Alcohol use disorder history moderates the relationship between avoidance coping and posttraumatic stress symptoms

Avoidance Coping as a Vulnerability Factor for Negative Drinking Consequences Among Injury Survivors Experiencing PTSD Symptoms:An Ecological Momentary Assessment Study

The purpose of this study was to examine the dynamic relationships between daily PTSD symptom severity (PTSS), cognitive and behavioral avoidance coping, and negative drinking consequences following recent injury. Participants consisted of 36 injury survivors (Mage = 34.0, SD = 10.8; 75.0% male; 69.4% White) who completed thrice daily assessments of PTSS, avoidance coping, and negative drinking consequences for 7 days at 6-weeks post-injury. Although hypothesized relationships were not statistically significant in full models with covariates that included alcohol consumption, the confidence intervals associated with focal predictors provided support for predictions. Follow-up analyses without covariates indicated that on occasions when an injury survivor engaged in more avoidance coping and experienced higher levels of PTSS, negative drinking consequences increased by 9% (b = 0.02, SE = 0.01, p = .006). This interaction was primarily driven by cognitive avoidance coping (b = 0.03, SE = 0.01, p = .008). Routine screening of avoidance coping, PTSS, and alcohol consumption in the aftermath of recent injury might assist with identifying survivors at risk for negative drinking consequences. Interventions that address cognitive avoidance coping and drinking among survivors experiencing elevated PTSS may help to prevent the development of this comorbidity.

Support-Seeking and Active Coping Mitigate the Association Between Posttrauma Symptom Severity and Attachment Insecurity in a Community Sample of Trauma Survivors

There is an established association between posttrauma symptom severity (PTSS) and attachment insecurity (anxiety and avoidance). However, few studies have examined this association among community samples of trauma-exposed individuals and identified factors that might moderate these associations. We sought to (a) replicate existing associations between PTSS and attachment insecurity in a community sample of trauma survivors and (b) determine the potential moderating role of support-seeking and coping behaviors. Our sample included 824 trauma-exposed individuals (MPCL-5 = 31.6, SD = 20.0; Mage = 37.4, SD = 13.2; 69.3% female; 79.1% White; 77.2% heterosexual). Participants completed an online survey via Amazon Mechanical Turk. Linear regression and moderation analyses tested the association between PTSS and attachment insecurity and whether support-seeking and coping behaviors moderated these associations. PTSS was positively associated with global attachment anxiety (β = .48, 95% confidence interval [.42, .54]) and global attachment avoidance (β = .06, [.15, .29]). The association between PTSS and attachment avoidance was weaker for people who reported greater instrumental and emotional support-seeking or greater active coping. This study provides evidence for the association between PTSS and attachment insecurity. Findings underscore the need to understand causal mechanisms underlying this association and critically evaluate how existing and future interventions can buffer attachment insecurity in trauma-exposed individuals.

Shake it off! Adaptive coping with stress reduces national narcissism

Examining the role of coping with stress strategies in shaping national narcissism, we proposed that this type of defensive national commitment (stemming from psychological shortcomings) should be lowered by adaptive coping strategies. In Study 1 (longitudinal, N = 603), we found that higher adaptive (i.e. self-sufficient) coping attenuated national narcissism. In Study 2 (experimental, N = 337), the priming of adaptive coping significantly decreased national narcissism. We also demonstrated the indirect effects of the induced adaptive coping strategy on conspiracy beliefs via national narcissism. These findings suggest that using adaptive coping strategies (either dispositional or situationally induced) may attenuate national narcissism. We discuss the role of coping with stress in shaping group-level phenomena.

Hope, proactive personality, coping styles, and satisfaction with life among veterans during COVID-19

Veterans of the U.S. Armed Forces are an at-risk population given their increased mental health concerns resulting from their military service. However, there has been limited research conducted with this population during the novel coronavirus (COVID-19) pandemic. The purpose of this exploratory study was to examine aspects of positive psychological functioning with 132 U.S. veterans during COVID-19 using Lazarus and Folkman's (1984) transactional model of stress and coping. Specifically, we examined the personal resources of hope and proactive personality, two coping styles, and satisfaction with life. We performed correlation analyses to determine how these constructs related to each other. We also conducted a regression analysis to examine if the two dimensions of hope, proactive personality, adaptive coping, and maladaptive coping predicted veterans' satisfaction with life. Lastly, we utilized a mediation analysis to investigate whether two coping styles mediated the relationships among personal resources and satisfaction with life. Findings from the regression analysis suggested hope pathways and proactive personality were significant predictors of satisfaction with life. Results from the mediation analysis suggested that adaptive and maladaptive coping did not mediate the relationships among personal resources and satisfaction with life.

Racial trauma as a risk factor for risky alcohol use in diverse college students

Exposure to potentially traumatic race-based experiences poses a risk factor for risky drinking among college students from historically marginalized racial/ethnic backgrounds. Objective: The current study examined the relationship between both the level (severity) and pattern of race-based traumatic stress (RBTS) reactions and risky drinking. Participants: The current study sample was made up of 62 male (23.5%) and 202 female (76.5%) Latino/a/x, Black, and Asian college students attending a minority-serving institution. Methods: Study participants were asked to participate in an anonymous online survey. Results: A criterion profile analysis revealed that higher scores on RBTS reactions overall, and elevated scores on RBTS - avoidance, low self-esteem, and anger, specifically, were indicative of more risky drinking. Conclusions: These findings highlight a distinct pattern of RBTS scores that may predict a vulnerability to risky drinking and underscore the importance of racial trauma healing in alcohol use prevention and intervention efforts.

