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Reznik A, Syunyakov T, Arbuzov A. Alcohol Addiction in War Veterans Treated in a In-patient Psychiatric Facility: Incidence, Comorbidity with PTSD Symptoms, Association with Combat Stressors. CONSORTIUM PSYCHIATRICUM 2022; 3:71-87. [PMID: 39044916 PMCID: PMC11262123 DOI: 10.17816/cp188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/26/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The dearth of and inconsistency in the data on the prevalence, risks of occurrence, comorbidity, and causation of stress-related disorders and alcohol use disorders in Russian veterans of local wars constituted the background for this study. AIM To study the psychopathological structure, clinical changes, and the reasons for the mental disorders suffered by Russian veterans of local wars; in particular, to study the prevalence, pathogenic factors, comorbidity of alcohol addiction and alcohol abuse, together with symptoms of stress disorders, in Russian veterans undergoing inpatient treatment. METHODS Our observational case-control study included 685 patients who were undergoing treatment in the psychiatric department of a military hospital: the Main group (veterans) consisted of 264 veterans of armed conflicts who had undergone inpatient treatment from 1992 to 2010; the Control group, 1, 296 patients, all servicemen and military pensioners who had undergone inpatient treatment during a calendar year and had never taken part in combat operations in the past; Control group 2, 125 military personnel (regular and reserve) who had not taken part in combat operations and corresponded to the patients of the main group in terms of the mean age and age distribution curve. We performed a clinical and psychopathological analysis of the symptoms identified in patients from the compared samples and, then, compared them with the ICD-10 criteria of post-traumatic stress disorder (PTSD) and alcohol-related disorders. This allowed us to establish the significance of the difference in their frequency and degree of association at the stage of the data analysis. RESULTS We uncovered no difference in the prevalence of symptoms of alcohol addiction and alcohol abuse among veterans and other servicemen and military pensioners who had not taken part in combat operations. However, there was a tendency to underdiagnose alcohol addiction in veterans in general and those with symptoms of PTSD, in particular. That is, alcohol addiction was not diagnosed in most cases when the veterans displayed symptoms of stress or other mental disorders, in addition to the signs of alcohol addiction. In most such cases, a stress-related mental disorder or another mental disorder with identified signs was diagnosed and alcohol abuse was described as a concomitant disorder or a complication. There was no significant association between any form of alcohol addiction or abuse and the presence of stress disorder symptoms in our sample of veterans; on the contrary, symptoms of re-experience of trauma were more often observed in veterans who were not prone to frequent drinking. The incidence of combat stressors traced in the medical history did not differ in veterans with any form of alcohol abuse and veterans who were not prone to frequent drinking. However, the main group subjects with alcohol addiction more often displayed cases of addictive behavior during combat operations. Therefore, alcohol abuse during combat operations requires additional research to better establish its prognostic significance. CONCLUSION This Study found no difference in the incidence of alcohol dependence and alcohol abuse among veterans and other officers. In the sample of veterans, there was no significant association between alcoholism and the presence of PTSD symptoms or a history of combat stressors. It is possible that the same risk of alcohol addiction in different categories of military officers is due to a compact of social stressors that equally had a more significant adverse effect on the entire population of Russian military personnel in the 90s of the last century and the first years of this century, as well as the massive abuse of alcohol, which could also equalize the risks of developing alcohol dependence in all groups of militaries.
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Esterman M, Fortenbaugh FC, Pierce ME, Fonda JR, DeGutis J, Milberg W, McGlinchey R. Trauma-related psychiatric and behavioral conditions are uniquely associated with sustained attention dysfunction. Neuropsychology 2019; 33:711-724. [PMID: 31144830 DOI: 10.1037/neu0000525] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE It is increasingly recognized that trauma victims, particularly Veterans, have co-occurring psychological and physical conditions that impact cognition, especially the domains of sustained attention and executive functioning. Although previous work has generally attempted to isolate the unique cognitive effects of common combat-related comorbidities, less work has been done to examine how these conditions co-occur, and whether unique cognitive signatures accompany certain clinical combinations. METHOD To address this gap, we examined how several deployment-related conditions were associated with performance on a well-validated measure of sustained attention (i.e., gradual onset continuous performance task [gradCPT]) and a battery of standard neuropsychological measures in 123 Veterans from the Translational Research Center for TBI and Stress Disorders. Initially, a Principal component analysis was conducted to investigate how comorbid conditions grouped together. RESULTS Several sustained attention measures from the gradCPT were differentially associated with four unique combinations of trauma-related pathology. Specifically, a somatic component representing the combination of current pain, sleep disturbance, and mild traumatic brain injury was associated with a higher rate of failures of attentional engagement. On the other hand, a comorbid posttraumatic stress disorder (PTSD) and mood disorder component (moodPTSD), as well as a substance use disorder component, were associated with higher rates of inhibitory control failures. Increased attentional instability was associated with moodPTSD as well as an anxiety disorder component. In contrast, the cognitive effects of deployment-related trauma were not observed on standard neuropsychological measures. CONCLUSION These findings suggest that unique combinations of trauma-related pathology have dissociable effects on sustained attentional control. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Joseph DeGutis
