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CORK Bibliography: Post-Traumatic Stress Disorder (PTSD)



37 citations. January 2011 to present

Prepared: March 2012



Austin J; McKellar JD; Moos R. The influence of co-occurring axis I disorders on treatment utilization and outcome in homeless patients with substance use disorders. Addictive Behaviors 36(9): 941-944, 2011. (28 refs.)

The current study examined the relationship between co-occurring substance use and Axis I psychiatric disorders and treatment utilization and outcome among homeless individuals (N = 365) who participated in an episode of intensive outpatient substance use treatment. Compared to patients without a co-occurring diagnosis, homeless patients with a diagnosis of major depressive disorder or PTSD participated in more substance use treatment. Diagnostic status did not predict 12-month alcohol or drug treatment outcome. Substance use treatment programs appear to successfully engage homeless individuals with major depressive disorder and PTSD in treatment. Such individuals appear to achieve similar benefits from standard substance use treatment as do homeless individuals without such disorders.

Copyright 2011, Elsevier Science


Barrett EL; Mills KL; Teesson M. Hurt people who hurt people: Violence amongst individuals with comorbid substance use disorder and post traumatic stress disorder. Addictive Behaviors 36(7): 721-728, 2011. (58 refs.)

Aims: The association between substance use disorder (SUD) and the perpetration of violence has been well documented. There is some evidence to suggest that the co-occurrence of post traumatic stress drsorder (PTSD) may increase the risk for violence. This study aims to determine the prevalence of violence perpetration and examine factors related to violence amongst individuals with comorbid SUD and PTSD. Design and participants: Data was collected via interview from 102 participants recruited to a randomised controlled trial of an integrated treatment for comorbid SUD and PTSD. Measurements: The interview addressed demographics, perpetration of violent crime, mental health including aggression, substance use, PTSD, depression, anxiety and borderline personality disorder. Findings: Over half of participants reported committing violence in their lifetime and 16% had committed violence in the past month. Bivariate associations were found between violence perpetration aid trait aggression, higher levels of alcohol and cannabis use, lower levels of other opiate use, and experiencing more severe PTSD symptoms, particularly in relation to hyperarousal. When entered into a backward stepwise logistic regression however, only higher levels of physical aggression and more severe PTSD hyperarousal symptoms remained as independent predictors of violence perpetration. Conclusions: These findings highlight the importance of assessing for PTSD amongst those with SUD particularly in forensic settings. They also indicate that it is the hyperarousal symptoms of PTSD specifically that need to be targeted by interventions aimed at reducing violence amongst individuals with SUD and PTSD.

Copyright 2011, Elsevier Science


Bonn-Miller MO; Vujanovic AA; Drescher KD. Cannabis use among military veterans after residential treatment for posttraumatic stress disorder. Psychology of Addictive Behaviors 25(3): 485-491, 2011. (40 refs.)

The present investigation prospectively evaluated whether treatment changes in PTSD symptom severity, among military Veterans in residential PTSD treatment, were related to cannabis use 4 months after discharge from residential rehabilitation. The sample was comprised of 432 male military Veteran patients (M(age) = 51.06 years, SD = 4.17), who had a primary diagnosis of PTSD and were admitted to a VA residential rehabilitation program for PTSD. Results demonstrated that lower levels of change in PCL-M scores between treatment intake and discharge were significantly predictive of greater frequency of cannabis use at 4-month follow-up (p < .05), even after accounting for the effects of length of treatment stay and frequency of cannabis use during the 2 months before treatment intake. Furthermore, post hoc analyses revealed that less change in PTSD avoidance/numbing and hyperarousal symptom severity during treatment was significantly predictive of a greater frequency of cannabis use at 4-month follow-up, after controlling for relevant covariates. Notably, these effects were specific to cannabis and were not found for the other substances examined among this sample, including alcohol and opiates. Implications of the findings are discussed with regard to the extant literature and future directions.

Copyright 2011, American Psychological Association


Brewerton TD. Posttraumatic stress disorder and disordered eating: Food addiction as self-medication. (editorial). Journal of Women's Health 20(8): 1133-1134, 2011. (19 refs.)

Bujarski SJ; Feldner MT; Lewis SF; Babson KA; Trainor CD; Leen-Feldner Ellen et al. Marijuana use among traumatic event-exposed adolescents: Posttraumatic stress symptom frequency predicts coping motivations for use. Addictive Behaviors 37(1): 53-59, 2012. (49 refs.)

Contemporary comorbidity theory postulates that people suffering from posttraumatic stress symptoms may use substances to cope with negative affect generally and posttraumatic stress symptoms specifically. The present study involves the examination of the unique relation between past two-week posttraumatic stress symptom frequency and motives for marijuana use after accounting for general levels of negative affectivity as well as variability associated with gender. Participants were 61 marijuana-using adolescents (M(age)=15.81) who reported experiencing lifetime exposure to at least one traumatic event. Consistent with predictions, past two-week posttraumatic stress symptoms significantly predicted coping motives for marijuana use and were not associated with social, enhancement, or conformity motives for use. These findings are consistent with theoretical work suggesting people suffering from posttraumatic stress use substances to regulate symptoms.

Copyright 2012, Elsevier Science


Bujarski SJ; Feldner MT; Lewis SF; Babson KA; Trainor CD; Leen-Feldner E et al. Marijuana use among traumatic event-exposed adolescents: Posttraumatic stress symptom frequency predicts coping motivations for use. Addictive Behaviors 37(1): 53-59, 2012. (49 refs.)

Contemporary comorbidity theory postulates that people suffering from posttraumatic stress symptoms may use substances to cope with negative affect generally and posttraumatic stress symptoms specifically. The present study involves the examination of the unique relation between past two-week posttraumatic stress symptom frequency and motives for marijuana use after accounting for general levels of negative affectivity as well as variability associated with gender. Participants were 61 marijuana-using adolescents (M(age) = 15.81) who reported experiencing lifetime exposure to at least one traumatic event. Consistent with predictions, past two-week posttraumatic stress symptoms significantly predicted coping motives for marijuana use and were not associated with social, enhancement, or conformity motives for use. These findings are consistent with theoretical work suggesting people suffering from posttraumatic stress use substances to regulate symptoms.

