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CORK Bibliography: Post-Traumatic Stress Disorder (PTSD)

68 citations. January 2007 to present

Prepared: March 2009

Acierno R; Lawyer SR; Rheingold A; Kilpatrick DG; Resnick HS; Saunders BE. Current psychopathology in previously assaulted older adults. Journal of Interpersonal Violence 22(2): 250-258, 2007. (23 refs.)

Older adult women age 55+ years (N = 549) were interviewed as part of a population-based epidemiological research study of lifetime experiences with physical and sexual assault and current mental health problems. Although overall rates of psychopathology were low, producing very small cells for comparison, women who reported experiencing physical assault an average of 28 years previously were more likely to present with past year substance abuse, depression, and avoidance and re-experiencing symptoms of posttraumatic stress disorder (PTSD) than those with no previous physical or sexual assault. Women who reported experiencing sexual assault an average of 50 years previously were more likely to present with autonomic arousal and avoidance symptoms of PTSD than those with no prior sexual assault. The aforementioned findings should be considered with caution, however, as sample cell sizes were minimal for all but the PTSD symptom subtypes. Mental health service implications for older adults are discussed.

Arevalo S; Prado G; Amaro H. Spirituality, sense of coherence, and coping responses in women receiving treatment for alcohol and drug addiction. Evaluation and Program Planning 31(1): 113-123, 2008. (92 refs.)

Purpose: To examine the role of spirituality, sense of coherence, and coping responses in relation to stress and trauma symptoms among women in substance abuse treatment. Data sources/study setting: Data for the present analyses were obtained from baseline interviews of 393 women in an urban area of Massachusetts. Interviews were conducted from April 2003 to September 2006. Participants came from four substance abuse treatment programs (three residential and one outpatient) participating in the Mother's Hope, Mind and Spirit Study, an evaluation of an intervention funded by the Substance Abuse and Mental Health Services Administration (SAMSHA). Principal findings: Stress was significantly associated with drug addiction severity and trauma symptoms were significantly related to alcohol addiction severity. Spirituality, sense of coherence, and coping responses did not mediate the relationship between perceived stress, and posttraumatic stress, and alcohol and drug addiction severity. However, negative and significant associations were found between perceived stress and spirituality, sense of coherence and coping responses, and between posttraumatic stress symptomatology and sense of coherence. Conclusion: Enhanced substance abuse treatments that increase spirituality, sense of coherence, and coping responses may be beneficial in helping women in substance abuse treatment to manage stress and posttraumatic stress symptoms. However, further research is needed to identify the pathways through which spirituality, sense of coherence and coping responses may mediate the effects of stress and posttraumatic stress symptoms on alcohol and drug addiction severity.

Babson KA; Feldner MT; Sachs-Ericsson N; Schmidt NB; Zvolensky MJ. Nicotine dependence mediates the relations between insomnia and both panic and posttraumatic stress disorder in the NCS-R sample. Depression and Anxiety 25(8): 670-679, 2008. (67 refs.)

Although a growing literature has demonstrated elevations in insomnia symptoms among persons with either panic disorder (PD) or posttraumatic stress disorder (PTSD) relative to people without psychopathology, comparably little is known about processes underlying these associations. In recognition of this important gap in the literature, this study tested nicotine dependence as a partial mediator of the relations between insomnia symptoms and both PD and PTSD among a nationally representative sample of 5,692 (3,311 females; M-agc = 43.33, SD = 16. 55) adults from the National Comorbidity Survey-Replication. Consistent with hypotheses, nicotine dependence partially mediated the relations between insomnia and both PD and PTSD after controlling for variance accounted for by diagnoses of major depressive episodes, drug and alcohol dependence, and gender Overall, results suggest nicotine dependence may be a possible mechanism that underlies insomnia among those with PD and PTSD.

Baschnagel JS; Coffey SF; Schumacher JA; Drobes DJ; Saladin ME. Relationship between PTSD symptomatology and nicotine dependence severity in crime victims. Addictive Behaviors 33(11): 1441-1447, 2008. (31 refs.)

Smoking rates are higher and cessation rates are lower among individuals with posttraumatic stress disorder (PTSD) compared to the general population, thus understanding the relationship between PTSD and nicotine dependence is important. In a sample of 213 participants with a crime-related trauma (109 with PTSD), the relationship between PTSD status, smoking status (smoker vs. non-smoker), substance abuse diagnosis (SUD), PTSD symptoms, and sex was assessed. SUD diagnosis was significantly related to smoking status, but PTSD symptomatology and sex were not. Among smokers (n = 117), increased nicotine dependence severity was associated with being male and with increased level of PTSD avoidance symptoms. Correlations indicated that PTSD avoidance and hyperarousal symptom clusters and total symptom scores were significantly related to nicotine dependence severity in males, while PTSD symptomatology in general did not correlate with dependence severity for females. The results suggest that level of symptomatology, particularly avoidance symptoms, may be important targets for smoking cessation treatment among male smokers who have experienced a traumatic event.

Beckham JC; Dennis MF; McClernon FJ; Mozley SL; Collie CF; Vrana SR. The effects of cigarette smoking on script-driven imagery in smokers with and without posttraumatic stress disorder. Addictive Behaviors 32(12): 2900-2915, 2007. (65 refs.)

The study investigated the effects of smoking a nicotinized or denicotinized cigarette on craving, affect and posttraumatic stress disorder (PTSD) symptoms while recalling neutral, stressful and traumatic events in smokers with and without PTSD. Smokers completed laboratory sessions during which they were presented with audiotapes of personalized scripts followed by smoking a cigarette. The effect of the script and cigarette conditions on dependent variables was evaluated. There was a main effect of script type across groups for smoking craving, negative affect and PTSD symptoms, with increased symptoms in trauma and stressful conditions. Responses were significantly higher in PTSD smokers. Smoking either cigarette type resulted in decreased craving, negative affect and PTSD symptoms in both groups. A second script presentation following smoking elicited similar responses, suggesting the ameliorative effect of having smoked a cigarette was short-lived. These results support that context and non-pharmacologic effects of smoking are important variables in smoking craving and mood, particularly in smokers with PTSD.

Beckham JC; Wiley MT; Miller SC; Dennis MF; Wilson SM; McClernon FJ et al. Ad lib smoking in post-traumatic stress disorder: An electronic diary study. Nicotine & Tobacco Research 10(7): 1149-1157, 2008. (39 refs.)

Using ambulatory methods for 1 week of monitoring, this study investigated the association between smoking and situational cues in 22 smokers with post-traumatic stress disorder (PTSD) and 23 smokers without PTSD. Generalized estimating equations contrasted 1,759 smoking and 1,088 nonsmoking situations by group status controlling for multiple covariates. PTSD smokers reported higher stress and PTSD symptoms across daily activities. For all smokers, higher nicotine dependence, craving, food and caffeine consumption, and being outside were related to smoking. PTSD smokers were more likely to smoke when experiencing PTSD symptoms, anxiety, and stress. Following smoking, smokers with PTSD reported a significant reduction in negative affect. These results are consistent with previous ambulatory findings regarding mood in smokers, and underscore that in smokers with PTSD, PTSD symptom variables as well as stress and anxiety are significantly associated with ad lib smoking.

Bonn-Miller MO; Vujanovic AA; Feldner MT; Bernstein A; Zvolensky MJ. Posttraumatic stress symptom severity predicts marijuana use coping motives among traumatic event-exposed marijuana users. Journal of Traumatic Stress 20(4): 577-586, 2007. (39 refs.)

The present study examines the relation between posttraumatic stress symptom severity and motives for marijuana use among 103 (55 women) young adult marijuana users (current) who reported experiencing at least one traumatic event in their lifetime. As expected, after covarying for the theoretically relevant variables of frequency of past 30-day marijuana use, number of cigarettes smoked per day, and volume of alcohol consumed, posttraumatic stress symptom severity was significantly related to marijuana use coping motives, but no other motives for marijuana use. Results are discussed in relation to better understanding the role of coping-motivated marijuana use among young adults experiencing posttraumatic stress.

Bouso JC; Doblin R; Farre M; Alcazar MA; Gomez-Jarabo G. MDMA-assisted psychotherapy using low doses in a small sample of women with chronic post-traumatic stress disorder. Journal of Psychoactive Drugs 40(3): 225-236, 2008. (61 refs.)

The purpose of this study was to investigate the safety of different doses of MDMA-assisted psychotherapy administered in a psychotherapeutic setting to women with chronic PTSD secondary to a sexual assault, and also to obtain preliminary data regarding efficacy. Although this study was originally planned to include 29 subjects, political pressures led to the closing of the study before it could be finished, at which time only six subjects had been treated. Preliminary results from those six subjects are presented here. We found that low doses of MDMA (between 50 and 75 mg) were both psychologically and physiologically safe for all the subjects. Future studies in larger samples and using larger doses are needed in order to further clarify the safety and efficacy of MDMA in the clinical setting in subjects with PTSD.

Buckley TC; Holohan DR; Mozley SL; Walsh K; Kassel J. The effect of nicotine and attention allocation on physiological and self-report measures of induced anxiety in PTSD: A double-blind placebo-controlled trial. Experimental and Clinical Psychopharmacology 15(2): 154-164, 2007. (55 refs.)

Rates of smoking among populations with psychiatric disorders are more than twice as high as among the general population, yet there are few controlled studies of the mechanisms of this relationship. This trial examined the effect of nicotine by way of cigarette smoking on both self-report and autonomic parameters of anxiety among individuals with PTSD who were also heavy smokers. Half of the participants were randomized to an anxiety-eliciting condition, whereas the other half were assigned to a condition of neutral emotional content. Within each of these conditions, participants were randomized into a nicotine condition (high-yield nicotine cigarette) or a placebo condition (denicotinized cigarette). The final layer of randomization involved assigning participants to either an attention-demanding task or a no task condition. We examined the interactive effects of nicotine and attentional demand on parameters of anxious responding. Nicotine exerted an anxiolytic effect relative to placebo on self-report measures; however, nicotine did not interact with attentional demand in producing this effect. In contrast to the findings on the self-report measures of distress, nicotine enhanced autonomic reactivity to trauma cues, thereby suggesting a decoupling of self-reported anxiety and autonomic arousal associated with responding to trauma-relevant cues. The implications for understanding smoking and psychiatric comorbidity are discussed.

