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CORK Bibliography: Post-Traumatic Stress Disorder (PTSD)

29 citations. January 2007 to present

Prepared: March 2008

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.

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.

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.

Coffey SF; Stasiewicz PR; Hughes PM; Brimo ML. Trauma-focused imaginal exposure for individuals with comorbid posttraumatic stress disorder and alcohol dependence: Revealing mechanisms of alcohol craving in a cue reactivity paradigm. Psychology of Addictive Behaviors 20(4): 425-435, 2006. (69 refs.)

With a sample (N = 43) of participants meeting current diagnostic criteria for both alcohol dependence and posttraumatic stress disorder (PTSD), the authors tested the hypothesis that alcohol craving elicited by a trauma cue might be attenuated if trauma-elicited negative emotion were reduced following trauma-focused imaginal exposure. In a laboratory-based experiment, participants were randomly assigned to either trauma-focused imaginal exposure or imagery-based relaxation. A cue reactivity Paradigm was used to assess alcohol craving prior to. and after completion of, the 6 clinical sessions. Attrition was high but did not differ between experimental conditions. For study completers, PTSD symptoms decreased in the exposure condition but not in the relaxation condition. Alcohol craving and distress elicited by trauma images decreased in the exposure condition but did not change in the relaxation condition. Results support the hypothesis that negative emotion is a mechanism of alcohol craving.

Dewart T; Frank B; Schmeidler J. The impact of 9/11 on patients in New York City's substance abuse treatment programs. American Journal of Drug and Alcohol Abuse 32(4): 665-672, 2006. (16 refs.)

Objectives: This article assesses the impact of the attacks on 9/11 in New York City on drug use, relapse, and mental health from the perspective of drug users and patients in substance abuse treatment programs. Methods: Structured interviews were conducted with 16 administrators and 75 randomly selected patients at 15 substance abuse treatment programs in New York City from December 2002 to April 2003. Results: Drug use and relapse was a significant issue on and after 9/11. While Post Traumatic Stress Disorder was related to drug use, other preexisting mental health problems were not. Men were more likely to relapse than women; however, women were more emotionally affected by events following 9/11. Conclusions: The attacks on 9/11 may have contributed to relapse among drug users and exacerbated existing mental health problems among patients with a history of concurrent drug use and mental illness.

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.

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.

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.

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.

Hunt YM; Kyle TL; Coffey SF; Stasiewicz PR; Schumacher JA. University of Rhode Island Change Assessment-Trauma: Preliminary psychometric properties in an alcohol-dependent PTSD sample. Journal of Traumatic Stress 19(6): 915-921, 2006. (40 refs.)

The co-occurrence of posttraumatic stress disorder with substance use disorders (PTSD-SUD) is common and is associated with poorer treatment outcomes. Attrition represents an ongoing, but poorly understood challenge in PTSD-SUD treatment research. The current study examined the initial psychometric properties ofthe University of Rhode Island Change Assessment-Trauma (URICA-T), a scale designed to assess attitudes and behaviors related to addressing trauma issues, in a sample of 42 individuals meeting diagnostic criteria for PTSD and alcohol dependence. Results suggest that the URICA-T may have acceptable psychometric properties as a continuous measure of motivational readiness in a PTSD-SUD sample. Preliminary data also suggests higher URICA-T scores are associated with retention of alcohol dependent-PTSD participants in a study utilizing trauma-focused exposure.

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.

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; Gallop RJ; Weiss RD. Seeking Safety therapy for adolescent girls with PTSD and substance use disorder: A randomized controlled trial. Journal of Behavioral Health Services & Research 33(4): 453-463, 2006. (39 refs.)