- Translational Research Center for TBI and Stress Disorders
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The association between post-traumatic stress disorder and lifetime DSM-5 psychiatric disorders among veterans: Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). J Psychiatr Res 2016; 82:16-22. [PMID: 27455424 PMCID: PMC5026976 DOI: 10.1016/j.jpsychires.2016.06.022] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 06/21/2016] [Accepted: 06/28/2016] [Indexed: 01/04/2023]
Abstract
This study examined the prevalence, correlates and psychiatric comorbidity of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) posttraumatic stress disorder (PTSD) in a nationally representative sample of U.S. veterans using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 3119 veteran respondents). The overall prevalence of lifetime PTSD was 6.9%. Lifetime PTSD prevalence was higher among veterans who were female (13.2%), aged 18-29 years (15.3%), Native American (24.1%) or Black (11.0%), previously or never married (9.6% and 11.2, respectively), had incomes less than $70,000 (7.2%-10.1%) and had >2 traumatic events (5.2%-14.7%). After adjusting for sociodemographic characteristics, comorbidity between lifetime PTSD and other psychiatric disorders was highest for any personality disorder (adjusted odds ratio [AOR] = 11.1, 95% confidence interval [CI], 5.7, 21.5), any mood disorder (AOR = 9.7, 95% CI, 4.6, 20.4) and any anxiety disorder (AOR = 9.6, 95% CI, 5.1, 17.7), followed by nicotine, drug, and alcohol use disorders (AOR = 3.4, 95% CI, 1.8, 6.5; AOR = 3.1, 95% CI, 2.0, 5.9; 2.1, 95% CI, 1.5, 3.1, respectively). Associations remained with any mood, anxiety, and personality disorders after controlling for other psychiatric disorders (AOR = 3.7, 95% CI, 1.2, 10.9; AOR = 3.5, 95% CI, 1.6, 7.4; AOR = 4.5, 95% CI, 2.3, 8.7, respectively). Veterans who sought treatment for PTSD had more comorbid conditions, although treatment was only associated with comorbid drug use disorder (AOR = 2.4, 95% CI, 1.0, 5.7). In U.S. veterans, PTSD is highly comorbid with other psychiatric disorders. Although many veterans remain untreated, comorbidity may influence treatment seeking.
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Kutlu MG, Gould TJ. Nicotine modulation of fear memories and anxiety: Implications for learning and anxiety disorders. Biochem Pharmacol 2015; 97:498-511. [PMID: 26231942 DOI: 10.1016/j.bcp.2015.07.029] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 07/24/2015] [Indexed: 12/14/2022]
Abstract
Anxiety disorders are a group of crippling mental diseases affecting millions of Americans with a 30% lifetime prevalence and costs associated with healthcare of $42.3 billion. While anxiety disorders show high levels of co-morbidity with smoking (45.3% vs. 22.5% in healthy individuals), they are also more common among the smoking population (22% vs. 11.1% in the non-smoking population). Moreover, there is clear evidence that smoking modulates symptom severity in patients with anxiety disorders. In order to better understand this relationship, several animal paradigms are used to model several key symptoms of anxiety disorders; these include fear conditioning and measures of anxiety. Studies clearly demonstrate that nicotine mediates acquisition and extinction of fear as well as anxiety through the modulation of specific subtypes of nicotinic acetylcholine receptors (nAChRs) in brain regions involved in emotion processing such as the hippocampus. However, the direction of nicotine's effects on these behaviors is determined by several factors that include the length of administration, hippocampus-dependency of the fear learning task, and source of anxiety (novelty-driven vs. social anxiety). Overall, the studies reviewed here suggest that nicotine alters behaviors related to fear and anxiety and that nicotine contributes to the development, maintenance, and reoccurrence of anxiety disorders.
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Affiliation(s)
| | - Thomas J Gould
- Temple University, Weiss Hall, Philadelphia, PA 19122, USA.
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Walling AM, Schreibeis-Baum H, Pimstone N, Asch SM, Robinson L, Korlekar S, Lorenz K, Nwajuaku T, Rosenfeld K. Proactive case finding to improve concurrently curative and palliative care in patients with end-stage liver disease. J Palliat Med 2014. [PMID: 25493552 DOI: 10.1089/jpm.2014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Palliative care and preparation for liver transplantation are often perceived as conflicting for patients with end-stage liver disease (ESLD). We sought to improve both simultaneously through a case finding and care coordination quality improvement intervention. METHODS We identified patients with cirrhosis using validated ICD-9 codes and screened them for ESLD by assessing medical records at a VA hospital for either a model for end-stage liver disease (MELD) ≥14 or a diagnosis of hepatocellular carcinoma (HCC) between October 2012 and January 2013. A care coordinator followed veterans from the index hospitalization through April 2013 and encouraged treating physicians to submit liver transplant evaluation consults for all veterans with a MELD ≥14 and palliative care consults for all veterans with a MELD ≥20 or inoperable HCC. RESULTS We compared rates of consultation for 49 hospitalized veterans and compared their outcomes to 61 pre-intervention veterans. Veterans were more likely to be considered for liver transplantation (77.6% versus 31.1%, p<0.001) and receive palliative care consultation during the intervention period, although the latter finding did not reach statistical significance (62.5% versus 47.1%, p=0.38). CONCLUSIONS Active case finding improved consideration for liver transplantation without decreasing palliative care consultation.