Calhoun PS; Dennis MF; Beckham JC. Emotional reactivity to trauma stimuli and duration of past smoking cessation attempts in smokers with posttraumatic stress disorder. Experimental and Clinical Psychopharmacology 15(3): 256-263, 2007. (54 refs.)

The present study examined whether reactivity to emotional stressors is related to early relapse from smoking cessation in persons with posttraumatic stress disorder (PTSD). Smokers with PTSD who had failed to sustain any previous quit attempt for 7 days (n = 26) and PTSD smokers who were able to sustain a quit attempt for more than a week (n = 50) were exposed to emotional stimuli in the form of personalized scripts that included neutral/ relaxing experiences, stressful/nontraumatic experiences, and traumatic experiences. Results indicated an interaction between script type and group. Although groups did not differ after presentation of neutral scripts, persons with PTSD unable to sustain a quit attempt for as long as 7 days responded with greater levels of emotional reactivity to both stressful and trauma stimuli relative to those able to sustain a quit attempt longer than 7 days. Further, results suggested that emotional reactivity to stressors (both traumatic and nontraumatic) is related to duration of past longest quit attempt in smokers with PTSD. Results are consistent with findings in nonpsychiatric samples that suggest that individual differences in affective regulatory processes are related to duration of smoking cessation attempts. Systematic replications including a prospective design are recommended.

Coffey SF; Schumacher JA; Brady KT; Cotton BD. Changes in PTSD symptomatology during acute and protracted alcohol and cocaine abstinence. Drug and Alcohol Dependence 87(2/3): 241-248, 2007. (52 refs.)

Previous research with substance users has demonstrated, across a variety of psychiatric disorders, significant decreases in psychological symptoms during early substance abstinence. To build on this literature, the current study prospectively assessed trauma symptomatology over 28 days during acute and protracted cocaine and alcohol abstinence. Participants were 162 male and female cocaine and/or alcohol dependent outpatients who reported a history of trauma. Trauma-related symptoms and substance use were assessed at 2, 5, 10, 14, 21, and 28 days following last substance use. For participants who were known to relapse, assessments began again after the last day of substance use. Latent growth modeling was employed to estimate changes in posttraumatic stress disorder (PTSD) symptoms. Consistent with studies of other psychiatric syndromes, PTSD symptoms declined across the 28-day study period regardless of withdrawal substance (i.e., cocaine or alcohol). The majority of change in trauma symptoms occurred within 2 weeks of last Substance use. Moreover, while trauma symptoms for the PTSD participants were more severe than those reported by the non-PTSD participants, trauma symptoms declined across the study period at the same rate irrespective of PTSD status.

Dantas HD; de Andrade AG. Comorbidity of post traumatic stress disorder (PTSD) with alcohol and drug abuse and dependency: a literature review. (review) [Portuguese]. Revista de Psiquiatria Clinica 35(Supplement 1): 55-60, 2008. (27 refs.)

Background: The literature reveals high comorbidity rates between post traumatic stress disorder (PTSD) and substance abuse and dependence (SAD). Objectives: This paper seeks to describe the relationship between the two disorders; the gender differences; and the primary treatments used to reduce PTSD as well as SAD symptoms. Methods: A review of the literature between 1995 anal 2007. A PubMed search was used to find articles with the key words: "trauma" AND "alcohol", "trauma" AND "substance abuse", "trauma" AND "dependence", "trauma" AND "drugs", "post traumatic stress" AND "alcohol", post traumatic stress" AND "substance abuse", "post traumatic stress" AND "dependence", "post traumatic stress" AND "drugs". Results: The following hypotheses were identified: 1) Substance abuse increases the risk of PTSD occurrence due to life styles that expose the individual to traumas and due to the fact that alcohol and drugs can increase the consequences of the traumatic event; 2) Alcohol and drugs are sometimes used by MD patients with the intent to relieve symptoms of their disorder, which in turn may lead to eventual abuse. Conclusions: The early identification of comorbidity between PTSD and SAD is essential for a good prognosis for the patient. It is also important to help minimize the chances of PDST in victims of the traumatic events.

Dennis MF; Clancy CP; Beckham JC. Gender differences in immediate antecedents of ad lib cigarette smoking in smokers with and without posttraumatic stress disorder: A preliminary report. Journal of Psychoactive Drugs 39(4): 479-485, 2007. (42 refs.)

Using ambulatory methods for monitoring, this study investigated gender differences regarding the association between smoking and situational cues in 63 smokers with posttraumatic stress disorder (PTSD) and 32 smokers without PTSD. Smokers were instructed to complete a diary entry each time an ambulatory blood pressure monitor took a reading and each time they prepared to smoke. Generalized estimating equations contrasted 682 smoking and 444 nonsmoking situations by group status. For all smokers, ad lib smoking was strongly related to craving. For women with PTSD, ad lib smoking was strongly related to total PTSD symptoms, PTSD reexperiencing symptoms, and PTSD hyperarousal symptoms. For men with PTSD, ad lib smoking was significantly related to negative affect, PTSD reexperiencing symptoms, restlessness, and worry. No other mood antecedents Were significant for women or men smokers without PTSD. These results are consistent with previous studies documenting gender differences-in smoking behavior, and underscore the importance of examining gender differences in psychiatric samples.

Desai RA; Harpaz-Rotem I; Najavits LM; Rosenheck RA. Impact of the Seeking Safety program on clinical outcomes among homeless female veterans with psychiatric disorders. Psychiatric Services 59(9): 996-1003, 2008. (20 refs.)

Objective: Seeking Safety is a manualized cognitive-behavioral therapy intervention that is designed to treat clients with comorbid substance abuse and trauma histories. This study examined its effectiveness when used with homeless women veterans with psychiatric or substance abuse problems at 11 Department of Veterans Affairs medical centers that had Homeless Women Veterans Programs. Methods: The intervention consists of 25 sessions that cover topics to help build safety in clients' lives and is present-focused, offering psychoeducation and coping skills. A cohort of homeless women veterans (N=359) was recruited before Seeking Safety was implemented (phase I). After clinicians were trained and certified in Seeking Safety, a postimplementation cohort was recruited and offered Seeking Safety treatment (phase II, N= 91). Phase I lasted from January 2000 to June 2003. Phase II lasted from June 2003 to December 2005. The intervention lasted for six months. All participants were interviewed every three months for one year and received intensive case management and other services during the study. Mixed models were used to compare one-year clinical outcomes across phases. Results: There were few differences across groups at baseline. All women entering the Homeless Women Veterans Programs showed significant improvement on most clinical outcome measures over one year. The Seeking Safety cohort reported significantly better outcomes over one year in employment, social support, general symptoms of psychiatric distress, and symptoms of post-traumatic stress disorder, particularly in the avoidance and arousal clusters. However, the Seeking Safety cohort was significantly more likely to have used drugs in the past 30 days. Conclusions: Seeking Safety appears to have had a moderately beneficial impact on several clinical outcomes. Although the nonequivalent comparison groups and low follow-up rates limit the internal validity of these results, availability of Seeking Safety may be of benefit for homeless female veterans. It is noteworthy that it could be delivered and implemented by case managers with little or no prior counseling experience.

Dragan M; Lis-Turlejska M. Lifetime exposure to potentially traumatic events in a sample of alcohol-dependent patients in Poland. Journal of Traumatic Stress 20(6): 1041-1051, 2007. (29 refs.)

Recent studies show a high prevalence of traumatic events in samples of patients with a substance use disorder. In the present study, the lifetime exposure to potentially traumatic events (PTEs) was estimated in a sample of 458 patients recruited at 17 randomly chosen alcohol-dependence treatment units in the public healthcare sector in Poland. Eighty percent of the patients reported a history of at least one potentially traumatic event. Sixty percent of them reported experiencing more than one probable trauma. However, only the patients who experienced physical assault reported worse clinical severity in posttraumatic stress and alcohol-use related symptomatology. The findings confirm the importance of trauma assessment in alcohol-dependent patients and the inclusion of trauma-related issues in the treatment of alcohol dependence.

Dragan M; Lis-Turlejska M. Prevalence of posttraumatic stress disorder in alcohol dependent patients in Poland. Addictive Behaviors 32(5): 902-911, 2007. (29 refs.)

The present study investigates the prevalence of comorbid posttraumatic stress disorder (PTSD) in a sample of Polish alcohol dependent patients and examines the relationship between cornorbid PTSD and alcohol use-related problems. Patients (n=458) were recruited from randomly chosen clinical settings and were administered self-report measures of trauma exposure, PTSD symptornatology, and alcohol use-related problems. From this sample, 67% of the patients reported having experienced at least one criterion A traumatic event, and 60% of them reported multiple traumas. Approximately 25% of them met the criteria for current PTSD. The only significant difference between the PTSD and non-PTSD groups was abuse/dependence of other psychoactive substances. However, patients reporting physical assaults committed by a non-stranger reported more frequent PTSD diagnosis, more extensive symptomatology, more conflicts with the law and more physical injuries due to drinking. The findings of the study confirm the importance of assessing trauma and PTSD in alcohol dependent patients.

Driessen M; Schulte S; Luedecke C; Schaefer I; Sutmann F; Ohlmeier M et al. Trauma and PTSD in patients with alcohol, drug, or dual dependence: A multi-center study. Alcoholism: Clinical and Experimental Research 32(3): 481-488, 2008. (22 refs.)