A Case Study of Prolonged Exposure for Posttraumatic Stress Disorder With a Latino Male with Polysubstance Use, Severe Depression, and Anger in a Residential Substance Use Treatment Program

Substance use disorders and post-traumatic stress disorder (PTSD) often co-occur, along with depression and anger. Despite evidence that Prolonged Exposure Therapy is effective for individuals with co-occurring PTSD and SUD when PE is implemented alongside SUD treatment, clinicians have been reluctant to offer PE or other trauma-focused therapies to individuals with co-occurring PTSD and SUD because of the belief that increased emotional distress would be counter-therapeutic for individuals in early recovery. A widely held explanation for the high degree of comorbidity is that individuals with PTSD use substances to reduce or avoid painful and disturbing PTSD symptoms. This case study describes the implementation and outcome of PE therapy with a 32-year-old man who had been admitted to a residential substance use treatment program for Latino males. The client had a long history of polysubstance use and severe PTSD. The client was homeless and reported significant depressive and anger symptoms. Assessment of PTSD revealed that he was using heroin and cocaine to avoid painful memories of a traumatic event that had occurred several years prior to his admission to this treatment program. Because the client reported using these substances to reduce emotional distress, PE was chosen as the PTSD intervention. During PE Therapy the client reported no thoughts or urges to use substances and at discharge from residential treatment he reported no problems with PTSD or depression. The client maintained all gains at 1-year follow-up, when he also reported that he was working full time and had remained abstinent since he completed treatment.

PTSD symptom heterogeneity and alcohol-related outcomes in U.S. military veterans: Indirect associations with coping strategies

INTRODUCTION

This study investigated the role of coping strategies in mediating the relationship between the 7-factor model of posttraumatic stress disorder (PTSD) symptoms and alcohol misuse in veterans.

METHODS

Data were analyzed from 615 veterans from a nationally representative study of U.S. veterans who met criteria for probable full or subthreshold PTSD. Path analyses examined the role of self-sufficient, socially-supported, and avoidant coping strategies in mediating associations between PTSD symptom clusters and alcohol use disorder (AUD), alcohol consumption, and alcohol-related consequences.

RESULTS

Negative affect PTSD symptoms were associated with AUD through increased use of avoidant coping. Additionally, dysphoric arousal PTSD symptoms were associated with AUD; avoidant coping was associated with AUD and increased alcohol consumption; self-sufficient coping was associated with reduced AUD likelihood anhedonia symptoms with decreased use of self-sufficient coping; and negative affect with decreased use of socially-supported coping and increased use of avoidant coping.

CONCLUSIONS

Results underscore the importance of avoidant coping strategies as potential mediators of the relation between PTSD symptoms and AUD. Interventions designed to mitigate engagement in avoidant coping strategies, and to bolster engagement in self-sufficient and socially-supported strategies may help reduce alcohol misuse in veterans with full or subthreshold PTSD.

Conceptualizing Suicide Prevention in Firefighters Through the lens of the Interpersonal-Psychological Theory of Suicide: A Narrative Review

Suicide is the 10th leading cause of death in the United States and is a significant public health problem. Suicide has also become a major concern among career American firefighters with rates for suicidal ideation and attempts in firefighters two to three times higher than rates in the general population. Firefighter suicide and mental health are major issues facing fire service leaders, mental health professionals, and most recently suicide experts. Despite an increased focus on understanding suicide in the fire service, there is little empirical evidence on the effectiveness of prevention in this population. The juxtaposition of elevated suicide rates with a dearth of empirical prevention data specific to firefighters warrants new approaches and conceptualizations of suicide prevention in this population. Grounded in the framework of the interpersonal-psychological theory of suicide (IPTS), this narrative review integrates select relevant firefighter specific suicide risk/protective factors and multi-level intervention/prevention literature to provide a structured approach to identifying current suicide intervention/prevention efforts with promising transportability to firefighters. Several recommendations for future intervention research specific to firefighters are also proposed.

Approach Coping Mitigates Distress of COVID-19 Isolation for Young Men With Low Well-Being in a Sample of 1,749 Youth From Australia and the USA

The unprecedented COVID-19 pandemic has led to lockdowns across the world with people being separated from their loved ones including partners, family, and friends. Here, using a large sample of 1,749 Australians and Americans, we investigated the impact of COVID-19 isolation on younger populations (13-25 years), and the influence of coping strategies and mental well-being on this impact. Overall, COVID-19 isolation had a more negative impact on adolescence (13-17 years) than young adulthood (18-25 years), but with no difference apparent between men and women, or between Australian and American residents. However, a deeper analysis revealed a gender-specific effect: the type of coping strategies differentially influenced the negative impact of COVID-19 isolation on men with various levels of well-being, an interaction effect not apparent in women. For men with lower levels of mental well-being, COVID-19 isolation appeared to have a less negative impact on them if they used more approach-oriented coping strategies (e.g., actively focusing on the problem). Our results provide cross-sectional evidence for a differential impact on young men at low levels of wellbeing by pandemic isolation. In sum, young men and adolescent boys with lower well-being coped better with COVID-19 isolation when they used more approach coping strategies.

