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Narvaez JCDM, Roglio VS, Di Tommaso B, Pechansky F. Transgenerational Cycle of Traumatization and HIV Risk Exposure among Crack Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5285. [PMID: 37047901 PMCID: PMC10093834 DOI: 10.3390/ijerph20075285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
The aim of this manuscript is to understand the impact of childhood sexual abuse on the development of Post-Traumatic Stress Disorder (PTSD), Human Immunodeficiency Virus (HIV) exposure. and parental neglect in crack cocaine users, considering the role of gender. This study is a secondary database analysis of a sample from a multicenter cross-sectional study with 715 crack cocaine users receiving outpatient treatment in public mental health networks in six Brazilian capitals. Prevalence ratios were estimated by Poisson regression. In crack cocaine users with childhood sexual abuse, traumatic experiences seem to remain fixed through the development of Post Traumatic Stress Disorder (PTSD) in adulthood. Crack cocaine users with childhood abuse and PTSD in adulthood showed more sexual risk behaviors, including outcomes such as HIV (PR = 3.6 p < 0.001 for childhood abuse and PR = 3.7 p < 0.001 for PTSD). Furthermore, this traumatic trajectory affects the functional ability of crack cocaine users, especially women, to work thus impacting their inclusion and sense of social belonging. Such a chain seems to be reflected in the establishment of a circle of transgenerational transmission, to the extent that subjects with a history of abuse and PTSD reported more parental neglect towards their children. This study reinforces the importance of preventive public policies regarding early socio-emotional vulnerabilities and the need to support families, especially women, to avoid HIV and self-destructive outcomes such as crack cocaine use.
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Affiliation(s)
- Joana Corrêa de Magalhães Narvaez
- Department of Psychology, Universidade Federal de Ciências da Saúde, Porto Alegre 90050-170, Brazil
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Brazil
| | - Vinícius Serafini Roglio
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Brazil
| | - Brittany Di Tommaso
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Brazil
| | - Flavio Pechansky
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Brazil
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Dunn KE, Turner GM, Oswald LM. Effects of Early Life Trauma on Risks for Adult Opioid Use Disorder Are Mediated by Stress and Occur Independent of Depression and Anxiety. J Addict Med 2022; 16:709-715. [PMID: 35914024 PMCID: PMC10834051 DOI: 10.1097/adm.0000000000001011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Adverse childhood experiences, or early life trauma (ELT), may be a potential risk factor for opioid use disorders (OUDs) that could be further influenced by depression, anxiety, and stress. The prevalence and strength of these associations are largely unknown. METHODS This study examined the association between current OUD severity and lifetime history of ELT, and the degree to which current depression, anxiety, and stress influenced this association, in persons (n = 310) with at least 1 lifetime exposure to opioids using an online survey. RESULTS Ninety-three percent of respondents experienced at least 1 trauma in their lifetime, and 65% met the criteria for OUD. Early life trauma was largely unassociated with demographics but demonstrated an almost "dose-dependent" association among all forms of ELT (total, general, physical, emotional, sexual), whereby more ELT was associated with more severe current OUD. A multivariate mediation model found perceived stress to be a robust mediator of this association. Current psychiatric functioning did not significantly moderate the relationship between ELT and OUD, suggesting that ELT may impact OUD severity at varying levels of psychiatric functioning. CONCLUSIONS These data support existing evidence that greater ELT may influence adult OUD severity and identify perceived stress as a potential mechanistic contributor to this association. Results are preliminary in nature but support continued research into mechanisms underlying the association between ELT and OUD, particularly conformational changes in the stress system resultant from ELT, and interventions to mitigate the impact of ELT on OUD development and/or develop trauma-informed OUD treatment approaches.