Background: We investigated (1) the prevalence of posttraumatic stress disorder (PTSD) in treatment-seeking subjects with substance use dependence (SUD), (2) the association between comorbid PTSD and the severity and course of addiction and psychopathology, and (3) this association in patients with subsyndromal PTSD, and in trauma exposure without PTSD. Methods: In this cross-sectional study, 459 subjects in 14 German addiction treatment centers participated with alcohol-dependence (A) in 39.7%, drug-dependence (D) in 33.6%, or both (AD) 26.8%. The diagnostic measures included the International Diagnostic Checklists (IDCL), Posttraumatic Diagnostic Scale (PDS), Addiction Severity Index (ASI), and the Brief Psychiatric Rating Scale (BPRS). Associations between independent characteristics and outcomes were analysed by univariate and multivariate statistics. Results: 25.3% of the subjects had PTSD confirmed by both IDCL and PDS with higher rates in the AD (34.1%) and D (29.9%) groups compared with group A (15.4%, p < 0.001). In 22.8%, PTSD was subsyndromal (either IDCL or PDS positive) without significant differences between SUD groups, and 18.3% met PTSD trauma criteria A without PTSD (exposure). After controlling for SUD and gender, trauma subgroups significantly differed regarding the onset of alcohol-related symptoms (p < 0.02), numbers of previous admissions (p < 0.03), severity of SUD (p < 0.001), current craving (p < 0.02), and psychopathology (p < 0.001). We observed the worst outcome in PTSD, while trauma exposure had no effects. Conclusions: The prevalence of PTSD is higher in drug than in alcohol dependence. The more strictly PTSD is diagnosed (by interviewer and questionnaire) the more clearly are associations with characteristics of SUD. PTSD seems to be an independent risk factor for an unfavorable outcome of SUD.

Eiden RD; Foote A; Schuetze P. Maternal cocaine use and caregiving status: Group differences in caregiver and infant risk variables. Addictive Behaviors 32(3): 465-476, 2007. (42 refs.)

This study examined differences between cocaine and non-cocame-using mothers, and between parental and non-parental caregivers of cocaine-exposed infants on caregiver childhood trauma, psychiatric symptoms, demographic, and perinatal risks. Participants included 115 cocaine and 105 non-cocaine mother-infant dyads recruited at delivery. Approximately 19% of cocaine mothers lost custody of their infants by I month of infant age compared to 0.02% of non-cocaine mothers. Mothers who used cocaine during pregnancy had higher demographic and obstetric risks. Their infants had higher perinatal risks. Birth mothers who retained custody of their infants had higher demographic risks and perinatal risks, higher childhood trauma, and higher psychiatric symptoms compared to birth mothers who did not use cocaine and non-parental caregivers of cocaine-exposed infants. Results highlight the importance of addressing childhood trauma issues and current psychiatric symptoms in substance abuse treatment with women who engaged in substance use during pregnancy.

Evans AS; Spirito A; Celio M; Dyl J; Hunt J. The relation of substance use to trauma and conduct disorder in an adolescent psychiatric population. Journal of Child & Adolescent Substance Abuse 17(1): 29-49, 2007. (59 refs.)

Substance abuse is one of the most problematic health risk behaviors among adolescents. Given that research consistently finds increased levels of substance use among adolescents with conduct problems as well as trauma-related symptoms, it is important that substance abuse be examined to better understand its role in Conduct Disorder (CD) and Post-Traumatic Stress Disorder (PTSD). This study further explored whether these relationships were better understood with additive and interactive processes. Adolescents (N = 192) admitted to a psychiatric inpatient unit completed a standard intake evaluation, including checklists and a semi-structured interview. Levels of substance abuse were greater for those with comorbid CD and PTSD as compared with either CD only or PTSD only. This difference was best explained by interactive rather than additive processes. Therefore, treatment implications are discussed.

Fahy A. The unbearable fatigue of compassion: Notes from a substance abuse counselor who dreams of working at Starbuck's. Clinical Social Work Journal 35(3): 199-205, 2007. (31 refs.)

Current research has determined that a larger percent of social workers and other counselors are affected by PTSD types of symptoms when working with traumatized clients than the general population. While much of this research addresses workers in specific trauma areas like sexual assault centers or child welfare agencies, little specific thought has been given towards the special stress that working with Substance Abuse Disorders (SA) and trauma may present. This paper takes a brief look at the issues of vicarious trauma and compassion fatigue with SA practice and describes future investigation pathways toward this goal.

Feldner MT; Babson KA; Zvolensky MJ; Vujanovic AA; Lewis SF; Gibson LE et al. Posttraumatic stress symptoms and smoking to reduce negative affect: An investigation of trauma-exposed daily smokers. Addictive Behaviors 32(2): 214-227, 2007. (43 refs.)

The present investigation examined the relations among posttraumatic stress symptoms and smoking motives. Participants included 100 daily smokers recruited from the community and university settings who reported exposure to at least one traumatic event that met criterion A for posttraumatic stress disorder. Consistent with prediction, higher levels of posttraumatic stress symptoms were associated with smoking to reduce negative affect; this relation was observed after controlling for variance accounted for by number of cigarettes smoked per day and gender. Results are discussed in terms of the implications of smoking to regulate affect among daily smokers who have been exposed to traumatic events.

Ford JD; Hawke J; Alessi S; Ledgerwood D; Petry N. Psychological trauma and PTSD symptoms as predictors of substance dependence treatment outcomes. Behaviour Research and Therapy 45(10): 2417-2431, 2007. (56 refs.)

Psychological trauma and post-traumatic stress disorder (PTSD) may complicate and reduce the effectiveness of treatment for substance use disorders (SUDs). This study assessed trauma history and symptoms of simple and complex PTSD at baseline in a randomized trial of contingency management (CM) compared to standard treatment (ST) with 142 cocaine- or heroin-dependent outpatients. History of exposure to each of eight types of psychological trauma was unrelated to treatment outcome, except for witnessed assaults and emotional abuse. Complex PTSD symptoms were inversely associated with short-term treatment outcomes, and PTSD symptoms were positively related to long-term outcome, independent of the effects of demographics, psychological distress, baseline substance use status, and treatment modality. Complex PTSD symptoms warrant further study as a potential negative prognostic factor in SUD interventions.

Ford JD; Smith SF. Complex posttraumatic stress disorder in trauma-exposed adults receiving public sector outpatient substance abuse disorder treatment. Addiction Research & Theory 16(2): 193-203, 2008. (59 refs.)

Adults with substance use disorders (SUD) often have experienced multiple psychological traumas and suffer from posttraumatic stress disorder (PTSD) and complex PTSD impairments (e.g., dissociation, affect dysregulation). Among adult addiction treatment outpatients with self-reported trauma histories, 50% had PTSD alone, 41% had comorbid PTSD and complex PTSD, and 4% had complex PTSD alone. Compared to PTSD alone, comorbid PTSD/complex PTSD was associated with a history of childhood sexual trauma, sexual retraumatization in adulthood, and more severe PTSD and depression symptoms. Patients with alcohol-related SUDs were at increased risk for PTSD, while those with cocaine or opiate SUDs had a reduced risk of comorbid PTSD/complex PTSD. Gender and ethnicity were unrelated to PTSD or complex PTSD except that women were at lower risk than men for PTSD alone. Complex PTSD may warrant clinical and research evaluation, particularly for patients with histories of childhood sexual trauma and retraumatization.

Fu SS; McFall M; Saxon AJ; Beckham JC; Carmody TP; Baker DG et al. Post-traumatic stress disorder and smoking: A systematic review. (review). Nicotine & Tobacco Research 9(11): 1071-1084, 2007. (89 refs.)

We conducted a systematic review of what is known about the relationship between post-traumatic stress disorder (PTSD) and smoking to guide research on underlying mechanisms and to facilitate the development of evidence-based tobacco treatments for this population of smokers. We searched Medline, PsychINFO, and the Cochrane Central Register of Controlled Trials and identified 45 studies for review that presented primary data on PTSD and smoking. Smoking rates were high among clinical samples with PTSD (40%-86%) as well as nonclinical populations with PTSD (34%-61%). Most studies showed a positive relationship between PTSD and smoking and nicotine dependence, with odds ratios ranging between 2.04 and 4.52. Findings also suggest that PTSD, rather than trauma exposure itself, is more influential for increasing risk of smoking. A small but growing literature has examined psychological factors related to smoking initiation and maintenance and the overlapping neurobiology of PTSD and nicotine dependence. Observational studies indicate that smokers with PTSD have lower quit rates than do smokers without PTSD. Yet a few tobacco cessation treatment trials in smokers with PTSD have achieved quit rates comparable with controlled trials of smokers without mental disorders. In conclusion, the evidence points to a causal relationship between PTSD and smoking that may be bidirectional. Specific PTSD symptoms may contribute to smoking and disrupt cessation attempts. Intervention studies that test behavioral and pharmacological interventions designed specifically for use in patients with PTSD are needed to reduce morbidity and mortality in this population.

Gatz M; Brown V; Hennigan K; Rechberger E; O'Keefe M; Rose T; Bjelajac P. Effectiveness of an integrated, trauma-informed approach to treating women with co-occurring disorders and histories of trauma: The Los Angeles site experience. Journal of Community Psychology 35(7): 863-878, 2007. (27 refs.)

Effectiveness of an integrated trauma-informed approach to treating women with co-occurring disorders and histories of trauma was evaluated. Baseline and 12-month assessments were completed by 136 intervention- and 177 comparison-group women. The intervention group received Seeking Safety, a trauma-specific group treatment focusing on safety and coping skills, in the context of integrated substance abuse and mental health services. The comparison group received similar services but not trauma-specific group treatment. Intervention women showed significantly better treatment retention over three months and greater improvement on posttraumatic stress symptoms and coping skills. On most outcomes, those who completed treatment improved more than those who discontinued. improvements on symptoms of distress and drug problem severity were partially mediated by gains in coping skills.

Grupp K. Women with co-occurring substance abuse disorders and PTSD: How women understand their illness. Journal of Addictions Nursing 19(2): 49-54, 2008. (25 refs.)

