Posttraumatic stress symptoms, shame, and substance use among Asian Americans

BACKGROUND

To examine the association between posttraumatic stress symptoms (PTSS) and substance use among Asian Americans and the influence of a culturally-relevant moderator, shame.

METHODS

From 2016 to 2017, 199 participants from Amazon Mechanical Turk and a university subject pool completed an online survey. Chi-square and Kruskal-Wallis tests explored demographic and clinical differences among three Asian American ethnic subgroups (East Asians, South Asians, and Southeast Asians). Generalized linear models assessed the association between PTSS and substance use (alcohol, tobacco, and other drugs) and the moderation of this relationship by shame.

RESULTS

Ethnic subgroups significantly differed on all three substance use variables. The severity in PTSS was significantly associated with hazardous drug use (IRR = 1.03, (1.01, 1.05), p = .003). The association between PTSS and days of tobacco use and binge drinking was significantly moderated by shame. Low levels of shame increased the effect of PTSS on binge drinking (IRR = 1.05, (1.00, 1.10), p = .035) and tobacco use (IRR = 1.15, (1.11, 1.19), p < .001). High levels of shame had no effect of PTSS on binge drinking (IRR = 1.01, (0.99, 1.03), p = .54) and a reduced effect on tobacco use (IRR = 1.07, (1.05, 1.09), p < .001).

CONCLUSIONS

Among Asian Americans, the association of PTSS and substance use depends on shame. Lower levels of shame are a risk factor, increasing the effect of PTSS on substance use. Culturally-modified addiction treatments should assess for shame among Asian Americans and attend to ethnic sub-group diversity in substance use.

Lagged effects of substance use on PTSD severity in a randomized controlled trial with modified prolonged exposure and relapse prevention

OBJECTIVE

To advance understanding of the effectiveness of evidence-based treatments for comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD), research must provide a more nuanced picture of how substance use affects change in PTSD symptoms over the course of treatments and whether prolonged exposure techniques can be efficacious during active substance use. A data set that included patients with PTSD/subthreshold-PTSD and SUD treated with an exposure-based intervention provided an opportunity to conduct a secondary analysis to test how patients' substance use impacted PTSD change over treatment.

METHOD

We applied growth models to week-to-week PTSD symptom and substance use changes during treatment and follow-up of a randomized controlled trial of two cognitive-behavioral treatments for PTSD and SUD: Concurrent Treatment of PTSD and SUD Using Prolonged Exposure (COPE) and Relapse Prevention Therapy (RPT). Cross-lagged analyses were used to determine whether prior week substance use impacted subsequent PTSD symptom severity.

RESULTS

Both treatments evidenced significant reductions in PTSD symptom severity. In the context of continued substance use, results suggest that individuals still benefit from exposure-based treatment.

CONCLUSION

Results provide evidence that RPT and COPE both led to significant reductions in PTSD, providing further support that exposure-based techniques tailored for SUD can be conducted without jeopardizing PTSD or SUD outcomes. Implications for clinical decision making around treatment selection are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Child Maltreatment and Physical Victimization: Does Heavy Drinking Mediate the Relationship?

Past studies examining the child maltreatment (CM)/victimization pathway have been limited by their focus on sexual victimization, narrow windows of assessment, and failure to examine gender differences. In the current study, we sought to examine (1) the impact of CM on physical victimization (PV) trajectories from adolescence to young adulthood and (2) the extent to which heavy drinking mediated the relationship between CM and later PV. Using three waves of the National Longitudinal Study of Adolescent to Adult Health, we found that CM was associated with a 69% greater odds of later PV for both genders, after the inclusion of control variables, and that the risk continued into adulthood. Further, heavy drinking was found to mediate the CM/victimization pathway at Wave I, but not at later waves. When mediation was examined separately for men and women, support for mediation was found for men and women. The current study suggests that CM represents a liability for interpersonal violence for both genders and highlights the importance of looking at victimization across time.

Past year non-medical opioid use and abuse and PTSD diagnosis: Interactions with sex and associations with symptom clusters

INTRODUCTION

Few studies have examined the associations between posttraumatic stress disorder (PTSD) and non-medical opioid use (NMOU), particularly in general U.S.

METHODS

We analyzed data from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of non-institutionalized adults, to examine (1) the relationship between PTSD diagnosis with NMOU, Opioid Use Disorder diagnosis, and average monthly frequency of NMOU; and (2) the relationship between PTSD symptom clusters with NMOU, Opioid Use Disorder diagnosis, and average monthly frequency of NMOU. We also explored sex differences among these associations.