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Affiliation(s)
- Anne M Walling
- 1 Greater Los Angeles Veterans Affairs Healthcare System, David Geffen School of Medicine at University of California , Los Angeles, California
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Walling AM, Schreibeis-Baum H, Pimstone N, Asch SM, Robinson L, Korlekar S, Lorenz K, Nwajuaku T, Rosenfeld K. Proactive case finding to improve concurrently curative and palliative care in patients with end-stage liver disease. J Palliat Med 2014; 18:378-81. [PMID: 25493552 DOI: 10.1089/jpm.2014.0265] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Palliative care and preparation for liver transplantation are often perceived as conflicting for patients with end-stage liver disease (ESLD). We sought to improve both simultaneously through a case finding and care coordination quality improvement intervention. METHODS We identified patients with cirrhosis using validated ICD-9 codes and screened them for ESLD by assessing medical records at a VA hospital for either a model for end-stage liver disease (MELD) ≥14 or a diagnosis of hepatocellular carcinoma (HCC) between October 2012 and January 2013. A care coordinator followed veterans from the index hospitalization through April 2013 and encouraged treating physicians to submit liver transplant evaluation consults for all veterans with a MELD ≥14 and palliative care consults for all veterans with a MELD ≥20 or inoperable HCC. RESULTS We compared rates of consultation for 49 hospitalized veterans and compared their outcomes to 61 pre-intervention veterans. Veterans were more likely to be considered for liver transplantation (77.6% versus 31.1%, p<0.001) and receive palliative care consultation during the intervention period, although the latter finding did not reach statistical significance (62.5% versus 47.1%, p=0.38). CONCLUSIONS Active case finding improved consideration for liver transplantation without decreasing palliative care consultation.
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Affiliation(s)
- Anne M Walling
- 1 Greater Los Angeles Veterans Affairs Healthcare System, David Geffen School of Medicine at University of California , Los Angeles, California
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Grosso JA, Kimbrel NA, Dolan S, Meyer EC, Kruse MI, Gulliver SB, Morissette SB. A test of whether coping styles moderate the effect of PTSD symptoms on alcohol outcomes. J Trauma Stress 2014; 27:478-82. [PMID: 25158641 PMCID: PMC5032643 DOI: 10.1002/jts.21943] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Coping style may partially account for the frequent co-occurrence of posttraumatic stress disorder (PTSD) and alcohol-use disorder (AUD). We hypothesized that avoidant and action-oriented coping styles would moderate the association between PTSD symptom severity and alcohol outcomes among U.S. Operation Enduring Freedom/Operation Iraqi Freedom veterans, such that PTSD symptoms would be most strongly and positively associated with negative alcohol-related consequences and drinking quantity when action-oriented coping was low and avoidant coping was high. The sample (N = 128; 85.2% male, M = 37.8 years old, 63.3% Caucasian) completed a diagnostic assessment for PTSD and AUD and self-report surveys measuring coping styles, drinking quantity, and negative alcohol-related consequences. Consistent with the main hypothesis, a 3-way interaction among PTSD symptom severity, avoidant coping, and action-oriented coping was found in the predicted direction (d = 0.47-0.55). Post hoc descriptive analyses indicated that veterans with a current diagnosis of PTSD, low action-oriented coping, and high avoidant coping had worse alcohol outcomes and were twice as likely to meet criteria for current AUD compared with veterans with fewer risk factors. Findings suggest that the combination of PTSD and maladaptive coping styles may be more important for understanding alcohol-related outcomes than the presence of any of these variables in isolation.
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Affiliation(s)
- Justine A. Grosso
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA
,Baylor University, Waco, Texas, USA
| | - Nathan A. Kimbrel
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA
,Texas A&M Health Science Center, College Station, Texas, USA
,Correspondence concerning this article should be sent to: Dr. Nathan A. Kimbrel, VA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Healthcare System, 4800 Memorial Drive (151C), Waco, Texas 76711, USA. Phone: 254-297-5232.