This article reports the findings of a qualitative study that explored women's understanding about their illness co-occurring substance use disorders (SUD), and post-traumatic stress disorder (PTSD). The findings are part of a larger study that investigated the effectiveness of Seeking Safety Treatment within a therapeutic community among women with SUD and PTSD co-morbidities. Seventy-eight women in treatment, who met the diagnostic criteria for Post Traumatic Stress Disorder, participated in the study. Typical study participants were Caucasian, heterosexual, single women between 25 and 38 years old, with 2 children, a high school level education, unemployed, and had annual incomes of less than $10,000. This study summarized responses to a questionnaire given to the women when they entered treatment. Responses are summarized according to question. The following represents a general summary: Drugs or addiction caused the illness that brought me to treatment, and it was largely the result of my family life. The illness numbs me. I hope that I can achieve sobriety through the treatment here. I have suffered multiple losses because of my illness, and I am most afraid that I will die because of it. The illness causes me to be very angry. I think my family should treat me lovingly. I have a bad, severe and lifelong illness. The findings of the study are intended to assist in developing effective treatment programs for women with multiple diagnoses accompanying their substance abuse disorders.

Harrington T; Newman E. The psychometric utility of two self-report measures of PTSD among women substance users. Addictive Behaviors 32(12): 2788-2798, 2007. (28 refs.)

Given the high rates of posttraurmatic stress disorder (PTSD) among substance users, integrated programs that target PTSD and substance use are recommended as best practice. To effectively implement such treatments, accurate and reliable PTSD screening instruments are needed. Unfortunately, no standardized PTSD measure has been validated among women substance abusers. Therefore, the goal of this investigation was to examine the psychometric utility of two PTSD measures to optimize the number of women clients correctly identified as meeting diagnostic criterion for PTSD. Forty-four women in residential substance use treatment were administered diagnostic interviews for PTSD (Clinician-Administered PTSD Scale) and then completed questionnaires regarding trauma exposure and related symptoms. In this group, 38.6% of the participants met diagnostic criteria for current PTSD. A score of 38 and above on the PTSD Checklist Civilian Version and a Pennsylvania Inventory score of 25 and above optimally maximized the number of women with PTSD identified and minimized false negative and false positive rates.

Hasin DS; Keyes KM; Hatzenbuehler ML; Aharonovich EA; Alderson D. Alcohol consumption and post-traumatic stress after exposure to terrorism: Effects of proximity, loss, and psychiatric history. American Journal of Public Health 97(12): 2268-2275, 2007. (40 refs.)

Objectives. We examined the effects of exposure to or interpersonal loss resulting from a terrorist attack on posttraumatic stress and alcohol consumption after we controlled for psychiatric history assessed before the attack. Methods. At baseline (1991-1992) and at 1- and 10-year follow-ups, an adult community sample of drinkers living approximately 12 mi (19.2 km) from the World Trade Center were evaluated for alcohol dependence and major depression. Of this group, 82.2% were assessed regarding the impact of the September 11, 2001, attacks, including proximity to the World Trade Center, interpersonal loss, posttraumatic stress, and alcohol consumption. Results. In regression models, interpersonal loss and past major depression, but not proximity to the World Trade Center, predicted posttraumatic stress symptoms. Proximity and past alcohol dependence, but not interpersonal loss, predicted high levels of post-September 11 alcohol consumption. Past alcohol dependence did not modify the proximity-drinking relationship, and past major depression did not modify the loss-posttraumatic stress relationship. Conclusions. Participants' responses to September 11 were specific to their type of exposure and not predetermined by their psychiatric history. A better understanding of responses to traumatic events should assist more effective prevention and intervention efforts.

Hedtke KA; Ruggiero KJ; Fitzgerald MM; Zinzow HM; Saunders BE; Resnick HS et al. A longitudinal investigation of interpersonal violence in relation to mental health and substance use. Journal of Consulting and Clinical Psychology 76(4): 633-647, 2008. (85 refs.)

The authors examined longitudinally the mental health status of women as a function of different types and combinations of exposure to interpersonal violence. A structured telephone interview was administered to a household probability sample of 4,008 women (18-89 years of age), who were then recontacted for 1- and 2-year follow-up interviews. Interviews assessed lifetime violence history (i.e., sexual assault, physical assault, witnessed serious injury or violent death), past-year mental health functioning (i.e., posttraumatic stress disorder [PTSD], depression, and substance use problems), and new instances of violence occurring after the baseline interview. Results indicate that (a) lifetime violence exposure was associated with increased risk of PTSD, depression, and substance use problems; (b) odds of PTSD, depression, and substance use problems increased incrementally with the number of different types of violence experienced; (c) relations were fairly stable over a 2-year period; and (d) new incidents of violence between the baseline and follow-tip interviews were associated with heightened risk of PTSD and substance use problems. Greater understanding of the cumulative impact of violence exposure will inform service provision for individuals at high risk.

Hyman SM; Paliwal P; Chaplin TM; Mazure CM; Rounsaville BJ; Sinha R. Severity of childhood trauma is predictive of cocaine relapse outcomes in women but not men. Drug and Alcohol Dependence 92(1/3): 208-216, 2008. (61 refs.)

We prospectively examined the gender-specific effects of childhood trauma on cocaine relapse outcomes in an inpatient sample of treatment engaged cocaine dependent adults. Cocaine dependent men (n = 70) and women (n = 54) participating in inpatient treatment for cocaine dependence were assessed on severity of childhood trauma and followed for 90 days after discharge from treatment. Greater severity of childhood emotional abuse was associated with an increased risk of relapse in women. Severity of emotional abuse, sexual abuse, and overall childhood trauma was associated with the number of days cocaine was used during follow-up in women, as was the association of severity of physical abuse and overall childhood trauma with the average amount of cocaine used per occasion. No associations between childhood trauma and cocaine relapse outcomes were found in men. These findings demonstrate that childhood trauma increases the likelihood of cocaine relapse and drug use escalation after initial relapse in women but not in men. Comprehensive assessments of childhood trauma and specialized treatments that address trauma-related pathophysiology could be of benefit in improving cocaine treatment outcomes in women.

Kaysen D; Dillworth TM; Simpson T; Waldrop A; Larimer ME; Resick PA. Domestic violence and alcohol use: Trauma-related symptoms and motives for drinking. Addictive Behaviors 32(6): 1272-1283, 2007. (38 refs.)

Alcohol use is frequently associated with posttraumatic stress disorder (PTSD), especially in the face of chronic traumatic experiences. However, the relationship between alcohol use and symptoms associated with chronic trauma exposure has not been evaluated. This study examined alcohol use in recently battered women (N=369). Differences were found in trauma symptoms between abstainers, moderate drinkers, and heavy drinkers, with heavy drinkers reporting more severe symptoms. Mediational analyses suggest that the relationship between drinking and trauma symptoms is mediated by drinking to cope, which has not been previously demonstrated in a battered population. Results suggest the importance of assessing trauma symptoms and motives for drinking in understanding alcohol use in recent survivors of domestic violence.

Killeen T; Hien D; Campbell A; Brown C; Hansen C; Jiang H et al. Adverse events in an integrated trauma-focused intervention for women in community substance abuse treatment. Journal of Substance Abuse Treatment 35(3): 304-311, 2008. (30 refs.)

A substantial number of women who enter substance abuse treatment have a history of trauma and meet criteria for posttraumatic stress disorder (PTSD). Fear regarding the extent to which PTSD treatment can evoke negative consequences remains a research question. This study explored adverse events related to the implementation of an integrated treatment for women with trauma and substance use disorder (Seeking Safety) compared with a nontrauma-focused intervention (Women's Health Education). Three hundred fifty-three women enrolled in community substance abuse treatment were randomized to 1 of the 2 study groups and monitored weekly for adverse events. There were no differences between the two intervention groups in the number of women reporting study-related adverse events (28 [9.6%] for the Seeking Safety group and 21[7.2%] for the Women's Health Education group). Implementing PTSD treatment in substance abuse treatment programs appears to be safe, with minimal impact on intervention-related adverse psychiatric and substance abuse symptoms. More research is needed on the efficacy of such interventions to improve outcomes of PTSD and substance use.

Kirby AC; Hertzberg BP; Collie CF; Yeatts B; Dennis MF; McDonald SD et al. Smoking in help-seeking veterans with PTSD returning from Afghanistan and Iraq. Addictive Behaviors 33(11): 1448-1453, 2008. (39 refs.)

Past research has shown that veterans and individuals with posttraumatic stress disorder (PTSD) have increased rates of smoking. However, the rates of smoking in younger help-seeking veterans returning from Afghanistan and Iraq, and possible correlates of smoking among this population are unknown. In this study, we evaluated the rate of lifetime and current smoking among a sample of 90 returning male veterans diagnosed with PTSD. Fifty-nine percent reported a lifetime history of smoking including 32% that were current smokers. Current smokers were significantly younger than non-smokers. Current smokers (mean age=31) reported a mean age of smoking onset as 15.86 with a pack year history of 8.89. These smokers reported on average five previous quit attempts. According to a stages of change model, one-half of the smokers were in the contemplation phase of stopping smoking (50%), 29% were in the pre-contemplation phase and 21% were in the preparation phase. The results are placed in the context of non-psychiatric and psychiatric smokers.

Koenen KC; Stellman SD; Sommer JE; Stellman JM. Persisting posttraumatic stress disorder symptoms and their relationship to functioning in Vietnam veterans: A 14-year follow-up. Journal of Traumatic Stress 21(1): 49-57, 2008. (37 refs.)

The authors examined the longitudinal association between persisting posttraumatic stress disorder (PTSD) symptoms and multiple domains of life functioning in a community sample of 1,377 American Legionnaire Vietnam veterans first assessed in 1984 and followed-up 14 years later. Almost 30 years after their return from Vietnam, 10% of veterans continued to experience severe PTSD symptoms. At all levels of combat exposure, persisting severe PTSD symptoms were associated with worse family relationships more smoking, less life satisfaction and happiness, more mental health service use, and more nonspecific health complaints at the 14-year follow-up. Further investigation is needed to determine whether the PTSD-functioning relationship is causal and if successful treatment of PTSD is associated with improvement in functioning.