Copyright 2012, Elsevier Science


Calhoun PS; Levin HF; Dedert EA; Johnson Y; Beckham JC. The relationship between posttraumatic stress disorder and smoking outcome expectancies among US military veterans who served since September 11, 2001. Journal of Traumatic Stress 24(3): 303-308, 2011. (23 refs.)

Posttraumatic stress disorder (PTSD) is associated with increased rates of smoking although little is known regarding the mechanisms underlying this relationship. The current study examined expectations about smoking outcomes among smokers with and without PTSD. The sample included 96 veterans (mean age of 34 years) and included 17% women and 50% racial minorities. Smoking expectancies were measured with the Smoking Consequences Questionnaire-Adult (Copeland, Brandon, & Quinn, 1995). Consistent with previous work suggesting that smokers with PTSD smoke in an effort to reduce negative affect, unadjusted analyses indicated that smokers with PTSD (n = 38) had higher expectations that smoking reduces negative affect than smokers without PTSD (d = 0.61). Smokers with PTSD also had increased expectancies associated with boredom reduction (d = 0.48), stimulation (d = 0.61), taste/sensorimotor manipulation aspects of smoking (d = 0.73), and social facilitation (d = 0.61). Results of hierarchical linear regression analyses indicated that PTSD symptom severity was uniquely associated with these expectancies beyond the effects of gender and nicotine dependence. More positive beliefs about the consequences of smoking may increase risk of continued smoking among those with PTSD who smoke. Further understanding of smoking expectancies in this group may help in developing interventions tailored for this vulnerable population.

Copyright 2011, Wiley-Blackwell


Chou KL; Mackenzie CS; Liang K; Sareen J. Three-year incidence and predictors of first-onset of dsm-iv mood, anxiety, and substance use disorders in older adults: Results from wave 2 of the national epidemiologyogic survey on alcohol and related conditions. Journal of Clinical Psychiatry 72(2): 144-155, 2011. (90 refs.)

Objective: The aim of this study was to determine the incidence rates of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mood disorders, anxiety disorders, and substance use disorders in older adults and to identify sociodemographic, psychopathological, health-related, and stress-related predictors of onset of these disorders. Method: A nationally representative sample of 8,012 community-dwelling adults aged 60 and above was interviewed twice over a period of 3 years, in 2000-2001 and 2004-2005. First incidence of mood, anxiety, and substance use disorders was assessed over a period of 3 years using the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV Version. Results: The 3-year incidence rates of DSM-IV mood, anxiety, and substance use disorders were highest for nicotine dependence (3.38%) and major depressive disorder ([MDD] 3.28%) and lowest for drug use disorder (0.29%) and bipolar II disorder (0.34%). Incidence rates were significantly greater among older women for MDD (99% CI, 1.22-3.13) and generalized anxiety disorder (GAD; 99% CI, 1.20-4.26) and greater among older men for nicotine dependence and alcohol abuse and dependence. Posttraumatic stress disorder predicted incidence of MDD, bipolar I disorder, panic disorder, specific phobia, and GAD, while Cluster B personality disorders predicted incident MDD, bipolar I and II disorders, panic disorder, social phobia, GAD, nicotine dependence, and alcohol dependence. Poor self-rated health increased the risk for the onset of MDD, whereas obesity decreased the incidence of nicotine dependence. Conclusions: Information about disorders that are highly incident in late life and risk factors for the onset of psychiatric disorders among older adults are important for effective early intervention and prevention initiatives.

Copyright 2011, Physicians Postgraduate Press


Cisler JM; Amstadter AB; Begle AM; Resnick HS; Danielson CK; Saunders BE et al. A prospective examination of the relationships between PTSD, exposure to assaultive violence, and cigarette smoking among a national sample of adolescents. Addictive Behaviors 36(10): 994-1000, 2011. (56 refs.)

Research demonstrates robust associations among posttraumatic stress disorder (PTSD), exposure to assaultive violence (i.e., sexual assault, physical assault, and witnessed violence), and cigarette smoking among adults and adolescents. Whether exposure to assaultive violence confers risk for cigarette smoking over and above the effects of PTSD and non-assaultive traumatic events (e.g., motor vehicle accidents) is unclear. The current study prospectively measured PTSD, assaultive violence exposure, non-assaultive traumatic event exposure, and cigarette smoking three times over approximately three years among a nationally representative sample of adolescents (N = 3614, age range 12-17 at Wave 1). Results revealed that multiple exposure to assaultive violence at Wave 1 was a consistent and robust prospective predictor of cigarette smoking at Waves 2 and 3. By contrast, PTSD diagnoses and non-assaultive traumatic event exposures at Wave 1 only predicted cigarette smoking at Wave 2, but not at Wave 3. Theoretical and clinical implications are discussed.

Copyright 2011, Elsevier Science


Connorton E; Miller M; Perry MJ; Hemenway D. Mental health and unintentional injurers: Results from the national co-morbidity survey replication. Injury Prevention 17(3): 171-175, 2011. (30 refs.)

Objective: To examine whether unintentionally injuring others is associated with subsequent mental illness, and whether mental illness is a risk factor for unintentionally injuring others. Methods: Onset of first psychiatric diagnoses was compared with onset of first unintentional injuring. Multivariate logistic regression estimated the association between unintentional injuring and lifetime prevalence of mental illness, specifically of Diagnostic and Statistical Manual of Mental Disorders IV disorders associated with trauma exposure among respondents of part II of the National Co-morbidity Survey Replication a household survey of 5692 US adults. Analyses controlled for age, sex, race and having been injured in a serious accident. Results: Of 5692 respondents, 110 reported unintentionally causing death or injury to another person. Unintentionally injuring others was a risk factor for subsequent mental health problems. Multivariate regression results showed an increased risk of subsequent depression (OR 3.1, CI 1.7 to 5.7), anxiety (OR 3.3, CI 1.6 to 6.6), posttraumatic stress disorder (PTSD) (OR 6.6, CI 3.1 to 14.0), alcohol use (OR 3.8, CI 1.9 to 7.3) and drug use (OR 8.0, CI 4.1 to 15.3). Conversely, mental health problems were a risk factor for unintentionally injuring another person. Multivariate regression results showed an increased risk of unintentional injuring among those with a prior diagnosis of depression, PTSD, alcohol use, and drug use. Conclusions: After injuring, unintentional injurers are likely to experience depression, anxiety, PTSD and drug or alcohol abuse/dependence compared with non-injurers. Those diagnosed with depression, anxiety, PTSD, alcohol or drug or alcohol abuse/dependence are more likely to cause serious injuries to others.