| | - Sara Dolan
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA
,Baylor University, Waco, Texas, USA
| | - Eric C. Meyer
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA
,Texas A&M Health Science Center, College Station, Texas, USA
| | - Marc I. Kruse
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA
,Texas A&M Health Science Center, College Station, Texas, USA
,Austin Fire Department & Austin-Travis County Emergency Medical Services, Austin, TX, USA
| | - Suzy B. Gulliver
- Texas A&M Health Science Center, College Station, Texas, USA
,Braver Institute, Scott and White Healthcare Division of Research, Waco, TX, USA
| | - Sandra B. Morissette
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA
,Texas A&M Health Science Center, College Station, Texas, USA
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Flores Morales R, Reyes Pérez V, Reidl Martínez LM. El Impacto Psicológico de la Guerra Contra el Narcotráfico en Periodistas Mexicanos. REVISTA COLOMBIANA DE PSICOLOGÍA 2014. [DOI: 10.15446/rcp.v23n1.37640] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Etiology of depression comorbidity in combat-related PTSD: a review of the literature. Clin Psychol Rev 2013; 34:87-98. [PMID: 24486520 DOI: 10.1016/j.cpr.2013.12.002] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 12/05/2013] [Accepted: 12/09/2013] [Indexed: 11/23/2022]
Abstract
Posttraumatic stress disorder is often diagnosed with other mental health problems, particularly depression. Although PTSD comorbidity has been associated with more severe and chronic symptomology, relationships among commonly co-occurring disorders are not well understood. The purpose of this study was to review the literature regarding the development of depression comorbid with combat-related PTSD among military personnel. We summarize results of commonly tested hypotheses about the etiology of PTSD and depression comorbidity, including (1) causal hypotheses, (2) common factor hypotheses, and (3) potential confounds. Evidence suggests that PTSD may be a causal risk factor for subsequent depression; however, associations are likely complex, involving bidirectional causality, common risk factors, and common vulnerabilities. The unique nature of PTSD-depression comorbidity in the context of military deployment and combat exposure is emphasized. Implications of our results for clinical practice and future research are discussed.
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Kim TY, Chung HG, Shin HS, Kim SJ, Choi JH, Chung MY, An SK, Choi TK, So HS, Cho HS. Apolipoprotein E gene polymorphism, alcohol use, and their interactions in combat-related posttraumatic stress disorder. Depress Anxiety 2013; 30:1194-201. [PMID: 23761065 DOI: 10.1002/da.22138] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 04/13/2013] [Accepted: 05/08/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The symptomatology of posttraumatic stress disorder (PTSD) is related not only to the intensity of the causative trauma, but also to alcohol use and genetic factors. Among the many candidate genes, the apolipoprotein E gene (APOE) is thought to be associated with stress reactivity. METHODS Korean veterans of the Vietnam War with (n = 128) or without (n = 128) PTSD participated in this study. The Clinician-Administered PTSD Scale and Combat Exposure Scale were administered, and the severity of alcohol use was assessed among these veterans. The APOE polymorphism and clinical variables of the subjects were compared, and associations between PTSD and potential explanatory variables were tested using logistic regression analysis. RESULTS Higher frequencies of APOE ε2 alleles and a greater number of individuals with the ε2 allele were found in the PTSD group. Among patients with PTSD, ε2-allele noncarriers consumed alcohol in greater amounts and more frequently than did ε2-allele carriers. Regression analysis revealed a significant interactional effect between harmful drinking and the absence of the ε2 allele associated with PTSD risk. CONCLUSIONS These results suggest that the APOE ε2 allele operates as a susceptibility gene for combat-related PTSD, with the relationship between alcohol use and PTSD differing according to the ε2-allele status. Future studies should determine the role of the APOE in adaptation to extreme stress, the development of PTSD, and comorbid alcohol-related disorders.
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Affiliation(s)
- Tae Yong Kim
- Department of Neuropsychiatry, Veterans Health Service Medical Center, Seoul, Republic of Korea; Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
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Petrakis IL, Ralevski E, Desai N, Trevisan L, Gueorguieva R, Rounsaville B, Krystal JH. Noradrenergic vs serotonergic antidepressant with or without naltrexone for veterans with PTSD and comorbid alcohol dependence. Neuropsychopharmacology 2012; 37:996-1004. [PMID: 22089316 PMCID: PMC3280636 DOI: 10.1038/npp.2011.283] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 10/04/2011] [Accepted: 10/05/2011] [Indexed: 01/08/2023]
Abstract
The wars in Iraq and Afghanistan are associated with high rates of post-traumatic stress disorder (PTSD) and comorbid alcohol use disorders. The pharmacotherapy of these comorbid conditions has received relatively little study. The current study compared the serotonin uptake inhibitor, paroxetine, to the norepinephrine uptake inhibitor, desipramine. It also evaluated the adjunctive efficacy of the Food and Drug Administration (FDA)-approved alcoholism pharmacotherapy, naltrexone, relative to placebo. Four groups of predominately male veterans (n=88) meeting current diagnostic criteria for both alcohol dependence (AD) and PTSD were randomly assigned under double-blind conditions to one of four groups: paroxetine+naltrexone; paroxetine+placebo; desipramine+naltrexone; desipramine+placebo. Main outcome measures included standardized scales that assessed symptoms of PTSD and alcohol consumption. Paroxetine did not show statistical superiority to desipramine for the treatment of PTSD symptoms. However, desipramine was superior to paroxetine with respect to study retention and alcohol use outcomes. Naltrexone reduced alcohol craving relative to placebo, but it conferred no advantage on drinking use outcomes. Although the serotonin uptake inhibitors are the only FDA-approved medications for the treatment of PTSD, the current study suggests that norepinephrine uptake inhibitors may present clinical advantages when treating male veterans with PTSD and AD. However, naltrexone did not show evidence of efficacy in this population. This study was registered with ClinicalTrials.gov, registration number NCT00338962 and URL: http://clinicaltrials.gov/ct2/show/NCT00338962?term=desipramine+AND+alcohol+dependence+AND+depression&recr=Closed&rank=1.