Coping strategy utilization among posttraumatic stress disorder symptom severity and substance use co-occurrence typologies: A latent class analysis

OBJECTIVE

There is a lack of research on primary prevention of posttraumatic stress disorder (PTSD) symptoms and substance use among trauma-exposed populations. To guide the development of more effective prevention efforts, the current study sought to identify underlying coping mechanisms that impact PTSD-substance use co-occurrence.

METHOD

A person-centered analytic approach (latent class analysis) examined PTSD-substance use co-occurrence typologies (classes) and identified theoretically adaptive (e.g., active coping) and maladaptive (e.g., denial) coping strategies that differentiated between classes among a sample of 1,270 trauma-exposed participants (Mage = 20.71, 73.5% female, 45.7% White).

RESULTS

Latent class analysis identified five distinct typologies, reflective of extant epidemiological and etiological work. Generally, behavioral disengagement and self-blame coping increased the likelihood of being in more severe PTSD-illicit substance use (e.g., cocaine) comorbidity classes. Positive reframing and planning differentiated between low and moderate illicit substance typologies with moderate PTSD severity. Venting, acceptance, and self-distraction differentiated between asymptomatic and moderate PTSD severity typologies with low illicit substance use.

CONCLUSIONS

Findings identify general coping strategies associated with increased likelihood of being in more severe comorbidity typologies, as well as several unique coping strategies associated with risk of transitioning between low/moderate PTSD and illicit substance use classes. Relevant interventions (e.g., trauma psychoeducation, guilt-reduction therapy, psychological first aid) that may be targets for future prevention-oriented work are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The utility of college student samples in research on trauma and posttraumatic stress disorder: A critical review

There is a widespread notion of the 'college sophomore problem' in social science research that posits that college student samples are samples of convenience with little generalizability to the general population. To address this concern, we conducted a critical review of the literature on college student samples in trauma research. Specifically, we reviewed how college student samples differ from non-college samples in four key areas of trauma research: (1) exposure rates to potentially traumatic events (PTEs), (2) prevalence of posttraumatic stress disorder (PTSD) symptoms, (3) factor structure of PTSD symptoms, and (4) PTSD's relation with common markers, correlates, and consequences. Lastly, we discussed the value and advantages of using college student samples in trauma research. Results of the critical review indicated similar trends of trauma-related findings (Points 1-4) between college student samples and both U.S. nationally collected and treatment-seeking samples; specifically, we identified a comparable lifetime PTE exposure rate, comparable rates of PTSD, a comparable factor structure of PTSD symptoms, and a comparable pattern of associations between PTSD symptoms and post-trauma markers/correlates/consequences. Although trauma-exposed college student samples are biased in some key areas, they may be no more biased than other commonly used trauma samples (e.g. epidemiological, treatment-seeking). Results of this critical review highlight the need to re-examine potentially unfounded biases on the part of the trauma research community, as well as the need to consider advantages of using college student samples in trauma research.

Attachment, coping, and psychological symptoms among military veterans and active duty personnel

Background and Objectives: Military service is a stressful occupation, including increased risk for psychological distress. In order to provide the best care for service members and veterans (SMVs), it is important to understand personality and behavioral patterns associated with negative outcomes. This study examined links between attachment processes, coping styles, problematic alcohol use and psychological distress.Design: Using a cross-sectional, correlational design, a multi-instrument survey was administered to participants either online or in-person.Methods: Veterans and active duty service members (N = 268) completed measures of adult attachment, coping styles, alcohol use, and psychological symptoms.Results: Attachment avoidance was positively associated with avoidant coping, alcohol use, depression, and PTSD symptoms, but negatively related to problem-focused coping. Attachment anxiety was associated with avoidant coping, depression, GAD, and PTSD symptoms. Avoidant coping, but not problem-focused coping, was associated with psychological symptoms, and significant indirect relationships were noted between insecure attachment processes, avoidant coping, and psychological symptoms.Conclusion: Findings highlight personality and behavioral factors that may be important treatment foci when working with SMVs. Future studies should evaluate this model using longitudinal designs.

The effect of pre-existing alcohol use disorder on the risk of developing posttraumatic stress disorder: results from a longitudinal national representative sample

Background: There is inconsistent evidence in the literature as to whether or not Alcohol Use Disorder (AUD) is a risk factor for Post-Traumatic Stress Disorder (PTSD).Objectives: We evaluated the risk of developing PTSD after trauma exposure in individuals with AUD. As a secondary analysis, we also tested if alcohol dependence or alcohol abuse separately increased the risk of PTSD development. We also explored the effect of AUD on exposure to various traumas.Methods: Longitudinal data was obtained from 30,180 individuals with and without AUD from National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) waves I and II. Using propensity score methods, we matched individuals with AUD (alcohol abuse and/or dependence using DSM-IV criteria) to those without AUD at baseline on demographic, familial, and clinical factors to estimate the risk of PTSD development after trauma exposure. Data were adjusted for complex survey methods.Results: Individuals with AUD had an increased risk of being exposed to various traumas between wave I and II (60.6% vs. 48.3% of controls). Among individuals exposed to trauma between the two waves (N = 14,107), AUD had no effect on subsequent PTSD development after matching and controlling for covariates (OR: 1.00; 95%CI: 0.72-1.39; p = .99). However, those with alcohol dependence only did have an effect on subsequent PTSD development (OR: 1.76; 95%CI: 1.05-2.95; p = .03).Conclusion: In individuals with alcohol dependence the experience of trauma increases the risk of developing PTSD. These findings suggest that prevention methods from PTSD after trauma exposure for individuals with alcohol dependence are needed.