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Affiliation(s)
- Kelly E Dunn
- From the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (KED, GMT); and Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD (LMO)
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Abstract
BACKGROUND Aspects of the canonical stress response differ in stimulant, opioid, and alcohol users relative to controls, and dysregulated responses to stress may contribute to continued use of these drugs. Little prior research has focused on stress responses in regular cannabis smokers. We assessed responses to a standardized laboratory social stress assay (the Trier Social Stress Task; TSST) in regular cannabis smokers (CANs) compared with controls (CONs). METHODS Healthy, non-treatment-seeking adult CANs (⩾4×/week; smoking cannabis as usual) and demographically matched CONs completed the TSST. Outcome measures were subjective mood, heart rate, and salivary cortisol. RESULTS Nineteen CANs (1 female) and 20 CONs (2 female) participated; groups were matched on trauma exposure, sex, race, and age. CANs smoked cannabis 6.4 ± 1.1 days/week. Eight CANs and one CON smoked tobacco cigarettes daily. Overall, the TSST produced expected increases in anxiety, negative mood states, cortisol, and heart rate. CANs had blunted subjective response to stress relative to CONs, but they did not differ in physiological (cortisol and cardiovascular) stress responding. CONCLUSION These results indicate that CANs have blunted mood responses to social stress, but normative physiological stress responding. Observed differences could be due to residual effects of cannabis, reluctance to endorse negative mood states, or to issues related to identifying (i.e., emotional identification) or feeling (i.e., interoception) stress-related affective states. Further research is warranted to characterize the mechanisms of these differences and assess implications for daily functioning and treatment outcomes.
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Affiliation(s)
- Richard J Xia
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northshore University Hospital/Long Island Jewish Medical Center, New York
| | - Thomas Chao
- Department of Psychology, The New School for Social Research, New York
| | - Divya Patel
- Department of Medicine, New York University School of Medicine, New York
| | - Gillinder Bedi
- New York State Psychiatric Institute, New York,Centre for Youth Mental Health, University of Melbourne, and Orygen Melbourne, Australia
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Tao CS, Ramakrishnan N, McPhee M, Lewandowska OP, Erb S. Anxiety mediates the relationship between childhood adversity and perceived current life stress in a diverse sample of emerging adults. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2021. [DOI: 10.1080/02673843.2021.1910050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Cinthia S. Tao
- Department of Psychology, University of Toronto Scarborough, Toronto, Canada
| | - Nayani Ramakrishnan
- Department of Psychology, University of Toronto Scarborough, Toronto, Canada
| | - Matthew McPhee
- Department of Psychology, University of Toronto Scarborough, Toronto, Canada
- Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, Canada
| | | | - Suzanne Erb
- Department of Psychology, University of Toronto Scarborough, Toronto, Canada
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Holgate JY, Tarren JR, Bartlett SE. Sex Specific Alterations in α4*Nicotinic Receptor Expression in the Nucleus Accumbens. Brain Sci 2018; 8:brainsci8040070. [PMID: 29671814 PMCID: PMC5924406 DOI: 10.3390/brainsci8040070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 12/11/2022] Open
Abstract
Background: The mechanisms leading from traumatic stress to social, emotional and cognitive impairment and the development of mental illnesses are still undetermined and consequently there remains a critical need to develop therapies for preventing the adverse consequences of traumatic stress. Research indicates nicotinic acetylcholine receptors containing α4 subunits (α4*nAChRs) are both impacted by stress and capable of modulating the stress response. In this study, we investigated whether varenicline, a partial α4β2*nAChR agonist which reduces nicotine, alcohol and sucrose consumption, can reduce stress, a driving factor in substance use disorders. We also examined the effect of stress on nucleus accumbens (NAc) α4*nAChR expression. Methods: Transgenic mice with fluorescent tags attached to α4*nAChRs were administered varenicline and/or yohimbine (a pharmacological stressor) and plasma corticosterone and NAc α4*nAChR expression were measured. A separated group of mice were exposed to maternal separation (MS) during post-natal day (P) 2–14, then restraint stressed (30 min) at six weeks of age. Body weight, anxiety-like behaviours (elevated plus maze), plasma corticosterone and NAc α4*nAChR levels were measured. Results: Varenicline attenuated yohimbine-induced plasma corticosterone increases with no effect on NAc α4*nAChR expression. MS reduced unrestrained plasma corticosterone levels in both sexes. In females, MS increased body weight and NAc α4*nAChR expression, whereas, in males, MS and restraint caused a greater change in anxiety-like behaviours and plasma corticosterone levels. Restraint altered NAc α4*nAChR expression in both male and female MS mice. Conclusions: The effects of stress on NAc α4*nAChR are sex-dependent. While varenicline attenuated acute stress-induced rises in corticosterone levels, future studies are required to determine whether varenicline is effective for relieving the effects of stress.
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Affiliation(s)
- Joan Y Holgate
- Institute of Health and Medical Innovation, Queensland University of Technology, Translational Research Institute, 37 Kent St, Woolloongabba, QLD 4102, Australia.
| | - Josephine R Tarren
- Institute of Health and Medical Innovation, Queensland University of Technology, Translational Research Institute, 37 Kent St, Woolloongabba, QLD 4102, Australia.
| | - Selena E Bartlett
- Institute of Health and Medical Innovation, Queensland University of Technology, Translational Research Institute, 37 Kent St, Woolloongabba, QLD 4102, Australia.