Copyright 2011, BML Publishing


Cougle JR; Bonn-Miller MO; Vujanovic AA; Zvolensky MJ; Hawkins KA. Posttraumatic stress disorder and cannabis use in a nationally representative sample. Psychology of Addictive Behaviors 25(3): 554-558, 2011. (20 refs.)

The present study examined the relations between posttraumatic stress disorder (PTSD) and cannabis use in a large representative survey of adults (N = 5,672) from the United States (Kessler et al., 2004). After adjusting for sociodemographic variables (i.e., age, marital status, ethnicity, education, income, and sex), alcohol use disorders, and nicotine dependence, lifetime and current (past year) PTSD diagnoses were associated with increased odds of lifetime history of cannabis use as well as past year daily cannabis use. Lifetime, but not current, PTSD diagnosis also was uniquely associated with increased risk for any past year cannabis use. Additional analyses revealed that the relations between PTSD (lifetime and current) and lifetime cannabis use remained statistically significant when adjusting for co-occurring anxiety and mood disorders and trauma type frequency. Overall, these findings add to the emerging literature demonstrating a possibly important relationship between PTSD and cannabis use.

Copyright 2011, American Psychological Association


Cucciare MA; Darrow M; Weingardt KR. Characterizing binge drinking among U.S. military veterans receiving a brief alcohol intervention. Addictive Behaviors 36(4): 362-367, 2011. (28 refs.)

Background: Brief web-based alcohol interventions (BAIs) are effective for reducing binge drinking in college students and civilian adults, and are increasingly being applied to U.S. military populations. However, little is known about factors associated with binge drinking in Veteran populations and therefore some concern remains on the generalizability of studies supporting BAIs for addressing binge drinking in this population. This study sought to better understand the characteristics (e.g., demographic, coping related mental health factors, prior exposure to traumatic events, and factors assessing motivation to change alcohol use) of a predominantly male sample of binge drinking Veterans receiving a BAI from a VA provider. Methods: A primarily male (93.5%) sample (N = 554) of Veterans completed a BAI consisting of brief assessment and personalized feedback. Results: We found that Veterans who were younger, used drugs/alcohol to cope with symptoms of PTSD and depression (e.g., nightmares and flashbacks and sleep difficulties), and had experienced sexual assault, had higher self-reported peak blood alcohol concentration and a higher likelihood for a binge drinking episode in the last 90 days. Conclusions: BAIs may be a promising approach for addressing binge drinking in Veterans. However, binge drinking among a sample of mostly male Veterans receiving a BAI may be associated with a complex set of factors that are less prevalent in the college student population and thus studies demonstrating the efficacy of BAIs with Veterans are needed.

Copyright 2011, Elsevier Science


Drapkin ML; Yusko D; Yasinski C; Oslin D; Hembree EA; Foa EB. Baseline functioning among individuals with posttraumatic stress disorder and alcohol dependence. Journal of Substance Abuse Treatment 41(2): 186-192, 2011. (40 refs.)

Comorbid posttraumatic stress disorder (PTSD) and alcohol dependence (AD) may lead to a complicated and potentially severe treatment profile. Our study examined 167 individuals with both PTSD and AD compared with 105 individuals with PTSD without an alcohol use disorder (AUD) and 240 individuals with AD without PTSD on baseline psychosocial functioning. We hypothesized that individuals with PTSD/AD would be more socially and functionally impaired than individuals with only one disorder. Results indicated that participants with PTSD/AD were more likely to be unemployed, have less education, and report less income and were less likely to live with a partner than the participants with only a single disorder. However, they did not differ on symptom severity within these disorders (drinking frequency/quantity, PTSD, and anxiety symptoms) with the exception of depression and alcohol craving. This contradicts clinical lore that comorbid patients are more impaired at treatment initiation and adds support for concurrent treatment as not only feasible but also possibly ideal for these patients.

Copyright 2011, Elsevier Science


Durai UNB; Chopra MP; Coakley E; Llorente MD; Kirchner JE; Cook JM et al. Exposure to trauma and posttraumatic stress disorder symptoms in older veterans attending primary care: Comorbid conditions and self-rated health status. Journal of the American Geriatrics Society 59(6): 1087-1092, 2011. (30 refs.)

OBJECTIVES: Assess the prevalence of posttraumatic stress disorder (PTSD) symptomatology and its association with health characteristics in a geriatric primary care population. DESIGN: Cross-sectional screening assessments during a multisite trial for the treatment of depression, anxiety, and at-risk drinking. SETTING: Department of Veterans Affairs (VA)-based primary care clinics across the United States. PARTICIPANTS: Seventeen thousand two hundred five veterans aged 65 and older. MEASUREMENTS: Sociodemographic information, the General Health Questionnaire (GHQ-12), questions about death wishes and suicidal ideation, quantity and frequency of alcohol use, smoking, exposure to traumatic events, and PTSD symptom clusters. RESULTS: Twelve percent (2,041/17,205) of participants screened endorsed PTSD symptoms. Veterans with PTSD symptoms from some (partial PTSD) or each (PTSD all clusters) of the symptom clusters were significantly more likely to report poor general health, currently smoke, be divorced, report little or no social support, and have a higher prevalence of mental distress, death wishes, and suicidal ideation than those with no trauma history or those with trauma but no symptoms. Group differences were most pronounced for mental distress and least for at-risk drinking. Presence of PTSD all clusters was associated with poorer outcomes on all of the above-mentioned health characteristics than partial PTSD. CONCLUSION: PTSD symptoms are common in a substantial minority of older veterans in primary care, and careful inquiry about these symptoms is important for comprehensive assessment in geriatric populations.

Copyright 2011, Wiley-Blackwell


Evren C; Dalbudak E; Evren B; Cetin R; Durkaya M. Self-mutilative behaviours in male alcohol-dependent inpatients and relationship with posttraumatic stress disorder. Psychiatry Research 186(1): 91-96, 2011. (71 refs.)