Relationships of attention-deficit hyperactivity disorder with defense styles and harm avoidance among male inpatients with alcohol use disorder

INTRODUCTION

Patients with alcohol use disorder (AUD) use immature defense styles, and AUD is related with adult attention-deficit hyperactivity disorder (ADHD). Harm avoidance (HA) is related with both AUD and particularly inattentiveness (IN) dimension of ADHD.

AIM

The aim of the present study was to evaluate the relationship of defense styles with probable ADHD and severity of ADHD symptoms while controlling the effect of HA among male inpatients with AUD.

SETTINGS AND DESIGN

The present study with cross-sectional design was conducted at the Alcohol and Drug Research, Treatment and Training Center (AMATEM) of Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery in Istanbul.

STATISTICAL ANALYSIS

Chi-square test, independent samples t-test, multiple logistic and linear regression analyses, and multivariate analysis of covariance (MANCOVA) were used.

MATERIALS AND METHODS

Participants (n = 151) were evaluated with the Adult ADHD Self-Report Scale, the Defense Style Questionnaire, and the HA Dimension of the Temperament and Character Inventory.

RESULTS

HA (particularly HA-1 [anticipatory worry and pessimism]) and immature defense style (particularly acting out) predicted the presence of probable ADHD. In linear regression analysis, HA (particularly HA-1 and HA-4 [fatigability and asthenia]), high immature (particularly acting out), and low mature defense styles predicted the severity of ADHD symptoms. In MANCOVA, immature defense style predicted both the IN and the hyperactivity/impulsivity (HI) dimensions of ADHD, whereas HA and IN dimension and low mature defense style predicted HI dimension.

CONCLUSIONS

These findings suggest that immature defense style (i.e., acting out) is related with both the presence of probable ADHD and severity of ADHD symptoms, together with HA, which must be taken into account while treating patients with ADHD among male populations with AUD.

Relationships between coping, anxiety, depression and health-related quality of life in outpatients with substance use disorders: results of the SUBUSQOL study

Previous research showed that coping strategies are associated with depressive symptoms and health-related quality of life (HRQoL) in patients with chronic somatic conditions. The aim of this study was to examine the coping strategies used in patients with substance use disorders and to assess the relationships between coping strategies, HRQoL, anxiety and depression. Coping was assessed in a prospective outpatient cohort by the Brief COPE. Additionally, sociodemographic and clinical data were collected, and questionnaires assessing HRQoL (SF-12) and states of anxiety and depression were completed. Cross-sectional analysis using Pearson correlations and multiple linear regression was performed. A total of 244 patients were included. Acceptance, planning and self-blame were the most used coping strategies. Strong correlations were found between anxiety, depression, coping strategies and HRQoL. On the MCS-12, better scores were associated with male gender, lack of anxiety or depression and coping styles based on less self-blame, on positive reframing, acceptance, and behavioral disengagement. Patients without depression or anxiety, and no comorbidity had better scores on the SF-12 PCS. Coping strategies of substance-dependent outpatients should be assessed, as they might be useful for identifying patients in need of support. Furthermore, interventions that improve coping capabilities might be helpful for improving HRQoL.

The age of onset of substance use is related to the coping strategies to deal with treatment in men with substance use disorder

BACKGROUND

The age of onset of substance use (OSU) as well as the coping strategies (CS) influence both the development and the course of Substance Use Disorders (SUD). We aim to examine the differences in the CS applied to deal with treatment in men with SUD, considering whether the age of OSU had begun at age 16 or earlier (OSU ≤ 16) or at 17 years or later (OSU ≥ 17), as well as the associations of the CS with clinical variables were studied.

METHODS

A total of 122 patients with at least three months of abstinence, 60 with OSU≤16 and 62 with OSU≥17, were evaluated through the Coping Strategies Inventory and clinical assessment tools.

RESULTS

The OSU≤16 patients were younger and presented a worse clinical state. Compared to the norms, the SUD patients were less likely to use adaptive CS, although this was more remarkable for the OSU≤16 group. Furthermore, the OSU≤16 patients presented a CS pattern of higher Disengagement, with lesser use of Social Support and higher Problem Avoidance and Social Withdrawal. In the whole SUD sample, the severity of addiction, number of relapses and age of OSU (as a continuous variable) were related to maladaptive coping. Nevertheless, the cut-off age of OSU modulated these results.

CONCLUSIONS

The OSU≤16 was a risk factor for presenting greater clinical severity and a more dysfunctional CS profile to deal with treatment. Thus, the cut-off age considered has allowed us to differentiate SUD patients with more vulnerability to present worse clinical prognosis who may require specific prevention and rehabilitation strategies discussed throughout this work.

Posttraumatic Stress Symptoms and Alcohol-Related Outcomes Among Municipal Firefighters

This study examined levels of posttraumatic stress symptoms (PTSS) and relationships between PTSS and alcohol-related outcomes in a near census of municipal firefighters. The study also assessed substance-use coping and drinking to cope as potential mediators of such outcomes. Firefighters (N = 740) completed measures that assessed PTSS, alcohol risk behaviors, alcohol problems, drinking motives, and coping with stress. Results showed that 32.4% of firefighters reported significant levels of PTSS using National Center for PTSD (2014) screening cutoff scores. Correlational analysis showed that PTSS was related to at-risk drinking (r = .18) and alcohol-related problems (r = .33), as well as use of maladaptive coping strategies (r = .58) and substance use coping (r = .40). Structural analyses comparing multiple alternative models suggested that a model that included substance use coping and drinking to cope as mediators of the association between PTSS and problem drinking provided the best fit to the data. Tests of multigroup invariance confirmed this model. Overall, PTSS were common in this population and they predicted maladaptive coping patterns and alcohol-related consequences. One implication of these findings is that fire departments might consider adding or enhancing screening and treatment options for PTS, alcohol misuse, or both.