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Fortuna LR, Porche MV, Padilla A. A treatment development study of a cognitive and mindfulness-based therapy for adolescents with co-occurring post-traumatic stress and substance use disorder. Psychol Psychother 2018; 91:42-62. [PMID: 28815876 DOI: 10.1111/papt.12143] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 07/13/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Substance use is common among adolescents with post-traumatic stress disorder (PTSD). We aimed to develop and study an integrated treatment for adolescents with co-occurring disorders. DESIGN This is a therapy development and open pilot trial study of a manualized therapy for adolescents with post-traumatic stress, depression, and substance use that uses a combination of cognitive therapy (CT) and mindfulness. METHODS Descriptive statistics and paired sample t-tests were calculated to assess for changes in PTSD symptoms, depression, and substance use frequency from baseline to end of treatment using standardized measures and validated by urine drug screens. We also examined for safety, predictors of clinical outcomes, and treatment retention. RESULTS Thirty-seven adolescents participated in the study; 62% were study completers as defined by retention for at least 6 weeks of treatment. There were significant improvements in PTSD and depression symptoms from baseline to end of treatment, reflecting medium effect sizes, and which was associated with changes in trauma-associated cognitions. There was a reduction in cannabis use, which was the most commonly used substance. CONCLUSIONS Preliminary results suggest feasibility, safety, and potential clinical effectiveness of an integrated therapy for adolescents with PTSD, depression, and substance use. Retention was comparable to other therapy clinical trial studies of adolescents despite the high risk for poor treatment retention and poor clinical outcomes among adolescents with PTSD and co-occurring disorders. We discuss the rationale for continued research of this mindfulness-based CT for adolescents with co-occurring disorders. PRACTITIONER POINTS Adolescents with co-occurring PTSD and substance use achieved meaningful improvement in PTSD and depression symptom severity after receiving a CT and mindfulness dual diagnosis approach. An integrated manualized therapy for dual diagnosis shows promise for reducing cannabis use in adolescents with PTSD. Changes in trauma-related cognitions have the potential to improve PTSD and depression symptoms in adolescents with substance use problems.
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Affiliation(s)
- Lisa R Fortuna
- Boston Medical Center, Boston University School of Medicine, Massachusetts, USA
| | | | - Auralyd Padilla
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Sarid O, Slonim-Nevo V, Sergienko R, Pereg A, Chernin E, Singer T, Greenberg D, Schwartz D, Vardi H, Friger M, Odes S. Daily hassles score associates with the somatic and psychological health of patients with Crohn's disease. J Clin Psychol 2017; 74:969-988. [PMID: 29244192 DOI: 10.1002/jclp.22561] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 08/20/2017] [Accepted: 09/21/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine the associations of daily hassles with the somatic and psychological health of Crohn's disease (CD) patients. METHOD A cross-sectional study of 400 self-selected adult CD patients was performed with completion of demographic, medical, and psychosocial questionnaires: economic status; Patient Harvey-Bradshaw Index of disease activity; Daily Hassles Scale (DHS); Short Inflammatory Bowel Disease Questionnaire (SIBDQ) and Short-Form Health Survey (SF-36 Physical and Mental Health) quality of life measures; Brief Symptom Inventory of psychological stress with summary Global Severity Index (GSI); Family Assessment Device; and List of Threatening Life Experiences. Analyses included correlations, regressions, and Sobel test statistic. RESULTS The patients were aged 38.7 ± 14.1 years, 61% female and 67% working. The Patient Harvey-Bradshaw Index was 5.52 ± 4.87. The DHS was 88.0 ± 23.2, similar in men and women, higher in smokers, and increased with greater disease activity (p < .001). The most commonly reported hassles were time, social, and work. DHS had significant negative correlations with age, disease duration, and economic status and positive correlations with GSI, SF-36, and SIBDQ. An increased Daily Hassles score was associated with reduced SIBDQ (p < .001) and SF-36 Mental Health (p < .001) and increased GSI (p < .001) and Patient Harvey-Bradshaw Index (p < .001). This effect of DHS on Patient Harvey-Bradshaw Index was mediated by GSI (Sobel t = 6.09, p < 0.001). CONCLUSION Daily hassles in CD patients are shown for the first time to be associated with increased psychological stress and disease activity and reduced quality of life and lower economic status. This has psychotherapeutic implications.