The aim of this study was to investigate the relationship between self-mutilation (SM) and posttraumatic stress disorder (PTSD) in male alcohol-dependent inpatients, and to examine whether there is something unique about self-mutilaters with the PTSD/alcohol-dependence co-morbidity, compared with self-mutilaters without PTSD in this population. Participants were 156 consecutively admitted male alcohol-dependent inpatients. Patients were investigated with the Self-mutilative Behaviour Questionnaire (SMBQ), the Traumatic Experiences Checklist (TEC), the Clinician Administered PTSD Scale (CAPS), the Symptom Checklist-Revised (SCL-90-R) and the Michigan Alcoholism Screening Test (MAST). Among alcohol-dependent inpatients, 34.0% (n = 53) were considered as group with SM. Rate of being unemployed, history of any trauma, history of suicide attempt and lifetime PTSD diagnosis were higher, whereas being married, current age, age at onset of regular alcohol use and duration of education were lower in the group with SM. Mean scores of SCL-90 subscales, TEC and MAST were higher in the SM group. Although SM might be related with PTSD among male alcohol-dependent inpatients, predictors of SM were age at onset of regular alcohol use, history of suicide attempt, anxiety, depression and hostility. Age at onset of regular alcohol use, history of suicide attempt, anxiety, depression and somatisation predicted SM in the subgroup of patients without PTSD, whereas hostility predicted SM alone in the subgroup of patients with PTSD. Results support the anti-suicide and the affect-regulation models of SM in the non-PTSD group, whereas they support the hostility model of SM in the subgroup with PTSD in alcohol-dependent inpatients. Thus, to reduce self-mutilative behaviour (SMB) among alcohol-dependent patients, clinicians must address different subjects in different subgroup patients; that is, focussing hostility in those with PTSD co-morbidity.

Copyright 2011, Elsevier Science


Evren C; Sar V; Dalbudak E; Cetin R; Durkaya M; Evren B et al. Lifetime PTSD and quality of life among alcohol-dependent men: Impact of childhood emotional abuse and dissociation. Psychiatry Research 186(1): 85-90, 2011. (68 refs.)

The aim of this study was to investigate the impact of lifetime posttraumatic stress disorder (PTSD), dissociation and a history of childhood trauma on quality of life (QoL) among men with alcohol dependency. A consecutive series of alcohol-dependent men (N=156) admitted to an inpatient treatment unit were screened using the Michigan Alcoholism Screening Test, the Clinician Administered PTSD Scale, the Dissociative Experiences Scale, and the Childhood Trauma Questionnaire. QoL was assessed using the Medical Outcomes Study Short-Form 36-item health survey. Fifty (32.1%) patients had lifetime diagnosis of PTSD. Besides problems related to severity of alcohol use, the lifetime PTSD group was impaired on several physical and mental components of QoL. While the lifetime PTSD group and remaining patients did not differ on reports of childhood trauma and dissociation, in lifetime PTSD group, dissociative patients had higher scores of childhood emotional abuse than those of the non-dissociative patients. In multivariate covariance analysis, both dissociation and lifetime PTSD predicted impairment in physical functioning, general health, vitality, and mental health components of QoL Among alcohol-dependent men with lifetime PTSD. a history of childhood emotional abuse contributes to impairment of QoL through its relationship with dissociation.

Copyright 2011, Elsevier Science


Harder LH; Chen S; Baker DG; Chow B; McFall M; Saxon A et al. The influence of posttraumatic stress disorder numbing and hyperarousal symptom clusters in the prediction of physical health status in veterans with chronic tobacco dependence and posttraumatic stress disorder. Journal of Nervous and Mental Disease 199(12): 940-945, 2011. (43 refs.)

Smoking and PTSD are predictors of poor physical health status. This study examined the unique contribution of PTSD symptoms in the prediction of the SF-36 physical health status subscales accounting for cigarette smoking, chronic medical conditions, alcohol and drug use disorders, and depression. This study examined baseline interview and self-report data from a national tobacco cessation randomized, controlled trial (Veterans Affairs Cooperative Study 519) that enrolled tobacco-dependent veterans with chronic PTSD (N = 943). A series of blockwise multiple regression analyses indicated that PTSD numbing and hyperarousal symptom clusters explained a significant proportion of the variance across all physical health domains except for the Physical Functioning subscale, which measures impairments in specific physical activities. Our findings further explain the impact of PTSD on health status by exploring the way PTSD symptom clusters predict self-perceptions of health, role limitations, pain, and vitality.

Copyright 2011, Lippincott, Williams & Wilkins


Hruska B; Fallon W; Spoonster E; Sledjeski EM; Delahanty DL. Alcohol use disorder history moderates the relationship between avoidance coping and posttraumatic stress symptoms. Psychology of Addictive Behaviors 25(3): 405-414, 2011. (71 refs.)

Avoidance coping (AVC) is common in individuals with posttraumatic stress disorder (PTSD) and in individuals with alcohol use disorder (AUD). Given that PTSD and AUD commonly co-occur, AVC may represent a risk factor for the development of comorbid posttraumatic stress and alcohol use. In this study, the relationship between AVC and PTSD symptoms (PTSS) was examined in individuals with versus without AUDs. Motor vehicle accident (MVA) victims were assessed 6 weeks postaccident for AUD history (i.e. diagnoses of current or past alcohol abuse or dependence) and AVC. PTSS were assessed 6 weeks and 6 months post-MVA. All analyses were conducted on the full sample of MVA victims as well as on the subset of participants who were legally intoxicated (blood alcohol concentration >= 0.08) during the accident. It was hypothesized that the relationship between AVC and PTSS would be stronger in those individuals with an AUD history and especially strong in the subset of individuals who were legally intoxicated during the MVA. Results were largely supportive of this hypothesis, even after controlling for in-hospital PTSS, gender, and current major depression. Early assessment of AUD history and avoidance coping may aid in detecting those at elevated risk for PTSD, and intervening to reduce AVC soon after trauma may help buffer the development of PTSD + AUD comorbidity.

Copyright 2011, American Psychological Association


Kroll J; Yusuf AI; Fujiwara K. Psychoses, PTSD, and depression in Somali refugees in Minnesota. Social Psychiatry and Psychiatric Epidemiology 46(6): 481- 493, 2011. (57 refs.)