Lester KM; Milby JB; Schumacher JE; Vuchinich R; Person S; Clay OJ. Impact of behavioral contingency management intervention on coping behaviors and PTSD symptom reduction in cocaine-addicted homeless. Journal of Traumatic Stress 20(4): 565-575, 2007. (34 refs.)

The purpose of this study was to examine changes in posttrauma symptoms among 118 homeless cocaine-dependent adults participating in a randomly controlled trial studying effective treatments for dually diagnosed homeless individuals. Among those with trauma exposure and PTSD symptoms, the group receiving more behaviorally intensive, contingency management treatment had significantly greater reductions in PTSD symptomatology than did the group receiving less-intensive treatment. Regression analyses revealed that greater positive distraction coping and lower negative avoidance coping at baseline, in addition to changes in avoidance coping over the 6-month study period, were significantly related to greater symptom and severity reductions. The study provides some initial evidence of important treatment outcomes other than abstinence in addiction-related interventions.

Levander E; Frye MA; McElroy S; Suppes T; Grunze H; Nolen WA et al. Alcoholism and anxiety in bipolar illness: Differential lifetime anxiety comorbidity in bipolar I women with and without alcoholism. Journal of Affective Disorders 101(1-3): 211-217, 2007. (33 refs.)

Introduction: This study was undertaken to evaluate the prevalence rate of anxiety comorbidity in bipolar subjects with and without alcohol use disorders (AUD). Methods: Bipolar men and women who entered the Stanley Foundation Bipolar Network (SFBN) underwent a Structured Clinical Interview for DSM-IV (SCID-IV) and were divided into those subjects meeting current or lifetime criteria for an alcohol use disorder (AUD = 213) vs. those subjects who did not (non-AUD = 137). Lifetime rates of comorbid anxiety disorder were evaluated between groups. Results: Of 350 subjects, 163 (46.5%) met criteria for an anxiety disorder. Panic disorder and OCD were the most common anxiety disorders in the AUD and non-AUD groups. OCD and specific phobia were significantly less prevalent in BP 1 patients with AUD compared to those without. Bipolar women with AUD had a significantly higher rate of PTSD than those without. Conclusion: These data highlight the added liability of anxiety comorbidity in BP disorder. Specifically, the greater amount of PTSD and lesser amount of OCD in bipolar women with alcohol comorbidity may have important diagnostic and treatment implications beyond dual diagnosis. Further study in comorbidity patterns is encouraged to not only better understand illness burden, but to maximize pattern-specific treatment outcomes.

Marshall EC; Zvolensky MJ; Vujanovic AA; Gibson LE; Gregor K; Bernstein A. Evaluation of smoking characteristics among community-recruited daily smokers with and without posttraumatic stress disorder and panic psychopathology. Journal of Anxiety Disorders 22(7): 1214-1226, 2008. (62 refs.)

The present investigation compared 123 community-recruited daily smokers with posttraumatic stress disorder (PTSD), panic disorder (PD), nonclinical panic attacks (PA), or no current Axis I psychopathology (controls; Q in terms of nicotine dependence, smoking rate, quit history, severity of symptoms during past quit attempts, and motivation for and expectancies about smoking. No differences were observed between groups in regard to smoking rate or nicotine dependence. The PTSD group reported making more lifetime quit attempts than the other groups, and the PTSD and PD groups perceived more severe symptoms during past quit attempts. The PD and PTSD groups reported greater motivation to smoke to reduce negative affect. Individuals with PTSD endorsed a stronger expectation that smoking would alleviate negative mood states and would produce negative consequences. Overall, results suggest that smokers with PD or PTSD differ from other smoking groups in a number of clinically significant ways.

Mills KL; Teesson M; Ross J; Darke S. Predictors of trauma and PTSD among heroin users: A prospective longitudinal investigation. Journal of Drug Issues 38(2): 585-599, 2008. (30 refs.)

This study is the first to examine exposure to trauma and the development of PTSD prospectively among heroin users. Participants were 309 heroin users followed up over two years as part of the Australian Treatment Outcome Study. Forty-one percent reported trauma exposure, and 5.8% developed PTSD over the follow-up period. Baseline characteristics that independently predicted trauma exposure were younger age and a history of imprisonment. Those who developed PTSD did not differ from those with a history of PTSD at baseline on any characteristics. Those who developed PTSD were, however, more likely to have a history of attempted suicide compared to those with no history of PTSD. These findings suggest that there is a need for trauma prevention programs particularly targeting younger people, those with a history of imprisonment, and those with a history of attempted suicide, who may be more susceptible to trauma exposure and the development of PTSD.

Mills K; Teesson M; Darke S; Ross J. Reliability of self-reported trauma exposure among people with heroin dependence: A longitudinal investigation. Journal of Traumatic Stress 20(3): 313-323, 2007. (42 refs.)

Estimates of trauma exposure rely almost exclusively on retrospective self-reports; however, the reliability of these reports has received little attention. The present study examined the reliability of self-reported lifetime trauma exposure among 309 dependent heroin users over 2 years, and the factors associated with inconsistent recall. The correlation between the number of events reported at baseline and follow-up was.72; however, 87% of the sample reported at least one event inconsistently. Variability in reporting was associated with trauma type, a lifetime posttraumatic stress disorder, and antisocial personality disorder. These findings suggest that dependent heroin users are moderately reliable in their reports of trauma exposure, and their reports of trauma exposure are as reliable as those of nonsubstance use disordered samples.

Mills KL; Teesson M; Ross J; Darke S. The impact of post-traumatic stress disorder on treatment outcomes for heroin dependence. Addiction 102(3): 447-454, 2007. (36 refs.)

Aims: To examine the impact of post-traumatic stress disorder ( PTSD) on 2-year treatment outcomes for heroin dependence. Design: Prospective longitudinal study. Participants Data were obtained from a predominantly treatment seeking sample of 615 dependent heroin users who were followed-up at 3, 12 and 24 months (follow-up rates: 89%, 81% and 76%, respectively). Measurements: Outcomes examined include treatment retention and exposure, substance use, general physical and mental health and employment. Findings Despite improvements in substance use, PTSD was associated with continued physical (beta - 1.69, SE 0.61, P < 0.01) and mental disability (beta - 2.07, SE 0.66, P < 0.01), and reduced occupational functioning ( OR 0.67, 95% CI: 0.48-0.93) throughout the 2-year follow-up. Conclusions: Although conventional treatment services are successful in producing improvements in substance use and associated disability, the disability associated with PTSD remains. An intervention targeting both heroin dependence and PTSD may help to improve the outcomes of those with PTSD.

Najavits LM; Harned MS; Gallop RJ; Butler SF; Barber JP; Thase ME; Crits-Christoph P. Six-month treatment outcomes of cocaine-dependent patients with and without PTSD in a multisite national trial. Journal of Studies on Alcohol and Drugs 68(3): 353-361, 2007. (54 refs.)

Objective: This study examined 6-month treatment outcomes among 428 cocaine-dependent outpatients with (n = 34) and without (n = 394) posttraumatic stress disorder (PTSD) in a randomized controlled multisite clinical trial of manual-based psychotherapies for substance use disorder (SUD). Method: Assessments were completed at baseline and monthly during the 6-month treatment. With longitudinal mixed-effects models, we compared outcomes between SUD-PTSD and SUD-only patients and also examined rates of within-group change. Results: Results indicated a highly consistent pattern: the SUD-PTSD patients were more impaired to begin with and remained so across time compared with SUD-only patients (with the exception of substance use and addiction-related legal and employment problems, which did not differ between groups). Also, the SUD-PTSD patients improved less than SUD-only patients in alcohol use and the majority of addiction-related psychosocial problems. However, the two groups did not differ significantly in improvement over time on drug use or global psychological severity. Conclusions: The greater impairment and relative lack of improvement of SUD-PTSD patients, compared with those with SUD-only, suggest a need for dual-diagnosis treatments that more directly target their areas of difficulty.

Norman SB; Inaba RK; Smith TL; Brown SA. Development of the PTSD-Alcohol Expectancy Questionnaire. Addictive Behaviors 33(6): 841-847, 2008. (14 refs.)

Alcohol effect expectancies have important implications in our understanding drinking behavior and motivations for drinking. Several instruments have been developed to asses alcohol expectancies among various populations. Although co-occurrence of PTSD among those with alcohol use disorders is extremely common, there is no measure of PTSD-related alcohol expectancies. The Post-traumatic stress disorder-Alcohol Expectancy Questionnaire (P-AEQ) is a 27-item, self-report questionnaire that was developed to measure individuals' beliefs about the effects of alcohol with regard to symptoms of post-traumatic stress disorder. The P-AEQ was found to measure two primary dimensions, positive and negative alcohol effect expectancies. This instrument demonstrated internal consistency, reliability, and concurrent validity within the Alcohol Expectancies Questionnaire. In addition, the P-AEQ appears to be capable of differentiating AUD from non-AUD populations in a male veteran sample.

Norman SB; Tate SR; Anderson KG; Brown SA. Do trauma history and PTSD symptoms influence addiction relapse context? Drug and Alcohol Dependence 90(1): 89-96, 2007. (49 refs.)

Exposure to traumatic events is common among individuals with substance use disorders (SUD), although not all go on to develop PTSD. We compared SUD treatment outcomes and relapse features in three groups of male veterans receiving SUD treatment: (I) those without trauma exposure (SUD-only: n=68), (2) those with PTSD (SUD-PTSD; n=32), and (3) those with trauma exposure but no PTSD (SUD-trauma; n=34). Veterans were assessed regarding psychiatric symptoms, substance use, and relapse features quarterly for I year. The groups did not differ on length of abstinence, relapse prevalence or severity. SUD-PTSD and SUD-trauma reported more depression, anxiety, PTSD, and total psychiatric symptoms prior to relapse than SUD-only. SUD-PTSD and SUD-trauma also endorsed more PTSD, and total symptoms following relapse than SUD-only. PTSD symptoms were associated with greater risk of relapse in intrapersonal and negative physiological contexts. Understanding relapse contexts for those experiencing PTSD symptoms can help us to understand one mechanism whereby those with both PTSD and SUD have a poorer clinical course.