Alcohol and drug toxicology screens at time of hospitalization do not predict PTSD or depression after traumatic injury

BACKGROUND

Identifying risk factors for the development of PTSD and depression is critical for intervention and recovery after injury. Given research linking toxicology screens and substance use and the evidenced relationship between substance misuse and distress, the current study aimed to gauge the predictive value of toxicology testing on PTSD and depression.

METHODS

Patients admitted to a Level I Trauma Center (N = 379) completed the PC-PTSD, PCL-C, and PHQ-8 at baseline, 3, 6, and 12 months.

RESULTS

Results showed 52% of tested patients had a positive toxicology test, 51% screened for PTSD, and 54% screened for depression. Positive drug or alcohol toxicology tests were not significantly associated with PTSD or depression.

CONCLUSIONS

Toxicology testing may not meaningful predict depression or PTSD in traumatic injury patients. Future research using validated measures of problematic substance use is needed to better understand how misuse may influence the development of psychological distress.

Natural Course of Co-Occurring PTSD and Alcohol Use Disorder Among Recent Combat Veterans

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) commonly co-occur in veterans, yet little is known about the longitudinal course of PTSD and drinking in comorbid populations. This study assessed the natural course of daily alcohol consumption and weekly changes in PTSD symptoms in 112 recent combat veterans over the course of 11 months. Latent class growth mixture modeling was used to classify individuals into distinct classes with similar PTSD symptom and alcohol use growth trajectories. We then investigated theorized predictors of class membership including sociodemographics; pre-, peri-, and postdeployment factors; coping; symptom severity; and number of mental health/substance use appointments attended. Results revealed that most participants had severe and nonremitting PTSD. Trajectories for alcohol use included gradual and drastic declines, and chronic low-level drinking. The use of behavioral health services (odds ratio = 2.47) and fewer current stressors (odds ratio = 0.42) predicted AUD remission. Because little variation was observed in the PTSD course, our study did not observe coordinated fluctuations of PTSD symptoms and heavy drinking. Our findings suggest that treatment impacts the course of AUD and that recent combat veterans who do not seek PTSD treatment may have chronic and severe PTSD symptoms.

Coping strategies related to treatment in substance use disorder patients with and without comorbid depression

Coping strategies exert an important influence in the development and course of both substance use disorder (SUD) and major depressive disorder (MDD) and its treatment outcomes. We examined the coping strategies related to treatment in SUD and SUD-MDD patients and their associations with clinical characteristics. Forty SUD and 40 SUD-MDD males, each group composed by 20 therapeutic community and 20 ambulatory treatment patients, were assessed through the Coping Strategies Inventory and clinical characteristics questionnaires. SUD-MDD patients scored higher in Disengagement strategies such as Social Withdrawal and lower in Engagement ones such as Problem Solving, Cognitive Restructuring and Social Support, as well as in self-perceived capacity for coping. No differences for treatment were found. SUD and, specially, SUD-MDD patients scored higher than norms in maladaptive strategies. Time of abstinence, age of onset and severity of SUD were related to maladaptive coping. SUD and SUD-MDD patients are prone to employ Disengagement coping strategies and SUD-MDD patients coping repertory is more maladaptive than the SUD ones. Likewise, clinical characteristics associated to maladaptive coping might differ by diagnosis and modality of treatment in male patients. These findings could be considered for the treatment design and to improve the recovery and prevent relapses.

Prevalence and correlates of cannabis use in an outpatient VA posttraumatic stress disorder clinic

Recent research has documented high rates of comorbidity between cannabis use disorders and posttraumatic stress disorder (PTSD) in veterans. However, despite possible links between PTSD and cannabis use, relatively little is known about cannabis use in veterans who present for PTSD treatment, particularly among samples not diagnosed with a substance use disorder. This study examined the prevalence of cannabis use and the psychological and functional correlates of cannabis use among a large sample of veterans seeking treatment at a Veterans Affairs (VA) PTSD specialty clinic. Male veterans (N = 719) who presented at a VA specialty outpatient PTSD clinic completed measures of demographic variables, combat exposure, alcohol, cannabis and other drug use, and PTSD and depressive symptoms. The associations among demographic, psychological, and functional variables were estimated using logistic regressions. Overall, 14.6% of participants reported using cannabis in the past 6 months. After controlling for age, race, service era, and combat exposure, past 6-month cannabis use was associated with unmarried status, use of tobacco products, other drug use, hazardous alcohol use, PTSD severity, depressive symptom severity, and suicidality. The present findings show that cannabis use is quite prevalent among veterans seeking PTSD specialty treatment and is associated with poorer mental health and use of other substances. It may be possible to identify and treat individuals who use cannabis in specialty clinics (e.g., PTSD clinics) where they are likely to present for treatment of associated mental health issues. (PsycINFO Database Record

Correlates of posttraumatic stress disorder in adults with congenital heart disease

OBJECTIVE

The aims of this study were to compare the level of posttraumatic stress disorder between adults with and without congenital heart disease, and to examine the correlates of posttraumatic stress disorder (e.g., sociodemographics).

