Herry Patel1, Katherine Holshausen1,2,3, Assaf Oshri4, Krysta Andrews2, Stephanie Penta3, Holly Raymond3, Margaret McKinnon2,3,5, Jennifer Brasch1,2,3, James MacKillop1,2,5, Michael Amlung1,6,7. 1. Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Ontario, Canada. 2. Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada. 3. Mental Health and Addictions Program, St. Joseph's Healthcare Hamilton, Ontario, Canada. 4. Department of Human Development and Family Science, University of Georgia, Athens, Georgia, USA. 5. Homewood Research Institute, Guelph, Ontario, Canada. 6. Department of Applied Behavioral Science, University of Kansas, Lawrence, Kansas, USA. 7. Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, Kansas, USA.
Abstract
OBJECTIVE: Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) present a complex and often severe clinical presentation within a concurrent disorders context. The objective of this study was to examine associations between PTSD symptoms and SUD outcomes to better understand the clinical phenomenon of comorbid PTSD and SUD. Multivariate statistical methods were used to test the hypothesis that elevated PTSD symptoms, both at the level of global severity and specific PTSD symptom clusters, are associated with greater substance use and related problems. METHODS: Data were collected from an intake assessment battery within a specialized concurrent disorders outpatient service in Hamilton, ON. The sample comprised 326 participants (mean age = 37.19, 45.4% female). Structural equation models examined associations between PTSD and alcohol, cannabis, and substance use frequency and problems, controlling for age and sex. Alcohol was ultimately dropped from the model due to non-significant bivariate associations. RESULTS: Higher global PTSD symptomatology was significantly associated with higher cannabis and other substance use frequency and related problems. Analyses using PTSD cluster scores showed higher scores for alterations in arousal were positively associated with cannabis-related problems, drug-related problems, and cannabis and other substance use frequency. Avoidance was significantly associated with cannabis frequency and cannabis-related problems. In general, effect sizes were small in magnitude, accounting for between 9% and 25% of variance. CONCLUSION: Significant cluster-level associations indicate the importance of specific PTSD symptoms (hyperarousal, avoidance) in relation to substance use when identifying therapeutic targets among individuals presenting with comorbid PTSD-SUD. This multivariate approach provides a higher resolution and potentially more clinically informative representation of the complex clinical presentation of PTSD and SUD in a concurrent disorder population and could guide the development of more effective treatment paths.
OBJECTIVE: Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) present a complex and often severe clinical presentation within a concurrent disorders context. The objective of this study was to examine associations between PTSD symptoms and SUD outcomes to better understand the clinical phenomenon of comorbid PTSD and SUD. Multivariate statistical methods were used to test the hypothesis that elevated PTSD symptoms, both at the level of global severity and specific PTSD symptom clusters, are associated with greater substance use and related problems. METHODS: Data were collected from an intake assessment battery within a specialized concurrent disorders outpatient service in Hamilton, ON. The sample comprised 326 participants (mean age = 37.19, 45.4% female). Structural equation models examined associations between PTSD and alcohol, cannabis, and substance use frequency and problems, controlling for age and sex. Alcohol was ultimately dropped from the model due to non-significant bivariate associations. RESULTS: Higher global PTSD symptomatology was significantly associated with higher cannabis and other substance use frequency and related problems. Analyses using PTSD cluster scores showed higher scores for alterations in arousal were positively associated with cannabis-related problems, drug-related problems, and cannabis and other substance use frequency. Avoidance was significantly associated with cannabis frequency and cannabis-related problems. In general, effect sizes were small in magnitude, accounting for between 9% and 25% of variance. CONCLUSION: Significant cluster-level associations indicate the importance of specific PTSD symptoms (hyperarousal, avoidance) in relation to substance use when identifying therapeutic targets among individuals presenting with comorbid PTSD-SUD. This multivariate approach provides a higher resolution and potentially more clinically informative representation of the complex clinical presentation of PTSD and SUD in a concurrent disorder population and could guide the development of more effective treatment paths.
Entities:
Keywords:
alcohol; cannabis; concurrent disorders; posttraumatic stress disorder; substance use
Authors: Ronald C Kessler; Peggy R Barker; Lisa J Colpe; Joan F Epstein; Joseph C Gfroerer; Eva Hiripi; Mary J Howes; Sharon-Lise T Normand; Ronald W Manderscheid; Ellen E Walters; Alan M Zaslavsky Journal: Arch Gen Psychiatry Date: 2003-02
Authors: Syune Hakobyan; Sara Vazirian; Stephen Lee-Cheong; Michael Krausz; William G Honer; Christian G Schutz Journal: J Clin Med Date: 2020-07-28 Impact factor: 4.241