Olff M; Langeland W; Draijer N; Gersons BPR. Gender differences in posttraumatic stress disorder. Psychological Bulletin 133(2): 183-204, 2007. (263 refs.)

One of the most consistent findings in the epidemiology of posttraumatic stress disorder (PTSD) is the higher risk of this disorder in women. Explanations reviewed within a psychobiological model of PTSD suggest that women's higher PTSD risk may be due to the type of trauma they experience, their younger age at the time of trauma exposure, their stronger perceptions of threat and loss of control, higher levels of peritraumatic dissociation, insufficient social support resources, and greater use of alcohol to manage trauma-related symptoms like intrusive memories and dissociation, as well as gender-specific acute psychobiological reactions to trauma. This review demonstrates the need for additional research of the gender differences in posttraumatic stress. Recommendations are made for clinical practice.

Pat-Horenczyk R; Peled P; Miron O; Brom D; Villa Y; Chemtob CM. Risk-taking behaviors among Israeli adolescents exposed to recurrent terrorism: Provoking danger under continuous threat? American Journal of Psychiatry 164(1): 66-72, 2007. (9 refs.)

OBJECTIVE: This study aimed to assess 1) the relationship between risk-taking behaviors and exposure to terrorism, 2) the relationship between posttraumatic symptoms and risk-taking behaviors, and 3) gender differences in the type and frequency of risk-taking behaviors and their differential associations with posttraumatic symptoms. METHOD: The participants were 409 Israeli adolescents 15 to 18 years of age. Exposure to terrorism was assessed with a questionnaire developed specifically for the Israeli security situation. Posttraumatic symptoms were measured with the University of California at Los Angeles Reaction Index. Functional impairment was measured with the Diagnostic Interview Schedule for Children. Risk-taking behavior-and the adolescents' perceptions of such behavior-was assessed with a self-report questionnaire. RESULTS: Israeli adolescents exposed to continuous threats of terrorist attacks reported high levels of risk-taking behaviors. The severity of risk-taking was associated with greater terrorism exposure. Adolescents suffering from posttraumatic symptoms reported more risk-taking behaviors than nonsymptomatic adolescents. Although there was no gender difference in the degree of exposure to terrorism, boys reported taking more risks than girls. The association between posttraumatic symptoms and risk-taking behaviors was stronger in boys than girls. Functional impairment, gender, avoidance symptoms, level of exposure, and degree of fear predicted the severity of risk-taking behaviors. CONCLUSIONS: Clinicians and educators should be aware of the strong link between posttraumatic distress and risk-taking behaviors. Risk-taking behaviors may be a manifestation of functional impairment and posttraumatic distress, especially for boys exposed to terrorism.

Peirce JM; Kindbom KA; Waesche MC; Yuscavage ASE; Brooner RK. Posttraumatic stress disorder, gender, and problem profiles in substance dependent patients. Substance Use & Misuse 43(5): 596-611, 2008. (24 refs.)

Patients with a chronic and severe substance use disorder who also have a history of posttraumatic stress disorder (PTSD) are thought to have a unique set of problems. The present study assessed psychiatric disorders, psychosocial problems, and traumatic events with structured interviews in 747 men and 693 women enrolling in urban opioid substitution treatment programs from 1995 to 2001. Participants with versus without a history of PTSD were more likely to have a history of many other psychiatric disorders and demonstrated more current and historical medical, employment, family/social, and psychiatric problems. PTSD was generally unrelated to substance use disorder severity or diagnoses, with the exception of an increased risk of alcohol dependence. Women were more likely than men to have experienced sexual assault, and less likely to have been physically assaulted, although these events precipitated PTSD at equivalent rates across gender In contrast, witnessing or hearing about the death or injury of others was more likely to precipitate PTSD in women than men. Female gender exposure to combat, sexual assault, or physical assault, and a history of major mood or anxiety disorder were the best predictors of PTSD in this group. Study limitations are noted.

Plotzker RE; Metzger DS; Holmes WC. Childhood sexual and physical abuse histories, PTSD, depression, and HIV risk outcomes in women injection drug users: A potential mediating pathway. American Journal on Addictions 16(6): 431-438, 2007. (43 refs.)

We explored links between childhood sexual abuse (CSA), childhood physical abuse (CPA), posttraumatic stress disorder (PTSD)/depression, and women injection drug users' (IDUs') risk in 113 women recruited from two syringe exchange sites. More than half (56%) reported CSA, 68% CPA, 23% likely were depressed-only, and 53% likely had PTSD/depression. CSA was associated with sexual (p = 0.003) and drug risk (p = 0.05); CPA was not. CSA was associated with PTSD=depression (p = 0.03); PTSD/depression was associated with sexual (p < 0.01) and drug (p < 0.03) risk. After PTSD/depression adjustment, CSA was no longer associated with sexual or drug risk. These results suggest that women IDUs' CSA-to-risk path is mediated by PTSD/depression.

Rash CJ; Coffey SF; Baschnagel JS; Drobes DJ; Saladin ME. Psychometric properties of the IES-R in traumatized substance dependent individuals with and without PTSD. Addictive Behaviors 33(8): 1039-1047, 2008. (49 refs.)

Posttraumatic stress disorder (PTSD) is common among treatment-seeking substance abusers. Despite the high prevalence of these co-occurring conditions, few PTSD screening tools have been evaluated for their utility in identifying PTSD in substance use disorder (SUD) populations. The present study evaluated the psychometric properties of the Impact of Event Scale-Revised (IES-R) in a sample of 124 substance dependent individuals. All participants had a history of a DSM-IV Criterion A traumatic event, and 71 individuals met diagnostic criteria for PTSD. Participants with comorbid PTSD reported significantly more symptoms of anxiety, depression, and PTSD compared to substance dependent individuals without PTSD. Acceptable internal consistency and convergent validity of the IES-R were established among a Substance dependent sample. Examination of diagnostic effectiveness suggested a cutoff value of 22 as optimal for a substance using population, resulting in adequate classification accuracy, sensitivity, and specificity.

Reed PL; Anthony JC; Breslau N. Incidence of drug problems in young adults exposed to trauma and Posttraumatic stress disorder: Do early life experiences and predispositions matter? Archives of General Psychiatry 64(12): 1435-1442, 2007. (65 refs.)

Context: Most estimated associations of posttraumatic stress disorder (PTSD) with DSM-IV drug dependence and abuse are from cross-sectional studies or from prospective studies of adults that generally do not take into account suspected causal determinants measured in early childhood. Objective: To estimate risk for incident drug disorders associated with prior DSM-IV PTSD. Design: Multiwave longitudinal study of an epidemiologic sample of young adults first assessed at entry to first grade of primary school in the fall semesters of 1985 and 1986, with 2 young adult follow-up assessments. Setting: Mid-Atlantic US urban community. Participants: Young adults (n=988; aged 19-24 years) free of clinical features of DSM-IV drug use disorders at the first young adult assessment and therefore at risk for newly incident drug use disorders during the 1-year follow-up period. Main Outcome Measures: During the 12-month interval between the 2 young adult follow-up assessments, newly incident (1) DSM-IV drug abuse or dependence; (2) DSM-IV drug abuse; (3) DSM-IV drug dependence; and (4) emerging dependence problems (1 or 2 newly incident clinical features of DSM-IV drug dependence), among subjects with no prior clinical features of drug use disorders. Results: Prior PTSD (but not trauma only) was associated with excess risk for drug abuse or dependence (adjusted relative risk, 4.9; 95% confidence interval, 1.6-15.2) and emerging dependence problems (adjusted relative risk, 4.9; 95% confidence interval, 1.2-20.1) compared with the no-trauma group controlling for childhood factors. Subjects with PTSD also had a greater adjusted relative risk for drug abuse or dependence compared with subjects exposed to trauma only (adjusted relative risk, 2.0; 95% confidence interval, 1.1-3.8) controlling for childhood factors. Conclusions: Association of PTSD with subsequent incident drug use disorders remained substantial after statistical adjustment for early life experiences and predispositions reported in previous studies as carrying elevated risk for both disorders. Posttraumatic stress disorder might be a causal determinant of drug use disorders, possibly representing complications such as attempts to self-medicate troubling trauma-associated memories, nightmares, or painful hyperarousal symptoms.

Resnick HS; Acierno R; Amstadter AB; Self-Brown S; Kilpatrick DG. An acute post-sexual assault intervention to prevent drug abuse: Updated findings. Addictive Behaviors 32(10): 2032-2045, 2007. (36 refs.)

Sexual assault and rape routinely produce extreme distress and negative psychological reactions in victims. Further, past research suggests that victims are at increased risk of developing substance use or abuse post-rape. The post-rape forensic medical exam may itself exacerbate peritraumatic distress because it includes cues that may serve as reminders of the assault, thereby potentiating post-assault negative sequelae. To address these problems, a two-part video intervention was developed to take advantage of the existing sexual assault forensic exam infrastructure, and to specifically (a) minimize anxiety/discomfort during forensic examinations, thereby reducing risk of future emotional problems, and (b) prevent increased substance use and abuse following sexual assault. Updated findings with a sample of 268 sexual assault victims participating in the forensic medical exam and completing one or more follow-up assessments at: (1)< 3 months post-assault; (2) 3 to 6 months post-assault; or (3) 6 months or longer post-assault indicated that the video was associated with significantly lower frequency of marijuana use at each time point, among women who reported use prior to the assault.

Roxburgh A; Degenhardt L; Copeland J; Larance B. Drug dependence and associated risks among female street-based sex workers in the greater Sydney area, Australia. Substance Use & Misuse 43(8/9): 1202-1217, 2008. (44 refs.)