DESIGN

Cross-sectional.

SETTING

Two university-affiliated heart hospitals in Tehran, Iran.

PATIENTS

A sample of 347 adults with congenital heart disease aged 18-64 years (52% women), and 353 adults without congenital heart disease matched by sex and age (±2 years) was recruited.

OUTCOME MEASURES

The PTSD Scale: Self-report version was used to assess the diagnosis and severity of posttraumatic stress disorder. Hierarchical multivariate logistic regression analyses were performed to explore correlates of likely posttraumatic stress disorder diagnosis among each group of participants.

RESULTS

The posttraumatic stress disorder in the patients was comparable to those of the control group, except for increased arousal (P = .027) which was scored higher among the patients. Over 52% of adults with congenital heart disease met the criteria for a likely posttraumatic stress disorder diagnosis compared with 48% of adults without congenital heart disease. The regression analyses among patients revealed that elevated depressive symptoms (OR = 1.27) and a positive history of cardiac surgery (OR = 2.02) were significantly associated with posttraumatic stress disorder. The model could explain 29% of the variance in posttraumatic stress disorder.

CONCLUSIONS

The high and comparable prevalence of posttraumatic stress disorder among patients and nonpatients highlight the significance of the context in which adults with congenital heart disease may face other/additional stressors than disease-related ones, an issue that clinicians need also take into account. Furthermore, the association of posttraumatic stress disorder with elevated depressive symptoms warrant a comprehensive psychological assessment and management of adults with congenital heart disease, in particular among those with a history of invasive procedures.

Changes in coping behavior in a randomized controlled trial of concurrent treatment for PTSD and alcohol dependence

OBJECTIVE

The current study examines changes in coping among 165 adults meeting DSM-IV criteria for co-morbid posttraumatic stress disorder (PTSD) and alcohol dependence (AD).

METHOD

Participants were randomized to receive naltrexone or placebo, with or without prolonged exposure (PE). All participants received supportive counseling focused on alcohol use (BRENDA). Assessments of coping, PTSD, and AD were conducted at pre-treatment, mid-treatment, post-treatment, 3-month follow-up, and 6-month follow-up.

RESULTS

Participants exhibited significant decreases in both avoidant coping and adaptive coping from pre-treatment to 6-month follow-up across all groups. Participants who received PE showed faster decreases in avoidant coping during this period than participants who did not receive PE. PTSD symptom reduction was associated with changes in both avoidant and adaptive coping across groups. Improvement in PTSD symptoms was related to a faster rate of reduction in avoidant coping in the PE groups compared to those receiving BRENDA alone.

CONCLUSIONS

The current results suggest that concurrent treatment for co-morbid PTSD-AD decreases avoidant and adaptive coping, and participants who show greater reductions in PTSD symptoms also show greater changes in coping style. Consistent with theorized mechanisms of change in PE, the addition of PE to supportive counseling for AD was associated with a greater reduction of avoidant coping than supportive counseling alone.

Strategies to cope with treatment in substance use disorder male patients with and without schizophrenia

Coping strategies (CS) are the efforts made by an individual to manage the internal and external demands of stressful situations. Studies showed that in patients with Substance Use Disorder (SUD), adaptive and problem-focused CS are related to fewer relapses and better treatment outcomes. Considering the high rates of comorbidity between SUD and schizophrenia (SZ), and the deficiencies observed in SZ patients in the use of active problem-focused CS, this study aims to explore CS used by SUD patients with and without SZ to deal with treatment. 82 males (18-55 year) under treatment for a SUD were considered in two groups: SUD without psychiatric comorbidity (SUD; N=43) and SUD with SZ (SZ+; N=39) and assessed through The Coping Strategies Inventory (CSI). Our results indicated that SUD and SZ+ patients only differed in the amount of Engagement strategies they used. Compared to SUD, SZ+ patients showed lesser use of Problem Solving, Social Support and Self-Criticism, and lower Self-Perceived Capacity to engage the Problem. Besides, compared to norms, SUD and SZ+ patients were less likely to use adaptive CS, although this was more remarkable for SZ+ group. Further studies are needed to explore possible benefits of improving CS as part of treatment outcomes.

Correlates of improvement in substance abuse among dually diagnosed veterans with post-traumatic stress disorder in specialized intensive VA treatment

Substantial rates of substance use comorbidity have been observed among veterans with Post-Traumatic Stress Disorder (PTSD), highlighting the need to identify patient and program characteristics associated with improved outcomes for substance abuse. Data were drawn from 12,270 dually diagnosed veterans who sought treatment from specialized intensive Veterans Health Administration PTSD programs between 1993 and 2011. The magnitude of the improvement in Addiction Severity Index (ASI) alcohol and drug use composite scores from baseline was moderate, with effect sizes (ES) of -.269 and -.287, respectively. Multivariate analyses revealed that treatment in longer-term programs, being prescribed psychiatric medication, and planned participation in reunions were all associated with slightly improved outcomes. Reductions in substance use measures were associated with robust improvements in PTSD symptoms and violent behavior. These findings suggest not only synergistic treatment effects linking improvement in PTSD symptoms with substance use disorders among dually diagnosed veterans with PTSD, but also to reductions in violent behavior. Furthermore, the findings indicate that proper discharge planning in addition to intensity and duration of treatment for dually diagnosed veterans with severe PTSD may result in better outcomes. Further dissemination of evidence-based substance abuse treatment may benefit this population.