RESULTS

In the adjusted model, a past year PTSD diagnosis was associated with higher odds of past year NMOU for women and men, but the association was stronger for women. In addition, PTSD was associated with higher odds of an Opioid Use Disorder diagnosis for women, but not for men. With regard to the relationship between specific symptom clusters among those with a past year PTSD diagnosis, important sex differences emerged. For women, the avoidance symptom cluster was associated with higher odds of NMOU, an Opioid Use Disorder diagnosis, and higher rate of average monthly frequency of NMOU, while for men the arousal/reactivity cluster was associated with higher odds of NMOU, an Opioid Use Disorder diagnosis, and a higher rate of average monthly frequency of NMOU. In addition, for men, the avoidance symptom cluster was associated with higher odds of an Opioid Use Disorder diagnosis, but a lower rate of average monthly frequency of NMOU.

CONCLUSIONS

Results add to the literature showing an association between PTSD and NMOU and suggest that PTSD is more strongly associated with substance use for women than men. Further, results based on individual symptom clusters suggest that men and women with PTSD may be motivated to use substances for different reasons.

Childhood sexual abuse, distress, and alcohol-related problems: Moderation by drinking to cope

Previous studies have found relationships between childhood sexual abuse (CSA) and problem alcohol use. However, few studies have explored mechanisms that may explain this relationship. The present study examined whether (a) distress mediated the relationship between CSA and both heavy drinking and alcohol consequences, (b) coping motives for drinking moderated the paths between distress and both heavy drinking and alcohol consequences, and (c) these relationships remained significant after controlling for other forms of abuse/trauma. Three hundred ninety-five undergraduate women completed survey measures of childhood abuse/trauma, alcohol use/consequences, distress, and drinking motives. Data were analyzed using path analyses. Results supported a moderated-mediation model in which distress mediated the relationship between CSA and alcohol consequences, but only among those who endorsed coping motives for drinking. After controlling for other forms of abuse/maltreatment, the moderated-mediated pathway was no longer significant, but there remained a direct path between CSA and alcohol consequences. The present study provides support for tension-reduction models of alcohol use among CSA-exposed women and demonstrates the moderating role of coping motives. The present study also highlights the need for future studies to control for other forms of abuse/trauma and suggests that other mechanisms and contextual variables need to be explored to explain the CSA/alcohol-use pathway.

Posttraumatic Stress Disorder Symptom Clusters and Perpetration of Intimate Partner Violence: Findings From a U.S. Nationally Representative Sample

Associations between posttraumatic stress disorder (PTSD) and perpetration of intimate partner violence (IPV) have not been extensively studied in nonveteran samples. Secondary analysis was conducted using a nationally representative U.S. sample and limited to those who reported being in a relationship in the past year (N = 25,652). This sample was mostly White (72.0%), the majority had completed high school/ general educational development (GED; 87.8%), about half were female (49.2%), and the mean age was 46.44 years (SD = 15.92). We hypothesized that a diagnosis of PTSD in the past year would be associated with greater perpetration of IPV and that the arousal/reactivity and intrusion symptom clusters would evidence the strongest associations with IPV. Consistent with expectations, a PTSD diagnosis in the past year was associated with greater perpetration of IPV, OR = 2.07, 95% CI [1.89, 2.26]. Among those with a PTSD diagnosis in the past year (n = 1,742), arousal/reactivity symptom cluster scores were associated with greater perpetration of IPV for both men and women, AOR = 1.27, 95% CI [1.11, 1.44]; intrusion symptom cluster scores were associated with perpetration of IPV for men only, AOR = 1.56, 95% CI [1.20, 2.04]; whereas negative cognitions/mood symptom cluster scores were only significant among women, AOR = 1.12, 95% CI [1.01, 1.24]. Results suggested that theoretical and empirical work linking PTSD and perpetration of IPV in military samples extends to the general population.

Differential relationships between religiosity, cigarette smoking, and waterpipe use: implications for college student health

OBJECTIVE

Using a framework informed by problem behavior theory, the authors examined differential relationships between religiosity and the frequency of cigarette and waterpipe tobacco smoking.

PARTICIPANTS

Six hundred fourteen individuals beginning their freshman year at a large, public, midwestern university.

METHODS

Paper-and-pencil surveys were administered to students who attended freshman orientation. Electronic surveys were sent to students who did not attend orientation.

RESULTS

Although a latent, generalized religiosity factor was negatively associated with frequency of cigarette smoking, there was no such relationship for frequency of waterpipe use.

CONCLUSIONS

Conceptualizing waterpipe tobacco smoking in terms of problem behavior theory may be inappropriate, given its lack of association with religiosity. These results may reflect the perception that waterpipe use is a more socially acceptable form of tobacco use that is less harmful to health than cigarette smoking, despite medical evidence to the contrary. Implications for prevention and intervention are discussed.