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Affiliation(s)
- Ismene L Petrakis
- VA Connecticut Healthcare System, Yale University School of Medicine, West Haven, CT, USA.
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Papastavrou E, Efstathiou G, Tsangari H, Suhonen R, Leino-Kilpi H, Patiraki E, Karlou C, Balogh Z, Palese A, Tomietto M, Jarosova D, Merkouris A. A cross-cultural study of the concept of caring through behaviours: patients’ and nurses’ perspectives in six different EU countries. J Adv Nurs 2011; 68:1026-37. [DOI: 10.1111/j.1365-2648.2011.05807.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The long-term impact of footshock stress on addiction-related behaviors in rats. Neuropharmacology 2011; 60:267-73. [DOI: 10.1016/j.neuropharm.2010.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 08/20/2010] [Accepted: 09/07/2010] [Indexed: 01/31/2023]
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Leeies M, Pagura J, Sareen J, Bolton JM. The use of alcohol and drugs to self-medicate symptoms of posttraumatic stress disorder. Depress Anxiety 2010; 27:731-6. [PMID: 20186981 DOI: 10.1002/da.20677] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Self-medication has been proposed as an explanation for the high rates of comorbidity between posttraumatic stress disorder (PTSD) and substance use disorders; however, knowledge of self-medication in PTSD is scarce. We describe the prevalence and correlates of self-medication in PTSD in the general population. METHODS Data came from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2 (N=34,653; response rate: 70.2%), a nationally representative survey of mental illness in community-dwelling adults. Self-medication was assessed separately for alcohol and drugs. Prevalence rates were determined for self-medication among individuals with DSM-IV PTSD. Regression analyses determined associations between self-medication and a variety of correlates, including sociodemographic factors, comorbid mental disorders, suicide attempts, and quality of life. RESULTS Approximately 20% of individuals with PTSD used substances in an attempt to relieve their symptoms. Men were significantly more likely than women to engage in self-medication behavior. In adjusted models, using illicit drugs or misusing prescription medications to control PTSD symptoms was associated with a substantially higher likelihood of dysthymia and borderline personality disorder. After controlling for mental disorder comorbidity, self-medication was independently associated with higher odds of suicide attempts (adjusted odds ratio=2.46; 95% confidence interval 1.53-3.97) and lower mental health-related quality of life. CONCLUSIONS Self-medication is a common behavior among people with PTSD in the community, yet has potentially hazardous consequences. Health care practitioners should assess reasons for substance use among people with PTSD to identify a subgroup with higher psychiatric morbidity.
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Affiliation(s)
- Murdoch Leeies
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
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Cooley-Strickland M, Quille TJ, Griffin RS, Stuart EA, Bradshaw CP, Furr-Holden D. Community violence and youth: affect, behavior, substance use, and academics. Clin Child Fam Psychol Rev 2009; 12:127-56. [PMID: 19472053 PMCID: PMC2700237 DOI: 10.1007/s10567-009-0051-6] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Community violence is recognized as a major public health problem (WHO, World Report on Violence and Health, 2002) that Americans increasingly understand has adverse implications beyond inner-cities. However, the majority of research on chronic community violence exposure focuses on ethnic minority, impoverished, and/or crime-ridden communities while treatment and prevention focuses on the perpetrators of the violence, not on the youth who are its direct or indirect victims. School-based treatment and preventive interventions are needed for children at elevated risk for exposure to community violence. In preparation, a longitudinal, community epidemiological study, The Multiple Opportunities to Reach Excellence (MORE) Project, is being fielded to address some of the methodological weaknesses presented in previous studies. This study was designed to better understand the impact of children's chronic exposure to community violence on their emotional, behavioral, substance use, and academic functioning with an overarching goal to identify malleable risk and protective factors which can be targeted in preventive and intervention programs. This paper describes the MORE Project, its conceptual underpinnings, goals, and methodology, as well as implications for treatment and preventive interventions and future research.