Introduction: Initial clinical observation of Somali patients seen at a busy inner-city community clinic (CUHCC) suggested that, in addition to the expected pictures of Posttraumatic Stress Disorder (PTSD) and depression previously seen in the clinic's Southeast Asian refugee population from 1980 to 2000, there was an unusually high number of young Somali men presenting with acute psychotic disturbances. Objectives The aim of this study of health care utilization of Somali refugees (N = 600) seen in the mental health unit of the clinic from 2001 to 2009 was to investigate the major patterns of psychiatric disorders in this outpatient population and compare these findings with a cohort of non-Somali patients (N = 3,009) seen at the same outpatient clinic during the years 2007-2009. If the results supported the initial clinical observations that the rate of psychoses was higher among young Somali men than non-Somali men attending CUHCC clinic, then several areas of further research would recommend itself. First, since this study was not a study of prevalence of mental illness in the Somali community, the next step would be to undertake a study of community prevalence of mental illness among different age and gender cohorts. Second, further research should look into likely causative and contributory risk factors to explain the development of psychoses among Somali young men. Methods: Somali and non-Somali patients were diagnosed according to DSM-IV-R criteria. Main outcome measures (diagnoses, age cohort, sex) were analyzed by Chi-square tests. Patterns of illness and adjustment varied significantly by age and gender cohorts, reflecting the relevance of age and gender at time of trauma on different trauma and loss experiences and cultural and religious shaping of subsequent adjustment and symptoms. Results: The study confirmed that almost half of the Somali male patients are under age 30, 80% of whom presented with psychoses, compared with the rate of psychosis (13.7%) in the non-Somali control group of same-aged males at the clinic. The older male, and the majority of Somali female patients, show predominantly depressive and PTSD symptomatology. Conclusions: War trauma experienced in childhood, early malnutrition from famines, head trauma, and excess Khat use in male adolescents provide partial explanations for the large number of young psychotic Somali men seen in the clinic from 2001 to 2009.

Copyright 2011, Springer


Lange B. Creating a communicative space to develop a mindfulness meditation manual for women in recovery from substance abuse disorders. Advances In Nursing Science 34(3): E1-E13, 2011. (46 refs.)

Mindfulness-Based Stress Reduction (MBSR) programs are becoming more integrated into the treatment of persons with substance use disorders (SUDs). A focus of MBSR is to increase awareness of sensations in the body and accept them in the moment without judgment. Little is known about the readiness of women, with posttraumatic stress disorder (PTSD), and their level of comfort to participate in MBSR programs. Habermas' ideal speech situation guided a cooperative inquiry with 45 women at 3 treatment centers. Women engaged in activities of MBSR and shared opinions on how to develop a manual that would address the readiness of women with SUDs-PTSD to participate in MBSR.

Copyright 2011, Lippincott, Williams & Wilkins


Marshall-Berenz EC; Vujanovic AA; MacPherson L. Impulsivity and alcohol use coping motives in a trauma-exposed sample: The mediating role of distress tolerance. Personality and Individual Differences 50(5): 588-592, 2011. (31 refs.)

The present investigation examined the mediating role of distress tolerance in the association between impulsivity and alcohol use coping motives among trauma-exposed individuals. Participants were 86 adults (64.3% women; M-age = 23.4, SD = 9.3) who met the DSM-IV-TR posttraumatic stress disorder (PTSD) Criterion A for at least one traumatic life event and endorsed alcohol use in the past month. Distress tolerance at least partially mediated the association between impulsivity and alcohol use coping motives, after controlling for the variance explained by PTSD symptom severity and alcohol use problems. Clinical implications and future directions related to this line of inquiry are presented and discussed.

Copyright 2011, Elsevier Science


McCart MR; Zajac K; Danielson CK; Strachan M; Ruggiero KJ; Smith DW et al. Interpersonal victimization, posttraumatic stress disorder, and change in adolescent substance use prevalence over a ten-year period. Journal of Clinical Child and Adolescent Psychology 40(1): 136-143, 2011. (30 refs.)

Epidemiological studies have identified recent declines in specific types of adolescent substance use. The current study examined whether these declines varied among youth with and without a history of interpersonal victimization or posttraumatic stress disorder (PTSD). Data for this study come from two distinct samples of youth (12-17 years of age) participating in the 1995 National Survey of Adolescents (N=3,906) and the 2005 National Survey of Adolescents-Replication (N=3,423). Results revealed significant declines in adolescents' use of cigarettes and alcohol between 1995 and 2005; use of marijuana and hard drugs remained stable. Of importance, declines in nonexperimental cigarette use were significantly greater among youth without versus with a history of victimization and declines in alcohol use were significantly greater among youth without versus with a history of PTSD.

Copyright 2011, Taylor & Francis


Najavits LM. Treatments for PTSD and pathological gambling: What do patients want? Journal of Gambling Studies 27(2): 229-241, 2011. (30 refs.)

This study explored the treatment preferences of 106 people with posttraumatic stress disorder (PTSD), pathological gambling (PG), or both. It is the first know study of its type for this comorbidity. Sixteen different treatment types were rated, with a broad array of modalities including manualized psychotherapies, medication, self-help, alternative therapies, coaching, and self-guided treatments (use of books and computerized therapy). A consistent finding was that PTSD treatments were rated more highly than PG treatments, even among those with both disorders. Further, of the sixteen treatment types, the sample expressed numerous preferences for some over others. For example, among PG treatments, self-help was the highest-rated. Among PTSD treatments, psychotherapies were the highest-rated; and individual therapy was rated higher than group therapy. For both PG and PTSD, medications were rated lower than other treatment types. Non-standard treatments (i.e., computerized treatment, books, coaching, family therapy, alternative therapies) were generally rated lower than other types. Discussion includes implications for the design of treatments, as well as methodological limitations.

Copyright 2011, Springer


Najavits LM; Meyer T; Johnson KM; Korn D. Pathological gambling and posttraumatic stress disorder: A study of the co-morbidity versus each alone. Journal of Gambling Studies 27(4): 663-683, 2011. (62 refs.)