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Woolman EO, Becker MM, Klanecky AK. PTSD Symptoms Mediate Academic Stress and Drinking to Cope in College Students. JOURNAL OF DRUG EDUCATION 2015; 45:96-112. [PMID: 26400899 DOI: 10.1177/0047237915607282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Heightened perceptions of academic stress may increase college alcohol use behaviors, namely problem drinking and drinking to cope. Leading from prior research, the current study examined posttraumatic stress disorder symptoms as a mediator between academic stress and alcohol use behaviors. Undergraduate participants (N=200) completed an online survey battery. Results indicated that posttraumatic stress disorder symptoms mediated the relationship between academic stress and drinking to cope. Findings maintained after excluding the small portion of the sample without prior trauma. Results suggest that early trauma exposure may increase stress sensitivity, which is associated with elevated nontraumatic academic stress and stress-related symptoms. An increase in stress symptoms likely promotes drinking as a method of coping. Information on the role of trauma and stress may be incorporated into alcohol intervention programs.
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Affiliation(s)
- Erin O Woolman
- Psychology Department, Creighton University, Omaha, NE, USA
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Homberg JR, Karel P, Verheij MMM. Individual differences in cocaine addiction: maladaptive behavioural traits. Addict Biol 2014; 19:517-28. [PMID: 24835358 DOI: 10.1111/adb.12036] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cocaine use leads to addiction in only a subset of individuals. Understanding the mechanisms underlying these individual differences in the transition from cocaine use to cocaine abuse is important to develop treatment strategies. There is agreement that specific behavioural traits increase the risk for addiction. As such, both high impulsivity and high anxiety have been reported to predict (compulsive) cocaine self-administration behaviour. Here, we set out a new view explaining how these two behavioural traits may affect addictive behaviour. According to psychological and psychiatric evolutionary views, organisms flourish well when they fit (match) their environment by trait and genotype. However, under non-fit conditions, the need to compensate the failure to deal with this environment increases, and, as a consequence, the functional use of rewarding drugs like cocaine may also increase. It suggests that neither impulsivity nor anxiety are bad per se, but that the increased risk to develop cocaine addiction is dependent on whether behavioural traits are adaptive or maladaptive in the environment to which the animals are exposed. This 'behavioural (mal)adaptation view' on individual differences in vulnerability to cocaine addiction may help to improve therapies for addiction.
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Affiliation(s)
- Judith R. Homberg
- Department of Cognitive Neuroscience, Radboud University Nijmegen Medical Centre; Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroscience; Nijmegen The Netherlands
| | - Peter Karel
- Department of Cognitive Neuroscience, Radboud University Nijmegen Medical Centre; Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroscience; Nijmegen The Netherlands
| | - Michel M. M. Verheij
- Department of Cognitive Neuroscience, Radboud University Nijmegen Medical Centre; Donders Institute for Brain, Cognition, and Behaviour, Centre for Neuroscience; Nijmegen The Netherlands
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10
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Oswald LM, Wand GS, Kuwabara H, Wong DF, Zhu S, Brasic JR. History of childhood adversity is positively associated with ventral striatal dopamine responses to amphetamine. Psychopharmacology (Berl) 2014; 231:2417-33. [PMID: 24448898 PMCID: PMC4040334 DOI: 10.1007/s00213-013-3407-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 12/11/2013] [Indexed: 12/17/2022]
Abstract
RATIONALE Childhood exposure to severe or chronic trauma is an important risk factor for the later development of adult mental health problems, such as substance abuse. Even in nonclinical samples of healthy adults, persons with a history of significant childhood adversity seem to experience greater psychological distress than those without this history. Evidence from rodent studies suggests that early life stress may impair dopamine function in ways that increase risks for drug abuse. However, the degree to which these findings translate to other species remains unclear. OBJECTIVES This study was conducted to examine associations between childhood adversity and dopamine and subjective responses to amphetamine in humans. METHODS Following intake assessment, 28 healthy male and female adults, aged 18-29 years, underwent two consecutive 90-min positron emission tomography studies with high specific activity [(11)C]raclopride. The first scan was preceded by intravenous saline; the second by amphetamine (AMPH 0.3 mg/kg). RESULTS Consistent with prior literature, findings showed positive associations between childhood trauma and current levels of perceived stress. Moreover, greater number of traumatic events and higher levels of perceived stress were each associated with higher ventral striatal dopamine responses to AMPH. Findings of mediation analyses further showed that a portion of the relationship between childhood trauma and dopamine release may be mediated by perceived stress. CONCLUSIONS Overall, results are consistent with preclinical findings suggesting that early trauma may lead to enhanced sensitivity to psychostimulants and that this mechanism may underlie increased vulnerability for drug abuse.