Drinking motives moderate daily relationships between PTSD symptoms and alcohol use

Posttraumatic stress disorder (PTSD) and alcohol dependence (AD) frequently co-occur, although results of both cross-sectional and longitudinal studies evaluating the nature of their relationship have been mixed. There has been varied support for competing models explaining how these conditions influence one another. To assess both the self-medication and mutual maintenance models, as well as examine the potential moderating role of drinking motives, the current study used Generalized Estimating Equations to evaluate daily associations for an average of 7.3 days between PTSD symptoms and alcohol use in a mixed-gender sample of individuals who met criteria for both PTSD and AD. Results generally supported a self-medication model with elevated PTSD symptoms predictive of greater alcohol use on that same day and on the following day. Contrary to a mutual maintenance model prediction, drinking did not predict next-day PTSD symptoms. Results also indicated that both coping and enhancement drinking motives were significant moderators of the PTSD and drinking relationships, suggesting that these relationships may be more or less salient depending on an individual's particular drinking motivations. For example, among those higher on coping drinking motives, a 1-unit increase in PTSD symptom severity was associated with a 35% increase in amount of alcohol consumed the same day, while among those low on coping drinking motives, a 1-unit PTSD increase was associated with only a 10% increase in alcohol consumption. We discuss implications of these findings for the larger literature on the associations between PTSD and alcohol use as well as for clinical interventions. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Associations among Trauma, Posttraumatic Stress, and Hazardous Drinking in College Students: Considerations for Intervention

Students with trauma and posttraumatic stress are disproportionately at risk for heavy drinking and for alcohol-related consequences. Brief motivational interventions (BMIs) have been shown to reduce hazardous drinking in college students, and could serve as a first-line approach to reduce heavy drinking in students with trauma and posttraumatic stress (PTS). Yet the standard BMI format may not adequately address the factors that lead to hazardous drinking in these students. Here, we review the literature on PTS and hazardous drinking in college students, and highlight cognitive (self-efficacy, alcohol expectancies) and behavioral (coping strategies, emotion regulation skills, protective behaviors) factors that may link trauma and PTS to drinking risk. Incorporating these factors into standard BMIs in a collaborative way that enhances their personal relevance may enhance intervention efficacy and acceptability for these at-risk students.

Sexual assault related distress and drinking: the influence of daily reports of social support and coping control

Introduction. A history of sexual assault (SA) is often associated with increased distress and heavy drinking. One's ability to cope with the distress and seek social support has been associated with drinking more generally. However, SA-related distress, drinking, and the extent to which a woman engages in adaptive coping or seeks social support is known to vary day-to-day. The goal of the present investigation was to examine the moderating influence of perceived coping control and social support on the event-level association between SA-related distress and drinking. Methods. This study included 133 college women with a history of SA who reported recent heavy drinking. Participants provided daily reports of their SA-related distress, perceived coping control, perceived social support, and alcohol consumption every day for 30days. Results. Results of generalized estimating equation models suggest that coping control moderated the association between distress and drinking such that those with less perceived coping control drank more as their SA-related distress increased from their average. Although social support did not moderate between distress and drinking, decreases in perceived social support were associated with more drinking on that day. Conclusions. The results suggest that daily deviations in SA-related distress may influence alcohol consumption more than average levels of distress, especially among women with low coping control. Interventions for women with SA histories should help them build coping skills as well as adequate social support in order to reduce drinking.

A controlled examination of two coping skills for daily alcohol use and PTSD symptom severity among dually diagnosed individuals

Investigations of targeted coping skills could help guide initial treatment decisions for individuals with co-occurring posttraumatic stress disorder (PTSD) and alcohol dependence (AD) who often endorse worse coping skills than those with AD but not PTSD. Although improvement in coping skills is associated with enhanced alcohol use outcomes, no study has evaluated the utility of teaching specific coping skills in the context of comorbid PTSD/AD. We compared the effects of teaching two coping skills (cognitive restructuring [CR] and experiential acceptance [EA]) or an attention control condition on drinking and PTSD symptoms among 78 men and women with comorbid PTSD/AD during a 5-week daily follow-up assessment. Both CR and EA skills were associated with decreased drinking compared to control, and that change in drinking over time did not significantly differ between those who received CR and EA. Individuals who received CR skills, however, consumed less alcohol on a given day than those who received EA skills. Neither CR nor EA was associated with a decrease in PTSD symptom severity. These results provide preliminary support for clinicians to prioritize CR and EA skills during initial treatment sessions when working with individuals with PTSD/AD, and offer ideas for continued investigation and intervention refinement.

A systematic review of the comorbidity between PTSD and alcohol misuse

PURPOSE

This systematic review aimed to assess (1) the level of comorbidity of post-traumatic stress disorder (PTSD) and alcohol misuse reported in research studies since 2007 and (2) any associations found between specific PTSD symptom clusters and alcohol misuse.

METHODS

A literature search was carried out to capture any papers published from 2007 to the end of July 2012. Six hundred and twenty abstracts were identified and reviewed, and 42 papers were included in the final review after applying inclusion and exclusion criteria.

RESULTS

The prevalence of comorbid alcohol misuse in those with PTSD ranged from 9.8 to 61.3 %. The prevalence of comorbid PTSD in those with alcohol misuse ranged from 2.0 to 63.0 %, and the majority of prevalence rates were over 10.0 %. Almost all of the odds ratios representing the strength of association between the conditions across a variety of populations were significant, and those ranged from 1.1 to 4.87. Of the different PTSD symptom clusters, this review found most evidence for associations between alcohol misuse and both avoidance/numbing symptoms and hyperarousal symptoms.