This report is the first empirical study to compare pathological gambling (PG), posttraumatic stress disorder (PTSD), and their co-occurrence. The sample was 106 adults recruited from the community (35 with current PG; 36 with current PTSD, and 35 with BOTH). Using a cross-sectional design, the three groups were rigorously diagnosed and compared on various measures including sociodemographics, psychopathology (e.g., dissociation, suicidality, comorbid Axis I and II disorders), functioning, cognition, life history, and severity of gambling and PTSD. Overall, the PG group reported better psychological health and higher functioning than PTSD or BOTH; and there were virtually no differences between PTSD and BOTH. This suggests that it is the impact of PTSD, rather than comorbidity per se, that appears to drive a substantial increase in symptoms. We also found high rates of additional co-occurring disorders and suicidality in PTSD and BOTH, which warrants further clinical attention. Across the total sample, many reported a family history of substance use disorder (59%) and gambling problems (34%), highlighting the intergenerational impact of these. We also found notable subthreshold PTSD and gambling symptoms even among those not diagnosed with the disorders, suggesting a need for preventive care. Dissociation measures had mixed results. Discussion includes methodology considerations and future research areas.

Copyright 2011, Springer


O'Hare T; Sherrer M. Drinking motives as mediators between PTSD symptom severity and alcohol consumption in persons with severe mental illnesses. Addictive Behaviors 36(5): 465-469, 2011. (52 refs.)

Research has consistently shown that drinking to alleviate negative emotional states predicts alcohol use and relapse among clients with co-occurring disorders including depressive and posttraumatic stress disorders. However, studies examining the mediating role of drinking motives in persons with severe mental illness (SMI) are few. The current survey of 116 community mental health clients (51.7% men; 47.4% women) diagnosed with either a schizophrenia spectrum disorder (41, 35.3%) or major mood disorder (75, 64.7%) tested the hypothesis that convivial drinking and drinking to cope with negative emotions would mediate posttraumatic stress symptoms (PSS-I) and alcohol consumption (QF). A series of path models revealed that convivial drinking fully mediated hyper-arousal symptoms and alcohol consumption, and negative coping fully mediated total posttraumatic stress symptoms, avoidance and hyper-arousal symptoms and alcohol consumption. The results support an emotional distress reduction model of alcohol use in people with severe mental illness, and highlight the need to assess specific drinking motives and target them in cognitive-behavioral treatment approaches. The cross sectional design employed limits cause-effect inferences regarding mediation, and highlights the need for longitudinal designs to sort out causal pathways among symptoms, drinking motives and alcohol consumption in clients with SMI.

Copyright 2011, Elsevier Science


Potter CM; Vujanovic AA; Marshall-Berenz EC; Bernstein A; Bonn-Miller MO. Posttraumatic stress and marijuana use coping motives: The mediating role of distress tolerance. Journal of Anxiety Disorders 25(3): 437-443, 2011. (55 refs.)

The present investigation examined the explanatory (i.e,. mediating) role of distress tolerance (DT) in the relation between posttraumatic stress (PTS) symptom severity and marijuana use coping motives. The sample consisted of 142 adults (46.5% women; M-age =22.18, SD = 7.22, range = 18-55), who endorsed exposure to at least one Criterion A traumatic life event (DSM-IV-TR, 2000) and reported marijuana use within the past 30 days. As predicted, results demonstrated that DT partially mediated the relation between PTS symptom severity and coping-oriented marijuana use. These preliminary results suggest that DT may be an important cognitive-affective mechanism underlying the PTS-marijuana use coping motives association. Theoretically, trauma-exposed marijuana users with greater PTS symptom severity may use marijuana to cope with negative mood states, at least partially because of a lower perceived capacity to withstand emotional distress.

Copyright 2011, Elsevier Science


Rhoades H; Wenzel SL; Golinelli D; Tucker JS; Kennedy DP; Green HD et al. The social context of homeless men's substance use. Drug and Alcohol Dependence 118(2-3): 320-325, 2011. (55 refs.)

Background: Homeless men may be at particular risk for the negative health effects of substance use. This cross-sectional study investigates the individual and personal network risk factors associated with substance use in this vulnerable population. Methods: Participants were a representative probability sample of 305 heterosexually active homeless men interviewed from meal programs in the Skid Row region of Los Angeles, CA. Interviews assessed individual, personal network, and substance use characteristics. Logistic regression examined individual and personal network predictors of the three most prevalent substances. Results: In the past 6 months, the three most prevalent substances were marijuana (56%), crack (40%), and alcohol to intoxication (38%). The mental health status of homeless men was associated with substance use, with PTSD more common among those who used crack. Riskier networks (comprised of a larger proportion of drug users) were associated with marijuana use, and normative social ties (family, employed and school/work contacts) were associated with a decreased likelihood of crack use. Conclusions: Mental health problems and riskier personal networks are associated with homeless men's substance use. These findings underscore the importance of interventions that focus on improving mental health, mitigating the drug-using norms of personal networks, and helping men to maintain contact with normative, low-risk alters. Mental health care and peer-based, network interventions to reduce substance use should be a priority for heterosexually active homeless men.

Copyright 2011, Elsevier Science


Rugani F; Maremmani AGI; Rovai L; Mautone S; Perugi G; Pani PP et al. Life events (loss and traumatic) and emotional responses to them in heroin-dependent patients before and after the dependence age of onset. Heroin Addiction and Related Clinical Problems 13(3): 17-25, 2011. (48 refs.)

Epidemiological data show frequent associations between post-traumatic stress disorder (PTSD) and substance use disorders. In this study we assessed the life events (loss events and potentially traumatic events) of 82 heroin-dependent patients before and after the dependence age of onset (DAO) and their emotional, physical and cognitive responses to these events, within a trauma and loss spectrum. We also assessed personality traits at risk for Post-Traumatic Stress Disorder (PTSD). In passing from the before-DAO to the after-DAO period, 97.6% of patients continued to experience life events, 82.9% loss events and 91.5% potentially traumatic events. The life events most frequently rated as the most important by patients are "death of a close friend or relative", "divorce" and "being neglected or abandoned". Sexual abuse seems to be present, but with a lower percentage. Criminal behaviours become very common after DAO. "Grief reactions" to loss events increase after DAO, as well as "reactions to the most important event", "re-experiencing", "avoidance and numbing", "maladaptive coping" and "arousal". After DAO, we found an increase in all the emotional, physical and cognitive behaviours typically reported in PTSD patients. This increase in the intensity of emotive reactions during a drug addiction history seems to configure a sort of PTSD spectrum resulting from the addictive process. At a therapeutic level it would be appropriate to consider this higher emotional reactivity in patients as being due to loss events and potentially traumatic events, so as to allow the optimization of therapeutic resources when these life events occur.