Background: This study examines drug use and dependence and associated risks among female street-based sex workers. Methods: Cross-sectional data collected from 72 women between April and August 2005 in Sydney, Australia, via face-to-face interviews. Sample: The average age was 34 years. Results: Risk factors associated with developing problematic drug use were prevalent. Child sexual abuse, leaving home before the age of 16, and exposure to multiple traumas was common. Depression and posttraumatic stress disorder were also prevalent. A substantial minority reported cocaine dependence which was associated with engaging in sex and injecting risk behaviors. Conclusions: More targeted interventions for this group are needed. Research on the value of extending existing outreach services to further reduce the harms associated with sex work and drug use is indicated. The study's limitations are noted.

Schafer I; Najavits LM. Clinical challenges in the treatment of patients with posttraumatic stress disorder and substance abuse. Current Opinion in Psychiatry 20(6): 614-618, 2007. (59 refs.)

Purpose of review The aim of this article is to review the current literature on co-occuring posttraumatic stress disorder and substance-use disorder, with an emphasis on clinical aspects and emerging treatments. Recent findings In clinical populations (focusing on either disorder), about 25-50% have a lifetime dual diagnosis of posttraumatic stress disorder and substance-use disorder. Patients with both disorders have a more severe clinical profile than those with either disorder alone, lower functioning, poorer well being, and worse outcomes across a variety of measures. In recent years, several promising treatment programs have been developed specifically for co-occuring posttraumatic stress disorder and substance-use disorder, with one model having been established as effective thus far. Summary Comorbid posttraumatic stress disorder/substance-use disorder is a frequent diagnosis in clinical populations that severely affects course and outcome. Treatment approaches appropriate for this vulnerable population need to be evaluated further and implemented in routine practice.

Seal KH; Bertenthal D; Maguen S; Gima K; Chu A; Marmar CR. Getting beyond "Don't Ask; Don't Tell": an evaluation of US veterans administration postdeployment mental health screening of veterans returning from Iraq and Afghanistan. American Journal of Public Health 98(4): 714-720, 2008. (26 refs.)

Objectives. We sought to evaluate outcomes of the Veterans Administration (VA) Afghan and Iraq Post-Deployment Screen for mental health symptoms. Methods. Veterans Administration clinicians were encouraged to refer Iraq or Afghanistan veterans who screened positive for posttraumatic stress disorder, depression, or high-risk alcohol use to a VA mental health clinic. Multivariate methods were used to determine predictors of screening, the proportions who screened positive for particular mental health problems, and predictors of VA mental health clinic attendance. Results. Among 750 Iraq and Afghanistan veterans who were referred to a VA medical center and 5 associated community clinics, 338 underwent postdeployment screening; 233 (69%) screened positive for mental health problems. Having been seen in primary care (adjusted odd ratio [AOR] = 13.3; 95% confidence interval [CI] = 8.311, 21.3) and at a VA community clinic (AOR= 3.28; 95% CI=2.03, 5.28) predicted screening. African American veterans were less likely to have been screened than were White veterans (AOR= 0.45; 95% CI = 0.22, 0.91). Of 233 veterans who screened positive, 170 (73%) completed a mental health follow-up visit. Conclusions. A substantial proportion of veterans met screening criteria for co-occurring mental health problems, suggesting that the VA screens may help overcome a "don't ask, don't tell" climate that surrounds stigmatized mental illness. Based on data from 1 VA facility, VA postdeployment screening increases mental health clinic attendance among Iraq and Afghanistan veterans.

Shaffer HJ; Nelson SE; LaPlante DA; LaBrie RA; Albanese M; Caro G. The epidemiology of psychiatric disorders among repeat DUI offenders accepting a treatment-sentencing option. Journal of Consulting and Clinical Psychology 75(5): 795-804, 2007. (51 refs.)

Psychiatric comorbidity likely contributes to driving tinder the influence (DUI) of alcohol among repeat offenders. This study presents one of the first descriptions of the prevalence and comorbidity of psychiatric disorders among repeat DUI offenders in treatment. Participants included all consenting eligible admissions (N = 729) to a 2-week inpatient treatment facility for court-sentenced repeat DUI offenders (i.e., offenders electing treatment in place of prison time) from April 17, 2005, to April 23, 2006. Participants completed the Composite International Diagnostic Interview, which assessed the following disorders using criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994): alcohol use and drug use, bipolar, generalized anxiety, posttraumatic stress, intermittent expolosive, conduct, attention deficit, nicotine dependence, pathological gambling, and major depressive. Repeat DUI offenders evidenced higher lifetime and 12-month prevalence of alcohol use and drug use disorders, conduct disorder, postraumatic stress disorder, generalized anxiety disorder, and bipolar disorder compared with the general population. Almost half qualified for lifetime diagnoses of both addiction (i.e., alcohol, drug, nicotine, and/or gambling) and a psychiatric disorder. Lifetime and past-year comorbidity rates were higher among participants than in the general population. These results suggest that clinicians should consider multimorbidity within DUI treatment protocols.

Stump MJ; Smith JE. The relationship between posttraumatic growth and substance use in homeless women with histories of traumatic experience. American Journal on Addictions 17(6): 478-487, 2008. (62 refs.)

Posttraumatic growth (PTG) namely, the experience of positive change in oneself or one's life following traumais particularly relevant for homeless women because they have greater trauma exposure than the general population, as well as higher rates of substance use. The present study examined PTG and substance use in this population. Fifty homeless women with trauma histories participated. In line with predictions, more current substance use was related to less PTG, more reliance on avoidant coping once approach coping was accounted for, and greater PTSD symptomatology. Levels of growth were comparable to those found in samples with less trauma exposure.

Tate SR; Norman SB; McQuaid JR; Brown SA. Health problems of substance-dependent veterans with and those without trauma history. Journal of Substance Abuse Treatment 33(1): 25-32, 2007. (35 refs.)

Substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) are associated with an increased risk for health problems. We examined whether trauma history and PTSD were related to physical health in patients with an SUD. We compared health stressors, health service utilization, and self-rated health status in three groups of male veterans receiving SUD treatment: (1) no trauma exposure (SUD-only group), n = 55; (2) with PTSD (SUD-PTSD group), n = 32; and (3) trauma exposure without PTSD (SUD-trauma group), n = 34. The veterans were assessed quarterly for I year. Groups differed in their likelihood of experiencing chronic health stressors at all time points. The SUD-only group consistently had the lowest rates of chronic health stressors, the SUD-PTSD group had the highest rates, and the SUD-trauma group fell in between. In contrast, groups did not differ in rates of acute health problems. Chronic health stressors appear to be associated with trauma exposure and psychologic response to the trauma. Substance use disorder interventions may benefit from incorporation of primary care services.

Testa M; Livingston JA; Hoffman JH. Does sexual victimization predict subsequent alcohol consumption? A prospective study among a community sample of women. Addictive Behaviors 32(12): 2926-2939, 2007. (48 refs.)

Although rape and sexual victimization experiences have been hypothesized to contribute to subsequent heavy drinking and alcohol problems among women, little prospective evidence exists. The present prospective study examined whether sexual victimization contributes to subsequent heavy drinking among a community sample of women, 18-30 years of age (n=927). Using three waves of data, 12 months apart, we examined the impact of T I sexual victimization on T2 heavy drinking, and of T2 sexual victimization on T3 heavy drinking. There were significant bivariate differences between sexually victimized and non-victimized women on heavy drinking both concurrently and prospectively. However, after controlling for prior heavy drinking and demographic variables, most differences disappeared. We also tested the hypothesis that Post-Traumatic Stress Disorder (PTSD) Symptoms would mediate the relationship between T2 sexual victimization and T3 heavy drinking. Although T2 sexual victimization predicted T2 PTSD symptoms, PTSD did not contribute to subsequent heavy drinking. Findings suggest that heavy drinking is relatively stable over time and that sexual victimization does not make a substantial independent contribution to heavy drinking among women in the general population.

Thompson SJ; Maccio EM; Desselle SK; Zittel-Palamara K. Predictors of posttraumatic stress symptoms among runaway youth utilizing two service sectors. Journal of Traumatic Stress 20(4): 553-563, 2007. (37 refs.)

Youth who run away often experience situations that produce symptoms of traumatic distress. This exploratory study assessed predictors of trauma symptomatology among runaway youth who had been admitted to youth emergency shelter services or juvenile detention. Findings demonstrated high levels of trauma-related symptoms for both groups. Worry about family, greater runaway episodes, and living with a father who abused alcohol/drugs significantly predicted higher posttraumatic stress symptoms in detained youth, whereas only worry about family relationships predicted higher trauma symptom scores among youth in emergency shelter care. Findings suggest distressful family life may induce complex emotional responses in youth. Although services to runaway youth must continue to focus on safe, short-term residential care, trauma issues must be acknowledged.

Toussaint DW; VonDeMork NR; Bornemann A; Graeber CJ. Modifications to the trauma recovery and empowerment model (TREM) for substance-abusing women with histories of violence: Outcomes and lessons learned at a Colorado substance abuse treatment center. Journal of Community Psychology 35(7): 879-894, 2007. (38 refs.)

A growing body of literature demonstrates the co-occurrence of posttraumatic stress disorder and substance use disorder for females seeking substance abuse treatment. Nonetheless, relatively few trauma-specific treatments have been implemented or evaluated with this population. In this quasi-experimental study (N = 170), the Trauma Recovery and Empowerment Model (TREM) was modified for use in an existing residential substance abuse program. Women who participated in the TREM showed significantly better outcomes than those who received treatment-as-usual on trauma-related symptoms, although not on alcohol or drug use. TREM appears to be a promising model that can be embedded in a residential substance abuse treatment setting. Implications for practice and further research are discussed.

van der Velden PG; Kleber RJ; Koenen KC. Smoking predicts posttraumatic stress symptoms among rescue workers: A prospective study of ambulance personnel involved in the Enschede Fireworks Disaster. Drug and Alcohol Dependence 94(1/3): 267-271, 2008. (26 refs.)