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Affiliation(s)
- Michele Cooley-Strickland
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
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Abstract
A challenging question that continues unanswered in the field of addiction is why some individuals are more vulnerable to substance use disorders than others. Numerous risk factors for alcohol and other drugs of abuse, including exposure to various forms of stress, have been identified in clinical studies. However, the neurobiological mechanisms that underlie this relationship remain unclear. Critical neurotransmitters, hormones and neurobiological sites have been recognized, which may provide the substrates that convey individual differences in vulnerability to addiction. With the advent of more sophisticated measures of brain function in humans, such as functional imaging technology, the mechanisms and neural pathways involved in the interactions between drugs of abuse, the mesocorticolimbic dopamine system and stress systems are beginning to be characterized. This review provides a neuroadaptive perspective regarding the role of the hormonal and brain stress systems in drug addiction with a focus on the changes that occur during the transition from occasional drug use to drug dependence. We also review factors that contribute to different levels of hormonal/brain stress activation, which has implications for understanding individual vulnerability to drug dependence. Ultimately, these efforts may improve our chances of designing treatment strategies that target addiction at the core of the disorder.
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Affiliation(s)
- Magdalena Uhart
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Roberts ME, Fuemmeler BF, McClernon FJ, Beckham JC. Association between trauma exposure and smoking in a population-based sample of young adults. J Adolesc Health 2008; 42:266-74. [PMID: 18295135 PMCID: PMC2675188 DOI: 10.1016/j.jadohealth.2007.08.029] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Revised: 08/01/2007] [Accepted: 08/10/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the relation between smoking and trauma exposure in a population-based, longitudinal sample. Contrary to current smoking trends in the general population, recent findings indicate continued high smoking rates in trauma-exposed samples. METHODS A nationally representative sample of 15,197 adolescents was followed from 1995 (mean age, 15.6 years) to 2002 (mean age, 22 years) as part of three waves of The National Longitudinal Study of Adolescent Health (Add Health). We examined the relation between self-reported trauma exposure and smoking behaviors (lifetime regular, current regular), nicotine dependence based on the Fagerström Test of Nicotine Dependence (FTND), number of cigarettes smoked per day, and age of onset of regular smoking. RESULTS Controlling for demographics and depressive symptoms, exposure to traumatic events yielded a significant increase in the odds of lifetime regular smoking. Nicotine dependence and cigarettes smoked per day was also significantly related to exposure to childhood physical and sexual abuse. Decreased age of regular smoking onset was seen for those reporting childhood physical abuse and childhood sexual abuse. CONCLUSIONS Exposure to traumatic life events during childhood and young adulthood increases the risk of smoking, highlighting the need to prevent and treat tobacco use in this vulnerable population.
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Affiliation(s)
- Miguel E Roberts
- Duke University Medical Center/ Durham Veterans Affairs Medical Center, Durham, North Carolina 27710, USA
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Feldner MT, Babson KA, Zvolensky MJ. Smoking, traumatic event exposure, and post-traumatic stress: a critical review of the empirical literature. Clin Psychol Rev 2007; 27:14-45. [PMID: 17034916 PMCID: PMC2575106 DOI: 10.1016/j.cpr.2006.08.004] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Revised: 08/01/2006] [Accepted: 08/31/2006] [Indexed: 11/15/2022]
Abstract
The current review critically examines the extant empirical literature focused on the associations among cigarette smoking, trauma, and post-traumatic stress. Inspection of the extant literature suggests that smoking rates are significantly higher among persons exposed to a traumatic event relative to those without such exposure. Moreover, smoking rates appear particularly high among persons with post-traumatic stress disorder (PTSD). In terms of the direction of this relation, evidence most clearly suggests that post-traumatic stress is involved in the development of smoking. Significantly less is known about the role of trauma and PTSD in terms of cessation outcome. Limitations of extant work, clinical implications, and key directions for future study are delineated.
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Affiliation(s)
- Matthew T Feldner
- Intervention Sciences Laboratory, Department of Psychology, University of Arkansas, Fayetteville, AR 72701, USA.
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20
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Steindl SR, Young RM, Creamer M, Crompton D. Hazardous alcohol use and treatment outcome in male combat veterans with posttraumatic stress disorder. J Trauma Stress 2003; 16:27-34. [PMID: 12602649 DOI: 10.1023/a:1022055110238] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The relationship between alcohol problems and posttraumatic stress disorder (PTSD) remains unclear. Six hundred and eight combat veterans diagnosed with PTSD were assessed for PTSD symptoms and alcohol problems prior to group cognitive-behavioral treatment. They were reassessed 3 and 9 months after treatment. Participants were classified into low-risk and hazardous drinkers at each time point. Drinking status at intake did not predict PTSD symptoms at intake or follow-up. However, drinking status was associated with PTSD symptoms when both were assessed at follow-up. PTSD arousal symptoms were the only symptom cluster to differentiate drinking groups.