Copyright 2011, Pacini Editore


Sartor CE; McCutcheon VV; Pommer NE; Nelson EC; Grant JD; Duncan AE et al. Common genetic and environmental contributions to post-traumatic stress disorder and alcohol dependence in young women. Psychological Medicine 41(7): 1497-1505, 2011. (41 refs.)

Background. The few genetically informative studies to examine post-traumatic stress disorder (PTSD) and alcohol dependence (AD), all of which are based on a male veteran sample, suggest that the co-morbidity between PTSD and AD may be attributable in part to overlapping genetic influences, but this issue has yet to be addressed in females. Method. Data were derived from an all-female twin sample (n=3768) ranging in age from 18 to 29 years. A trivariate genetic model that included trauma exposure as a separate phenotype was fitted to estimate genetic and environmental contributions to PTSD and the degree to which they overlap with those that contribute to AD, after accounting for potential confounding effects of heritable influences on trauma exposure. Results. Additive genetic influences (A) accounted for 72% of the variance in PTSD; individual-specific environmental (E) factors accounted for the remainder. An AE model also provided the best fit for AD, for which heritability was estimated to be 71%. The genetic correlation between PTSD and AD was 0.54. Conclusions. The heritability estimate for PTSD in our sample is higher than estimates reported in earlier studies based almost exclusively on an all-male sample in which combat exposure was the precipitating traumatic event. However, our findings are consistent with the absence of evidence for shared environmental influences on PTSD and, most importantly, the substantial overlap in genetic influences on PTSD and AD reported in these investigations. Additional research addressing potential distinctions by gender in the relative contributions of genetic and environmental influences on PTSD is merited.

Copyright 2011, Cambridge University Press


Selic P; Serec M; Petek D; Rus-Makovec M. Intra-and inter-personal factors of psychosocial status in Slovenian military personnel with regard to their traumatic event experience. Zdravstveno Varstvo 50(3): 201-211, 2011. (34 refs.)

Problem: The main objectives of this study were to identify differences in the psychosocial status of military personnel who had and who had no traumatic event experience, and to screen for potential mental health vulnerability related to post-traumatic stress. Methods: 390 military personnel were included in the study, with 103 of them reporting traumatic event experience. The Mini-International Neuropsychiatric Interview Screening for Post-Traumatic Stress Disorder, the CAGE instrument, the Eysenck Personality Scales, the Folkman-Lazarus Ways of Coping Questionnaire, the Rosenberg Self-Esteem scale and self-evaluative questions about important relationships were administered. Results: The respondents who reported traumatic event experience (TEE) also reported a significantly higher frequency of other stressful events, a significantly more frequent past history of depression (16.5 % of respondents with TEE and 6.2 % of respondents without TEE) and significantly higher risky alcohol drinking; the latter, however, is not higher than the estimate for the total Slovenian population (10.7 % of respondents with TEE and 2.7 % of participants without TEE). Respondents with TEE smoke less frequently than respondents who reported no TEE (46.6 % vs. 60.1 %), and more often rely on self in stressful situations. There was no significant difference between the respondents with reported TEE and those without TEE in their personality traits, coping styles, and self-esteem, or in the majority of job-and family-related factors. No difference was found between male and female personnel as concerns intra-personal factors and in stress-related behaviour. Conclusions: Intra-personal factors (personality, coping styles, and self-esteem) of military personnel indicate good personal potential for resilience. Stress-related substance (ab) use, especially smoking rates well above the Slovenian average, need further attention. Professional support needs to be promoted, especially in female personnel, who are less likely than men to seek social support in times of stress, and in military personnel exposed to cumulative stressors.

Copyright 2011, Institute of Public Health, Republic of Slovenia


Sikkema KJ; Watt MH; Meade CS; Ranby KW; Kalichman SC; Skinner D et al. Mental health and HIV sexual risk behavior among patrons of alcohol serving venues in Cape Town, South Africa. Journal of Acquired Immune Deficiency Syndromes 57(3): 230-237, 2011. (60 refs.)

Background: Alcohol-serving venues in South Africa provide a location for HIV prevention interventions due to risk factors of patrons in these establishments. Understanding the association between mental health and risk behaviors in these settings may inform interventions that address alcohol use and HIV prevention. Methods: Participants (n = 738) were surveyed in 6 alcohol-serving venues in Cape Town to assess post-traumatic stress disorder (PTSD) and depression symptoms, traumatic experiences, sexual behavior, and substance use. Logistic regression models examined whether traumatic experiences predicted PTSD and depression. Generalized linear models examined whether substance use, PTSD, and depressive symptoms predicted unprotected sexual intercourse. Men and women were analyzed separately. Results: Participants exhibited high rates of traumatic experiences, PTSD, depression, alcohol consumption, and HIV risk behaviors. For men, PTSD was associated with being hit by a sex partner, physical child abuse, sexual child abuse and HIV diagnosis; depression was associated with being hit by a sex partner, forced sex and physical child abuse. For women, both PTSD and depression were associated with being hit by a sex partner, forced sex, and physical child abuse. Unprotected sexual intercourse was associated with age, frequency and quantity of alcohol use, drug use, and PTSD for men and frequency and quantity of alcohol use, depression, and PTSD for women. Conclusion: Mental health in this setting was poor and was associated with sexual risk behavior. Treating mental health and substance-use problems may aid in reducing HIV infection. Sexual assault prevention and treatment after sexual assault may strengthen HIV prevention efforts.

Copyright 2011, Lippincott, Wilkins & Wilkins


Steel C; Haddock G; Tarrier N; Picken A; Barrowclough C. Auditory hallucinations and posttraumatic stress disorder within schizophrenia and substance abuse. Journal of Nervous and Mental Disease 199(9): 709-711, 2011. (20 refs.)

There is a high prevalence of traumatic events within individuals diagnosed with schizophrenia and of auditory hallucinations within individuals diagnosed with posttraumatic stress disorder (PTSD). However, the relationship among the symptoms associated with these disorders remains poorly understood. We conducted a multidimensional assessment of auditory hallucinations within a sample diagnosed with schizophrenia and substance abuse, both with and without comorbid PTSD. The results suggest a rate of comorbid PTSD similar to those reported in other studies. Patients who have comorbid PTSD reported more distressing auditory hallucinations. However, the hallucinations were not more frequent or of longer duration. The need for a multidimensional assessment is supported. The results are discussed within current theoretical accounts of traumatic psychosis.