This randomized, controlled trial evaluated a manualized psychotherapy, Seeking Safety (SS), for posttraumatic stress disorder (PTSD) and substance use disorder (SUD) in adolescent females. To our knowledge, no prior study has evaluated any psychotherapy designed for this population. SS was compared to treatment as usual (TAU) for 33 outpatients, at intake, end-of-treatment, and 3 months follow-up. SS evidenced significantly better outcomes than TAU in a variety of domains at posttreatment, including substance use and associated problems, some trauma-related symptoms, cognitions related to SUD and PTSD, and several areas of pathology not targeted in the treatment (e.g., anorexia, somatization). Effect sizes were generally in the moderate to high range. Some gains were sustained at follow-up. SS appears a promising treatment for this population, but needs further study and perhaps additional clinical modification.

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.

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.

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.

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.

Ruzek IJ. Concurrent posttraumatic stress disorder and substance use disorder among veterans: Evidence and treatment issues. IN: Ouimette P; Brown PJ, eds. Trauma and Substance abuse: Causes, Consequences, and Treatment of Comorbid Disorders. Washington DC: American Psychological Association, 2003. pp. 191-207

This chapter reviews evidence and treatment issues in concurrent posttraumatic stress disorder (PTSD) and substance use disorder (SUD) among veterans. The author describes the literature related to the dual diagnosis in specific groups of veterans (Vietnam, World War II and Korea), identify clinical practices helpful in working with these veterans, and explore key challenges to the better integration of PTSD and SUD treatment.

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.

Schiff M; Benbenishty R; Mckay M; Devoe E; Liu X; Hasin D. Exposure to terrorism and Israeli youths' psychological distress and alcohol use: An exploratory study. American Journal on Addictions 15(3): 220-226, 2006. (66 refs.)

This study examined the associations between physical and psychological proximity to terrorist attacks and post-traumatic symptoms (PTS), depressive symptoms, and alcohol use among Israeli youth. Self-administered questionnaires were completed under anonymous conditions by 1,150 high and junior high school students (51.3% boys and 48.7% girls) in a town in the Tel Aviv metropolitan area. Standardized, validated scales were used to measure psychological symptoms and alcohol use. High levels of exposure to terrorism were reported. Physical and psychological proximity to terrorist attacks were associated with more PTS symptoms and alcohol consumption. Physical proximity was also associated with symptoms of depression. The implications of terror-associated early drinking for later alcohol problems should be explored.

Schumacher JA; Coffey SF; Stasiewicz PR. Symptom severity, alcohol craving, and age of trauma onset in childhood and adolescent trauma survivors with comorbid alcohol dependence and posttraumatic stress disorder. American Journal on Addictions 15(6): 422-425, 2006. (25 refs.)

Posttraumatic stress disorder (PTSD) and alcohol dependence ( AD) are frequently comorbid disorders. Given evidence that childhood traumas may be associated with broader, more severe psychological sequelae than later traumas, the present study examined whether the association between alcohol and trauma symptomatology is more pronounced among individuals with earlier trauma onsets in a sample of 42 childhood and adolescent trauma survivors diagnosed with comorbid AD-PTSD. As predicted, individuals reporting childhood traumas reported greater severity of trauma and alcohol symptoms and greater alcohol craving. These results suggest that individuals with childhood trauma histories may be particularly vulnerable to relapse following AD treatment.

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.

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.

Zlotnick C; Johnson DM; Stout RL; Zywiak WH; Johnson JE; Schneider RJ. Childhood abuse and intake severity in alcohol disorder patients. Journal of Traumatic Stress 19(6): 949-959, 2006. (47 refs.)

In a sample of 336 patients with an alcohol use disorder this study examined, whether patients with histories of childhood sexual abuse (CSA) and childhood physical abuse (CPA) compared to those without such histories have a greater severity of alcohol and other clinical difficulties. Whether lifetime posttraumatic stress disorder (PTSD) mediates the relationship between childhood abuse and clinical outcomes was explored. Results were that CSA was associated with earlier age of onset for alcohol disorder, greater Axis I comorbidity as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994), more social and psychiatric problems, but lower drinking frequency. Childhood physical abuse was related to greater drinking consequences, social and psychiatric dysfunction, and Axis I comorbidity, but also lower drinking frequency. Posttraumatic stress disorder partially mediated the effect of both CSA and CPA on severity of psychiatric problems.