Background: Examining whether smoking is a risk factor for posttraumatic stress disorder (PTSD) symptoms among rescue workers affected by a disaster. Methods: Ambulance personnel (N = 66) participated in surveys 2-3 weeks (T1) and 18 months after a fireworks disaster (T2). Hierarchical multiple regression analyses were conducted with cigarette consumption at T1 as a predictor of PTSD symptoms at T2. Demographic characteristics, disaster experiences, peritraumatic dissociation, intrusions and avoidance, psychological distress and alcohol consumption assessed at T1 were included as covariates. Results: Regression analyses showed that smoking at T1 independently predicted intrusions, avoidance, hostility, and depression symptoms at T2. Results were not affected by controlling for post-disaster critical incidents at work. Conclusions: This is the first prospective study among rescue workers demonstrating that smoking soon after a disaster predicts PTSD symptoms in the intermediate term. Findings substantiate results of previous studies indicating that smoking is a relevant risk factor. Future research on how changes in cigarettes consumption post-trauma affect risk of PTSD is required.

Vaughn MG; Ollie MT; McMillen JC; Scott L; Munson M. Substance use and abuse among older youth in foster care. Addictive Behaviors 32(9): 1929-1935, 2007. (5 refs.)

The purpose of this study was to explore prevalence and predictors of current and lifetime substance use, substance abuse disorder, and polysubstance use among older youth in foster care. Interviews were conducted with 406 17-year old youth (90% of those eligible) in one state's foster care system between December 2001 and June 2003. Forty-five percent of foster care youth reported using alcohol or illicit drugs within the last six months; 49% had tried drugs sometime during their lifetime and 35% met criteria for a substance use disorder. Having a diagnosis of Conduct Disorder and/or living in an independent living situation significantly increased the likelihood of current and lifetime substance use and disorder. A diagnosis of Post Traumatic Stress Disorder also predicted increased likelihood of polysubstance use and substance abuse disorder. In conclusion, older youth in the foster care system report similar levels of lifetime alcohol and illicit substance use when compared to the general adolescent population. However, rates of substance use disorder are high. Particularly at risk for both high rates of use and disorder are youth in independent living situations and youth with a diagnosis of Conduct Disorder or Post Traumatic Stress Disorder.

Vetter S; Rossegger A; Rossler W; Bisson JI; Endrass J. Exposure to the tsunami disaster, PTSD symptoms and increased substance use - an Internet based survey of male and female residents of Switzerland. BMC Public Health 8(e-article 92), 2008. (31 refs.)

Background: After the tsunami disaster in the Indian Ocean basin an Internet based self-screening test was made available in order to facilitate contact with mental health services. Although primarily designed for surviving Swiss tourists as well as relatives and acquaintances of the victims, the screening instrument was open to anyone who felt psychologically affected by this disaster. The aim of this study was to evaluate the influences between self-declared increased substance use in the aftermath of the tsunami disaster, trauma exposure and current PTSD symptoms. Methods: One section of the screening covered addiction related behavior. We analyzed the relationship between increased substance use, the level of PTSD symptoms and trauma exposure using multivariable logistic regression with substance use as the dependent variable. Included in the study were only subjects who reported being residents of Switzerland and the analyses were stratified by gender in order to control for possible socio-cultural or gender differences in the use of psychotropic substances. Results: In women PTSD symptoms and degree of exposure enlarged the odds of increased alcohol, pharmaceuticals and cannabis use significantly. In men the relationship was more specific: PTSD symptoms and degree of exposure only enlarged the odds of increased pharmaceutical consumption significantly. Increases in alcohol, cannabis and tobacco use were only significantly associated with the degree of PTSD symptoms. Conclusion: The tsunami was associated with increased substance use. This study not only replicates earlier findings but also suggests for a gender specificity of post-traumatic substance use increase.

Vik PW; Islam-Zwart KA; Ruge LN. Application of the PTSD-Alcohol Expectancy Questionnaire (P-AEQ) to sexually assaulted college women. Addiction Research & Theory 16(6): 585-594, 2008. (44 refs.)

Risk of alcohol use problems is an important clinical concern for women who have been sexually assaulted and experience PTSD symptoms. This study explored this risk by testing a factor structure of an alcohol expectancy questionnaire that assesses beliefs about alcohol's effects on posttraumatic stress symptoms (P-AEQ). Symptom-specific expectancy scores were then tested as predictors of alcohol consumption. Subjects were 96 female undergraduate women who reported being forced to have sex, 68 who experienced pressure to have sex, and 149 who denied any forced or pressured sex. Alternative factor models were tested using confirmatory factor analysis. A four-factor model reflecting posttraumatic stress symptom domains (Intrusions, Avoidance, Arousal, and Numbing) was found. The numbing factor was correlated with drinking among assaulted women; however, no support was found for symptom-specific expectancies to moderate between assault and drinking. Findings supported a role for posttrauma symptom-specific alcohol expectancies as a potential link between sexual assault and alcohol consumption.

Waldrop AE; Ana EJS; Saladin ME; McRae AL; Brady KT. Differences in early onset alcohol use and heavy drinking among persons with childhood and adulthood trauma. American Journal on Addictions 16(6): 439-442, 2007. (16 refs.)

We examined predictors for age at onset of first alcohol use and onset of heaviest alcohol use among men (n = 43) and women (n = 46) with alcohol dependence and PTSD, PTSD only, alcohol dependence only, and controls, with a particular focus on individuals with child versus adult trauma. Using analysis of variance procedures, results showed differences in onset of first alcohol use and heaviest drinking between childhood and adulthood trauma victims. These preliminary results indicate that behavioral mechanisms associated with alcohol use patterns between individuals with childhood and adulthood trauma are dissimilar, suggesting greater psychopathological consequences for individuals with childhood trauma.

Waldrop AE; Back SE; Sensenig A; Brady KT. Sleep disturbances associated with posttraumatic stress disorder and alcohol dependence. Addictive Behaviors 33(2): 328-335, 2008. (18 refs.)

Sleep disturbances commonly appear in the context of both posttraumatic stress disorder (PTSD) and alcohol disorders. Sleep symptoms typically reported among clinical populations include delayed sleep onset, poor sleep continuity, early morning awakening, and disturbed sleep architecture. The aim of the present study was to examine multiple forms of sleep disturbances among individuals with comorbid PTSD and alcohol dependence, PTSD only, alcohol dependence only, and a control group. Both PTSD and alcohol dependence diagnoses were associated with multiple forms of sleep disturbance, but comorbidity of the two disorders did not appear to increase the risk over and above either single disorder for reporting any of the sleep difficulties examined. As PTSD symptom severity increased, so did sleep latency, mid-sleep wakening, and early morning wakening. However, contrary to our hypothesis, no significant direct relationship between severity of alcohol use and sleep disturbances was revealed. These findings suggest a need for thorough assessment of sleep symptoms in patients presenting with PTSD or alcohol dependence.

Waldrop AE; Back SE; Verduin ML; Brady KI. Triggers for cocaine and alcohol use in the presence and absence of posttraumatic stress disorder. Addictive Behaviors 32(3): 634-639, 2007. (15 refs.)

The present study compared high-risk triggers and substance use situations among 72 (34 men, 38 women) individuals with alcohol (AD) or cocaine dependence (CD), with or without comorbid PTSD. Consistent with the self-medication hypothesis, individuals with PTSD reported significantly greater use of substances in response to negative situations, such as unpleasant emotions and physical discomfort, as compared to individuals without PTSD. CD individuals were significantly more likely than AD individuals to report using in temptation situations, regardless of PTSD status. Also, CD individuals with PTSD reported greater use of cocaine during pleasant times with others, as compared to those without PTSD. The findings highlight the importance of addressing individual-specific high-risk situations in relapse prevention.

Wilens TE; Vitulano M; Upadhyaya H; Adamson J; Parcell T; Westerberg D et al. Concordance between cigarette smoking and the modified Fagerstrom Tolerance Questionnaire in controlled studies of ADHD. American Journal on Addictions 17(6): 491-496, 2008. (26 refs.)

Our objective was to compare scores on a smoking questionnaire to a diagnosis of cigarette smoking. As part of follow-ups in studies of ADHD, we assessed for cigarette smoking using structured interviews and the modified Fagerstrom Tolerance Questionnaire (mFTQ). Data were obtained from 162 subjects (mean = 19.2 yrs). ROC analysis and kappa coefficients revealed that a cutoff score of 3 on the mFTQ showed the strongest agreement with a full diagnosis of cigarette smoking (kappa = 0.68). Clinicians and researchers using the mFTQ in adolescents and young adults should consider a cutoff score of 3 to be indicative of cigarette smoking.

Yehuda R; Bell A; Bierer LM; Schmeidler J. Maternal, not paternal, PTSD is related to increased risk for PTSD in offspring of Holocaust survivors. Journal of Psychiatric Research 42(13): 1104-1111, 2008. (49 refs.)

Background: A significant association between parental PTSID and the occurrence of PTSD in offspring has been noted, consistent with the idea that risk for the development of PTSD is transmitted from parent to child. Two recent reports linking maternal PTSD and low offspring cortisol prompted us to examine the relative contributions of maternal vs. paternal PTSD in the prediction of PTSD and other psychiatric diagnoses in offspring. Methods: One hundred seventeen men and 167 women, recruited from the community, were evaluated using a comprehensive psychiatric battery designed to identify traumatic life experiences and lifetime psychiatric diagnoses. 211 of these subjects were the adult offspring of Holocaust survivors and 73 were demographically comparable Jewish controls. Participants were further subdivided based on whether their mother, father, neither, or both parents met diagnostic criteria for lifetime PTSD. Results: A higher prevalence of lifetime PTSD, mood, anxiety disorders, and to a lesser extent, substance abuse disorders, was observed in offspring of Holocaust survivors than controls. The presence of maternal PTSD was specifically associated with PTSD in adult offspring of Holocaust Survivors. However, other psychiatric diagnoses did not show specific effects associated with maternal PTSD. Conclusion: The tendency for maternal PTSD to make a greater contribution than paternal PTSD to PTSD risk suggests that classic genetic mechanisms are not the sole model of transmission, and paves way for the speculation that epigenetic factors may be involved. In contrast, PTSD in any parent contributes to risk for depression, and parental traumatization is associated with increased anxiety disorders in offspring.