Copyright 2011, Lippincott, Williams & Wilkins


Torchalla I; Nosen L; Rostam H; Allen P. Integrated treatment programs for individuals with concurrent substance use disorders and trauma experiences: A systematic review and meta-analysis. Journal of Substance Abuse Treatment 42(1): 65-77, 2012. (70 refs.)

The purpose of this study was to examine the evidence of psychotherapeutic integrated treatment (IT) programs for individuals with concurrent substance use disorders and trauma histories. Electronic searches of Cochrane Central Register of Controlled Trials, MEDLINE, Web of knowledge, PubMed, PsycINFO, CINAHL, PILOTS, and EMBASE identified 17 IT trials (9 controlled trials). Both narrative review and meta-analysis indicate that IT effectively reduces trauma symptoms and substance abuse from pretreatment to longest follow-up. However, IT and nonintegrated programs appear to produce similar declines in symptoms. Methodological issues limiting the current body of work and recommendations for future research are discussed. Well-designed randomized controlled trials are clearly needed, particularly large sample studies evaluating understudied IT programs and exposure-based approaches.

Copyright 2012, Elsevier Science


Tull MT; McDermott MJ; Gratz KL; Coffey SF; Lejuez CW. Cocaine-related attentional bias following trauma cue exposure among cocaine dependent in-patients with and without post-traumatic stress disorder. Addiction 106(10): 1810-1818, 2011. (82 refs.)

Aims: Although the co-occurrence of post-traumatic stress disorder (PTSD) and cocaine dependence is associated with a wide range of negative clinical outcomes, little is known about the mechanisms that underlie this association. This study investigated one potential mechanism-attentional bias to cocaine imagery following trauma cue exposure. Design: Male and female cocaine-dependent in-patients with and without PTSD were exposed to both a neutral and personalized trauma script on separate days, followed by a visual dot-probe task. A 2 (PTSD versus non-PTSD) x 2 (neutral versus trauma script) x 2 (male versus female) design was used to examine hypotheses. Setting: Participants were recruited from a residential substance use disorder (SUD) treatment center. Participants"Participants were 60 trauma-exposed cocaine dependent in-patients, 30 with current PTSD and 30 without a history of PTSD. Measurements Attentional bias was assessed using a visual dot-probe task depicting cocaine-related imagery following both a neutral script and personalized trauma script. Findings: Following neutral script exposure, PTSD (versus non-PTSD) participants exhibited an attentional bias away from cocaine imagery. This effect was reversed following trauma script exposure, with PTSD participants exhibiting a greater attentional bias towards the location of cocaine imagery than non-PTSD participants. Severity of subjective distress following trauma script exposure predicted level of attentional bias among PTSD participants. Conclusions: Cocaine appears to serve an emotion-regulating function among post-traumatic stress disorder patients and may be a potential target for brief post-traumatic stress disorder-substance use disorder interventions that can facilitate residential substance use disorder treatment retention.

Copyright 2011, Society for the Study of Addiction


Williams M; Jayawickreme N; Sposato R; Foa EB. Race-specific associations between trauma cognitions and symptoms of alcohol dependence in individuals with comorbid PTSD and alcohol dependence. Addictive Behaviors 37(1): 47-52, 2012. (37 refs.)

Posttraumatic Stress Disorder (PTSD) changes the way people think about themselves, others, and the safety of the world. These cognitions may play a role in alcohol dependence, where alcohol dependence is maintained as an attempt to manage posttraumatic anxiety. The current study examined black-white differences in various PTSD cognitions and their relationship to symptoms of alcohol dependence in a dually diagnosed sample (N=167). Analyses revealed racial differences in trauma cognitions and their impact on symptoms of alcohol dependence, suggesting that trauma cognitions are more strongly associated with adverse consequences of drinking and alcohol craving severity among African Americans than European Americans. Additional relationships between ethnic identification and trauma-related cognitions are described and theoretical and clinical implications of these findings are discussed.

Copyright 2012, Elsevier Science


Williams M; Jayawickreme N; Sposato R; Foa EB. Race-specific associations between trauma cognitions and symptoms of alcohol dependence in individuals with comorbid PTSD and alcohol dependence. Addictive Behaviors 37(1): 47-52, 2012. (37 refs.)

Posttraumatic Stress Disorder (PTSD) changes the way people think about themselves, others, and the safety of the world. These cognitions may play a role in alcohol dependence, where alcohol dependence is maintained as an attempt to manage posttraumatic anxiety. The current study examined black-white differences in various PTSD cognitions and their relationship to symptoms of alcohol dependence in a dually diagnosed sample (N = 167). Analyses revealed racial differences in trauma cognitions and their impact on symptoms of alcohol dependence, suggesting that trauma cognitions are more strongly associated with adverse consequences of drinking and alcohol craving severity among African Americans than European Americans. Additional relationships between ethnic identification and trauma-related cognitions are described and theoretical and clinical implications of these findings are discussed.

Copyright 2012, Elsevier Science


Zahradnik M; Stewart SH; Sherry SB; Stevens D; Wekerle C. Posttraumatic stress hyperarousal symptoms mediate the relationship between childhood exposure to violence and subsequent alcohol misuse in Mi'kmaq youth. Journal of Traumatic Stress 24(5, special issue): 566-574, 2011. (70 refs.)

This study was part of a school-based collaborative research project with a Canadian Mi'kmaq community that examined the potential role of posttraumatic stress (PTS) symptom clusters in mediating the relationship between childhood exposure to violence (EV) and alcohol misuse in a sample of Mi'kmaq adolescents (N = 166). The study employed a cross-sectional design and used several well-validated self-report questionnaires. Path analytic results showed that when each PTS symptom cluster was independently investigated for mediating effects while controlling for depressive symptoms, age, and gender, only the PTS hyperarousal symptom cluster fully mediated the EV-alcohol misuse relationship. Results are discussed within the context of previous theory and research on the topic of PTS as a mediator between EV and alcohol misuse.

Copyright 2011, Wiley-Blackwell