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Affiliation(s)
- Stanley R Steindl
- Department of Psychiatry, The University of Queensland, Brisbane, Australia
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21
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Mehlum L, Weisaeth L. Predictors of posttraumatic stress reactions in Norwegian U.N. peacekeepers 7 years after service. J Trauma Stress 2002; 15:17-26. [PMID: 11936717 DOI: 10.1023/a:1014375026332] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A sample of 1,624 Norwegian veterans from the UNIFIL (United Nations Interim Force in Lebanon) was investigated on average 6.6 years after service, completing a questionnaire focusing on stress exposure and posttraumatic stress reactions. The prevalence of posttraumatic stress disorder (measured by the Posttraumatic Symptom Scale [PTSS-10]) was 5% overall, but 16% in the subgroup of personnel having been prematurely repatriated from UNIFIL. Multiple regression analyses showed that the following variables made separate and significant contributions to the explained variance of the PTSS-10: Service stress exposure, perceived lack of meaningfulness with respect to the military mission, and stressful life-events in life after service. These factors explained 25% (overall sample) and 37% (repatriated sample) of the variation in the posttraumatic symptom score.
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Donovan B, Padin-Rivera E, Kowaliw S. "Transcend": initial outcomes from a posttraumatic stress disorder/substance abuse treatment program. J Trauma Stress 2001; 14:757-72. [PMID: 11776422 DOI: 10.1023/a:1013094206154] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper describes the development of a comprehensive treatment program for combat veterans diagnosed with posttraumatic stress disorder (PTSD) and substance abuse (SA). Outcome data are presented on 46 male patients who completed treatment between 1996 and 1998. The treatment approach, defined by a detailed manual, integrates elements of cognitive-behavioral skills training, constructivist theory approaches, SA relapse prevention strategies, and peer social support into a group-focused program. The Clinician-Administered PTSD Scale (CAPS) and the Addiction Severity Index (ASI) were used to assess treatment effectiveness at discharge and 6- and 12-month follow-up. Significant symptom changes revealed on CAPS and ASI scores at discharge and follow-up are analyzed. Discussion focuses on hypotheses regarding treatment effectiveness, study limitations, and suggestions for further research.
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Affiliation(s)
- B Donovan
- Louis Stokes Cleveland Veterans Affairs Medical Center, Ohio 44141, USA.
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23
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Nishith P, Resick PA, Mueser KT. Sleep difficulties and alcohol use motives in female rape victims with posttraumatic stress disorder. J Trauma Stress 2001; 14:469-79. [PMID: 11534879 PMCID: PMC2977933 DOI: 10.1023/a:1011152405048] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The purpose of this study was to assess the relationship between sleep difficulties and drinking motives in female rape victims with posttraumatic stress disorder (PTSD). Seventy-four participants were assessed for PTSD symptoms, depression, sleep difficulties, and drinking motives. Results demonstrated that neither PTSD symptoms nor depression were related to any motives for using alcohol. On the other hand, after controlling for education, sleep difficulties were significantly related to drinking motives for coping with negative affect, but not pleasure enhancement or socialization. The findings suggest that sleep difficulties may be an important factor contributing to alcohol use in rape victims with PTSD.
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Affiliation(s)
- P Nishith
- Department of Psychology, Center for Trauma Recovery, University of Missouri-St. Louis, 63121, USA.
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Xian H, Chantarujikapong SI, Scherrer JF, Eisen SA, Lyons MJ, Goldberg J, Tsuang M, True WR. Genetic and environmental influences on posttraumatic stress disorder, alcohol and drug dependence in twin pairs. Drug Alcohol Depend 2000; 61:95-102. [PMID: 11064187 DOI: 10.1016/s0376-8716(00)00127-7] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We investigated whether and to what degree genetic and environmental contributions overlap among posttraumatic stress disorder (PTSD), alcohol dependence (AD) and drug dependence (DD). Subjects were 3304 monozygotic and dizygotic male-male twin pair members of the Vietnam Era Twin Registry who participated in 1992 telephone administration of the Diagnostic Interview Schedule Version 3 Revised (DIS-3R). Genetic model fitting was performed to estimate the magnitude of genetic and environmental contributions to the lifetime co-occurrence of DSM-III-R PTSD, AD and DD. The liability for PTSD was partially due to a 15.3% genetic contribution common to AD and DD and 20.0% genetic contribution specific to PTSD. Risk for AD was partially due to a 55.7% genetic contribution common to PTSD and DD. Genetic influences common to PTSD and AD accounted for 25.2% of the total risk for DD. Specific family environmental influence accounted for 33.9% of the total variance in risk for DD. Remaining variance for all three disorders was due to unique environmental factors both common and specific to each phenotype. These results suggest that PTSD, AD and DD each have etiologically distinct components and also have significant genetic and unique environmental contributions in common.
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Affiliation(s)
- H Xian
- Department of Internal Medicine, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA.