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Affiliation(s)
- Lynn M. Oswald
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD 21201, USA,Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Gary S. Wand
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA,Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Hiroto Kuwabara
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Dean F. Wong
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA,Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA,Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA,Department of Environmental Health Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Shijun Zhu
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD 21201, USA
| | - James R. Brasic
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Schwartz RM, Weber KM, Schechter GE, Connors NC, Gousse Y, Young MA, Cohen MH. Psychosocial correlates of gender-based violence among HIV-infected and HIV-uninfected women in three US cities. AIDS Patient Care STDS 2014; 28:260-7. [PMID: 24724987 DOI: 10.1089/apc.2013.0342] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Gender-based violence (GBV) is common among women with and at risk for HIV, yet little is known about the GBV associated psychological factors that could be modifiable through behavioral interventions. The current study examined the associations between some of these psychological factors (i.e., hopelessness, consideration of future consequences, self esteem), mental health symptoms, substance abuse, and GBV among a sample of 736 HIV-infected and sociodemographically similar uninfected participants in the Women's Interagency HIV Study (WIHS). Results indicated high rates of lifetime GBV among the sample (58%), as well as high rates of childhood sexual abuse (CSA) (22.2%). HIV-infected women were more likely to be hopeless and to experience lower consideration of future consequences as compared to uninfected women. Multivariable analysis indicated that current non-injection drug use and a history of injection drug use were the main correlates of GBV and CSA, even when other psychosocial variables were included in analytic models. Being born outside of the US reduced the likelihood of GBV and CSA. Future research directions and intervention implications are discussed.
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Affiliation(s)
- Rebecca M. Schwartz
- Department of Population Health, North Shore-LIJ Health System, Hofstra North Shore-LIJ School of Medicine, Great Neck, New York
| | - Kathleen M. Weber
- Core Center, Cook County Health and Hospital System, Chicago, Illinois
| | - Gabrielle E. Schechter
- STAR Health Center, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York
| | - Nina C. Connors
- STAR Health Center, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York
| | - Yolene Gousse
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Medical Center, Brooklyn, New York
| | - Mary A. Young
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia
| | - Mardge H. Cohen
- Core Center, Cook County Health and Hospital System, Chicago, Illinois
- Departments of Medicine, Stroger Hospital and Rush University, Chicago, Illinois
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Back SE, Killeen TK, Teer AP, Hartwell EE, Federline A, Beylotte F, Cox E. Substance use disorders and PTSD: an exploratory study of treatment preferences among military veterans. Addict Behav 2014; 39:369-73. [PMID: 24199930 DOI: 10.1016/j.addbeh.2013.09.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 09/15/2013] [Accepted: 09/19/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Substance use disorders (SUDs) and Post Traumatic Stress Disorder (PTSD) frequently co-occur among Veterans and are associated with poor treatment outcomes. Historically, treatments for SUDs and PTSD have been delivered sequentially and independently. More recently, however, integrated treatments have shown promise. This study investigated Veterans' perceptions of the interrelationship between SUDs and PTSD, as well as treatment preferences. METHODS Participants were 35 Veterans of recent military conflicts in Iraq and Afghanistan, and prior operations, who completed the Treatment Preferences Questionnaire as well as an in-depth interview. RESULTS The majority (94.3%) perceived a relationship between their SUD and PTSD symptoms. Veterans reported that PTSD symptom exacerbation was typically (85.3%) associated with an increase in substance use, and PTSD symptom improvement was typically (61.8%) followed by a decrease in substance use (p<.01). Approximately 66% preferred an integrated treatment approach. CONCLUSIONS Although preliminary, the findings provide clinically-relevant information that can be used to enhance the development and provision of care for Veterans with SUDs and PTSD.
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Affiliation(s)
- Sudie E Back
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC, United States; Ralph H. Johnson Veterans Affairs Medical Center, 109 Bee Street, Charleston, SC, United States.