CONCLUSIONS

Given that comorbidity appears to be common, the evidence from this systematic review supports the use of routine screening for comorbidity in populations who are known to have PTSD or alcohol misuse.

The relationship between assault and physical health complaints in a sample of female drinkers: roles of avoidant coping and alcohol use

Trauma exposure and PTSD are associated with poorer physical health. Psychological and behavioral mechanisms may help account for this relationship. In this study, we tested avoidant coping and alcohol use as mediators of the relationship between trauma exposure, PTSD, and self-reported physical health complaints in female drinkers. In 827 college women, we compared three groups: women with no trauma history, women with a sexual assault but no PTSD, and women with a sexual assault and PTSD, on avoidant coping, alcohol use, and physical health complaints. We found that PTSD was positively associated with alcohol use and that PTSD and trauma exposure were associated with increased avoidant coping. We also found that avoidant coping mediated the relationship between trauma, PTSD, and physical health complaints. Alcohol use did not predict physical health but was associated with PTSD. These results suggest that in female college students, coping may be more critical in the PTSD/physical health relationship than alcohol and have implications for targeting coping in young trauma-exposed women to improve physical health.

Relationship between dispositional mindfulness and substance use: findings from a clinical sample

There has been rapidly increasing interest over the past decade in the potential of mindfulness-based approaches to psychological and medical treatment, including a recent growth in the area of substance abuse. Thus, the relationship between trait mindfulness and substance use has been explored in several studies. Results, however, have been mixed. While several studies of college student populations have evinced positive correlations between levels of trait mindfulness and substance use, the opposite seems to be true in clinical samples, with multiple studies showing a negative association. The current study reviews research in both non-treatment seeking college students and in clinical samples, and examines the relationship between trait mindfulness and substance dependence in a clinical sample (N=281). Further, the study assesses the moderating effect of avoidant coping that might explain the disparate findings in the clinical versus nonclinical samples.

Brief alcohol counseling improves mental health functioning in veterans with alcohol misuse: results from a randomized trial

BACKGROUND

Alcohol misuse occurs at high rates among U.S. Military Veterans presenting to primary care and is linked to numerous negative social and health consequences. The Veterans Health Administration has recently implemented brief alcohol interventions (BAI) in VA primary care settings. An emerging literature suggests that BAIs that target alcohol consumption may also have secondary health benefits such as reducing symptoms of depression and anxiety in civilian samples. The present study sought to examine whether secondary health benefits of BAIs observed in civilians generalize to a sample of alcohol misusing Veterans presenting to primary care.

METHODS

Veterans (N=167) screening positive for alcohol misuse during a routine primary care visit were randomized to receive treatment-as-usual (TAU) or TAU plus a web-delivered BAI. Assessment of overall mental health functioning, posttraumatic stress disorder, and depression occurred at baseline, three- and six-month post-treatment.

RESULTS

Veterans receiving both BAI protocols demonstrated significant improvements in mental health functioning, depressive symptoms, and use of approach coping from baseline to six-month follow-up. No differential treatment effects on these outcomes were observed.

LIMITATIONS

Findings are limited by the lack of a no-treatment control group, and the potential impact of regression to the mean and assessment effects on outcomes.

CONCLUSIONS

Our findings replicate prior studies suggesting that a single-dose BAI may have some secondary mental health benefits for Veterans presenting to primary care with alcohol misuse.

Relationship between defense styles, alexithymia, and personality in alcohol-dependent inpatients

In the present study, the defense styles were assessed in alcohol-dependent patients to verify whether they used less adaptive defense mechanisms compared with healthy controls and to evaluate if immature defense styles (IDSs) are related with alexithymia, while controlling the effect of age, temperament, and character on this relationship in male alcohol-dependent inpatients. Participants were consecutively admitted 118 male alcohol-dependent inpatients and 60 healthy controls. Patients were investigated with the Defense Style Questionnaire, the Toronto Alexithymia Scale, and the Temperament and Character Inventory. The alcohol-dependent patients were using neurotic defense style, some IDSs (projection, acting out, splitting, and somatization) more, and the mature defense style humor less than the control group. Together with higher age, IDS discriminated alcohol dependents from the control group (higher age, acting out, and splitting and lower humor in the second regression model). Immature defense style was positively correlated with novelty seeking, harm avoidance, self-transcendence, difficulty in identifying feelings (DIF), difficulty in describing feelings, external oriented thinking, and total alexithymia score in the present study, whereas it was negatively correlated with self-directedness and cooperativeness. Mean scores of neurotic and IDS were higher in the alexithymic group than the nonalexithymic group, and alexithymia was correlated with some IDSs. Higher difficulty in describing feelings predicted mature defense style, higher harm avoidance and DIF predicted neurotic defense style, and lower cooperativeness and self-transcendence and higher DIF predicted IDS. These suggest that alcohol dependents are using maladaptive IDS more, which can be taken into account in the development of therapeutic programs for these patients. In addition, IDS seems to be related with alexithymia, particularly DIF factor, whereas low cooperativeness and high self-transcendence are significant covariants. Thus, these results could indicate the use of specific strategies in the clinical and psychotherapeutic management of patients with alexithymic feature and IDS.