Alcohol and Marijuana Polysubstance Use: Comparison of PTSD Symptom Endorsement and Severity Patterns

Abstract

A growing body of work links posttraumatic stress disorder (PTSD) symptoms and substance use. Unfortunately, much of the literature has examined associations in isolation (e.g., alcohol only). Failure to account for simultaneous or concurrent substance use may limit conclusions that can be drawn from existing research, including the extent to which specific substances contribute differentially to PTSD symptom patterns. The current study examined differences in PTSD symptom profiles between individuals using one or both of the most commonly co-administered psychoactive substances-alcohol and marijuana. Trauma-exposed participants (N = 533; Mage = 21.15) comprised two mutually-exclusive groups: past-month alcohol-only use (n = 334) or past-month alcohol and marijuana use (n = 199). Clusterlevel and symptom-level profile analyses evaluated mean differences and shape (parallelism) of PTSD symptom severity profiles between the groups. Follow-up analyses examined symptom-specific difference in PTSD symptom endorsement and severity. Overall, individuals using marijuana and alcohol evidenced greater PTSD negative cognition (30.8% greater) and hyperarousal (26.4% greater) symptom severity. Alcohol and marijuana users were more likely to endorse, and report greater severity of, mood-related PTSD negative cognition symptoms (e.g., anhedonia, negative affect) and externalizing hyperarousal symptom (e.g., irritability/aggression, risky behaviors) than alcohol-only users. Findings highlight important PTSD differences between individuals that are often lumped into homogenous categories of isolated substance users. Findings provide preliminary support for an 'additive' self-medication model between PTSD and polysubstance use. Lastly, findings indicate that mood-related negative cognition symptoms and externalizing hyperarousal symptoms may be important targets for PTSD-polysubstance use intervention.

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

“…Only participants who endorsed that at least one of the 16 specified traumatic events “happened to me” (cf. “witnessed it”) were included in the analyses, consistent with the conservative approach used in trauma research (e.g., Kearns, Cloutier, Carey, Contractor, & Blumenthal, 2019; Paulus, Vujanovic, & Wardle, 2016; Thornley, Vorstenbosch, & Frewen, 2016).…”

“…Responses to each substance use question ranged from zero occasions to 20 or more occasions . Participants reporting zero occasions were coded as 0 (no), indicating no past-month use of that category of substances; conversely, participants reporting one to two occasions or higher were coded as 1 (yes), indicating past-month use of that category of substances (Kearns et al, 2019).…”

Posttraumatic Stress Disorder Symptomatology and Substance Use in an Outpatient Concurrent Disorders Sample

“…Greater PTSD symptom severity in clusters of NACM and alterations in arousal are seen in individuals who engage in co-use of alcohol and cannabis compared to those who use alcohol alone. 20 Taken together, these associations indicate a strong unique relationship between PTSD and substance use which needs to be accounted for when identifying therapeutic targets for intervention. 21 Despite the importance of these relations, there is a lack of consensus as to which PTSD symptom clusters are more strongly associated with AUD/SUD and prior studies typically evaluated associations between PTSD and alcohol and drug use separately despite high overlap between the use of these substances.…”

The Role of Attachment in Poly-Drug Use Disorder: An Overview of the Literature, Recent Findings and Clinical Implications

“…Importantly, while polydrug use is highly prevalent in individuals with opioid use disorder, individuals with this pattern of drug use also show a high prevalence of comorbid posttraumatic stress disorder (PTSD) (75). Therein, PTSD and PUD may be connected by “an ‘additive’ self-medication model” (p. 39) (92). In addition, the number of polysubstance opioid overdoses seems to be increasing in certain areas (93) and SUD persistence rates seem to be consistently higher in PUD than in other SUD (94).…”

“…In line with this, recent findings suggest that treatment strategies should target these broader liabilities instead of focusing on specific SUD (95). However, several studies also highlight the need for a closer examination of the characteristics and treatment requirements of individuals with PUD (92, 96, 97).…”