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Grassi-Oliveira R, Pezzi JC, Daruy-Filho L, Viola TW, Francke IDA, Leite CE, Brietzke E. Hair Cortisol and Stressful Life Events Retrospective Assessment in Crack Cocaine Users. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:535-8. [DOI: 10.3109/00952990.2012.694538] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Faravelli C, Gorini Amedei S, Rotella F, Faravelli L, Palla A, Consoli G, Ricca V, Batini S, Lo Sauro C, Spiti A, Catena Dell'osso M. Childhood traumata, Dexamethasone Suppression Test and psychiatric symptoms: a trans-diagnostic approach. Psychol Med 2010; 40:2037-2048. [PMID: 20132583 DOI: 10.1017/s0033291710000115] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Childhood traumatic events and functional abnormalities of the hypothalamus-pituitary-adrenal (HPA) axis have been widely reported in psychiatric patients, although neither is specific for any diagnosis. Among the limited number of studies that have evaluated these topics, none has adopted a trans-diagnostic approach. The aim of the present research is to explore the relationship between childhood stressors, HPA axis function and psychiatric symptoms, independent of the diagnosis. METHOD A total of 93 moderate to severely ill psychiatric out-patients of Florence and Pisa University Psychiatric Units and 33 healthy control subjects were recruited. The assessment consisted of salivary cortisol pre- and post-low dose (0.5 mg) Dexamethasone, early and recent life events, 121 psychiatric symptoms independent of diagnosis, SCID, BPRS. RESULTS In total, 33.5% of patients were Dexamethasone Suppression Test (DST) non-suppressors, compared with 6.1% of controls (p=0.001). Among patients, non-suppression was associated with particular symptoms (i.e. depressive and psychotic), but not to any specific diagnosis. Early stressful life events were significantly associated with higher salivary cortisol levels, with DST non-suppression and with approximately the same subset of symptoms. A recent stressful event seemed to be associated to the HPA response only in those subjects who were exposed to early traumata. CONCLUSIONS Our report suggests a relationship between life stress, HPA axis and psychopathology. A cluster of specific psychiatric symptoms seems to be stress related. Moreover, it seems that an abnormal HPA response is possibly triggered by an excessive pressure in vulnerable individuals.
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Affiliation(s)
- C Faravelli
- Department of Neurology and Psychiatry, Florence University, Viale Morgagni 85, 50134 Firenze, Italy.
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Johnson SD, Cottler LB, O'Leary CC, Ben Abdallah A. The association of trauma and PTSD with the substance use profiles of alcohol- and cocaine-dependent out-of-treatment women. Am J Addict 2010; 19:490-5. [PMID: 20958843 DOI: 10.1111/j.1521-0391.2010.00075.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The association of trauma and posttraumatic stress disorder (PTSD) with alcohol and cocaine use is explored to determine if there is additive risk associated with dual dependence. Data were collected from out-of-treatment women enrolled in an HIV-prevention study. Women who experienced a DSM-IV qualifying event (n = 791) were stratified into four substance use groups based on lifetime alcohol and cocaine use. Women with lifetime comorbid alcohol and cocaine dependence experienced significantly more traumatic events and had a higher prevalence of violent events and lifetime diagnosis of PTSD and PTSD-related impairment. There is added risk for associated trauma and subsequent PTSD among women who have dual substance dependence.
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Affiliation(s)
- Sharon D Johnson
- School of Social Work, University of Missouri-St. Louis, St. Louis, Missouri 63121, USA. Sharon
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Gil-Rivas V, Prause J, Grella CE. Substance use after residential treatment among individuals with co-occurring disorders: the role of anxiety/depressive symptoms and trauma exposure. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2009; 23:303-14. [PMID: 19586147 DOI: 10.1037/a0015355] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This longitudinal study examined the contribution of anxiety/depressive symptoms and lifetime and recent trauma exposure to substance use after residential substance abuse treatment among individuals with co-occurring disorders. Data were collected from adults at treatment entry and 6 and 12 months later. At treatment entry, nearly all participants reported lifetime trauma exposure, and over one third met criteria for posttraumatic stress disorder (PTSD). Over the follow-up, nearly one third of the participants were exposed to trauma. Lifetime trauma exposure and a diagnosis of PTSD at treatment entry were not associated with substance use over the follow-up. Trauma exposure and anxiety/depressive symptoms over the follow-up were associated with an increased likelihood of substance use. Gender did not moderate the association between trauma exposure and anxiety/depressive symptoms and substance use. These findings highlight the importance of monitoring for trauma exposure and symptoms of anxiety/depression to better target interventions and continuing care approaches to reduce the likelihood of posttreatment substance use in this population.
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Affiliation(s)
- Virginia Gil-Rivas
- Interdisciplinary Health Psychology, University of North Carolina at Charlotte, Charlotte, NC 28213, USA.
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