problem, this research explores the impact of sexual trauma, and exploitation through the eyes of young racialized women, aged 18–24 years, whose voices are often absent. We interrogate three broad themes: (1) the impact of mental health for those who have experienced or witnessed sexual violence; (2) interrogating the interlocking of age, gender, race, and neighborhood as it compounds the experiences of sexual violence; and (3) understanding of the services and accessibility for survivors of sexualized violence/trauma and strategies towards increasing accessibility.
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Résumé Depuis une quinzaine d’années, la forte prévalence de la co-morbidité des « troubles liés à l’utilisation d’une substance et à l’état de stress post-traumatique » a amené un nombre croissant d’auteurs à s’intéresser aux conséquences de celle-ci sur le traitement. Les données empiriques issues de ces études mettent d’abord en relief que la clientèle qui consulte pour alcoolisme et toxicomanie présente un tableau clinique à l’entrée en traitement nettement plus détérioré lorsque le trouble lié à l’utilisation d’une substance s’accompagne de l’état de stress post-traumatique. En plus de se présenter avec un profil clinique plus complexe, les usagers avec ces troubles concomitants retirent généralement moins de bénéfices du traitement de la toxicomanie. Des programmes de traitement intégré s’avèrent prometteurs pour accroître les bénéfices lorsque les deux troubles sont présents simultanément, mais ne semblent pas contrer le problème de l’abandon prématuré du traitement. Bien qu’aucune étude n’ait été élaborée spécifiquement dans le but d’identifier les facteurs impliqués dans ce processus, la recension des écrits révèle plusieurs indices qui suggèrent trois hypothèses explicatives : l’hypothèse d’automédication, la faiblesse de l’alliance thérapeutique et le manque de soutien social sans compter la contribution potentielle d’obstacles pratiques tels que des difficultés de transport ou des contraintes financières. Ces hypothèses devraient orienter la recherche et ainsi fournir des éléments essentiels à la conception de traitements mieux adaptés à la réalité des survivants de trauma.
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