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25
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Bollinger AR, Riggs DS, Blake DD, Ruzek JI. Prevalence of personality disorders among combat veterans with posttraumatic stress disorder. J Trauma Stress 2000; 13:255-70. [PMID: 10838674 DOI: 10.1023/a:1007706727869] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Many combat veterans with PTSD have co-occurring symptoms of other forms of psychopathology; however, there have been limited studies examining personality disorders among this population. The few extant studies typically have assessed only two or three personality disorders or examined a small sample, resulting in an incomplete picture and scope of comorbidity. This study assessed all DSM-III-R personality disorders in 107 veterans in a specialized, inpatient unit. Using the Structured Clinical Interview for DSM-III-R Personality Disorders, 79.4% of the participants were diagnosed with at least one personality disorder: 29.9% received only one diagnosis, 21.5% had two, 15.9% had three, and 12.1% had four or more. The most frequent single diagnoses were Avoidant (47.2%), Paranoid (46.2%), Obsessive-Compulsive (28.3%), and Antisocial (15.1%) personality disorders.
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Affiliation(s)
- A R Bollinger
- VA Boston Healthcare System (116B), Massachusetts 02130, USA.
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McFarlane AC. Epidemiological evidence about the relationship between PTSD and alcohol abuse: the nature of the association. Addict Behav 1998; 23:813-25. [PMID: 9801718 DOI: 10.1016/s0306-4603(98)00098-7] [Citation(s) in RCA: 187] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article uses the Bradford Hill criteria for assessing causal associations to examine the nature of the relationship between PTSD and alcohol abuse. A series of studies are presented which examine this relationship. A cross-sectional study of 2,501 subjects in a community sample examined the relationship between at-risk drinking and 11 types of traumatic events. The traumatic events associated with at-risk drinking were involvement in life threatening accidents, witnessing severe injury, rape, being the victim of serious physical assault using the CIDI. In a longitudinal study of 469 firefighters exposed to a natural disaster, PTSD was associated with both an increase and decrease in alcohol consumption and PTSD rather than exposure accounted for the changes in drinking behaviour. In three other populations, psychiatric inpatients, motor accident victims and female prisoners, the association between PTSD and alcohol abuse emphasised the clinical and public health importance of this relationship. The available evidence does nevertheless support the causal nature of this relationship. Other risk factors are necessary to predict alcohol abuse following exposure to traumatic events, although exposure to traumatic events can be caused by alcohol abuse.
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Affiliation(s)
- A C McFarlane
- University of Adelaide, Department of Psychiatry, Queen Elizabeth Hospital, Woodville, Australia
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Abstract
It is clear from the existing data that PTSD often occurs in the context of other major psychological conditions. Evidence to support this comes from clinical studies, epidemiological studies, and studies of PTSD among substance abusers. Clearly, probably several different subgroups of PTSD patients exist including those who had psychological or behavioral problems before exposure to traumatic events (e.g., substance abuse), those who developed other problems concurrent with exposure to the traumatic events, and those who developed problems secondary to the development of PTSD, perhaps in efforts to cope with the intensely debilitating symptoms of PTSD. With this knowledge, research on PTSD must begin to contend with the comorbidity issue in systematic ways. The use of comparison groups that are carefully selected is one key way in which conclusions about PTSD can be most conservatively drawn. The use of statistical procedures to control for difference in levels of comorbidity is another responsible way in which to approach the problem. Finally, efforts to employ global measures of functioning such as the Global Assessment of Functioning to equate subjects within a study on minimally this characteristic may be the most economical method for trying to rule out the role of comorbidity and severity of condition in conclusions drawn in research studies. All these solutions presuppose the careful measurement of comorbidity in studies of PTSD, a recommendation that requires serious consideration for researchers operating in this field.
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Affiliation(s)
- T M Keane
- Department of Veterans Affairs Medical Center, Boston, Massachusetts 02130, USA
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28
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Hyer L, Leach P, Boudewyns PA, Davis H. Hidden PTSD in substance abuse inpatients among Vietnam veterans. J Subst Abuse Treat 1991; 8:213-9. [PMID: 1787545 DOI: 10.1016/0740-5472(91)90041-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Alcohol use patterns among Vietnam combat veterans is an area with little research. This study evaluated three groups of Vietnam subjects on a chemical dependency unit who had a current Axis I diagnosis of alcohol abuse. No subject possessed a PTSD diagnosis. Two groups involved in-country veterans divided by presence or absence of PTSD based on the MMPI-PTSD scale (In-country and PTSD). The third group did not experience combat and was below the mean on the MMPI-PTSD scale (Noncombat). These groups were compared on the MMPI and the Alcohol Use Inventory (AUI), a measure of alcohol use patterns. Results showed that the PTSD Group had significantly higher scores on the MMPI and AUI reflective of deteriorated and binge drinking patterns. Discussion focused on the "hidden" dimension of PTSD among chemically dependent Vietnam veteran inpatients. The Relapse Prevention model was endorsed.
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Affiliation(s)
- L Hyer
- VA Medical Center, Augusta, Georgia 30910
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Keane TM, Wolfe J. Comorbidity In Post-Traumatic Stress Disorder An Analysis of Community and Clinical Studies1. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 1990. [DOI: 10.1111/j.1559-1816.1990.tb01511.x] [Citation(s) in RCA: 204] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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