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

Abstract

Objective: Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) present a complex and often severe clinical presentation within a concurrent disorders context. The objective of this study was to examine associations between PTSD symptoms and SUD outcomes to better understand the clinical phenomenon of comorbid PTSD and SUD. Multivariate statistical methods were used to test the hypothesis that elevated PTSD symptoms, both at the level of global severity and specific PTSD symptom clusters, are associated with greater substance use and related problems. Methods: Data were collected from an intake assessment battery within a specialized concurrent disorders outpatient service in Hamilton, ON. The sample comprised 326 participants (mean age = 37.19, 45.4% female). Structural equation models examined associations between PTSD and alcohol, cannabis, and substance use frequency and problems, controlling for age and sex. Alcohol was ultimately dropped from the model due to non-significant bivariate associations. Results: Higher global PTSD symptomatology was significantly associated with higher cannabis and other substance use frequency and related problems. Analyses using PTSD cluster scores showed higher scores for alterations in arousal were positively associated with cannabis-related problems, drug-related problems, and cannabis and other substance use frequency. Avoidance was significantly associated with cannabis frequency and cannabis-related problems. In general, effect sizes were small in magnitude, accounting for between 9% and 25% of variance. Conclusion: Significant cluster-level associations indicate the importance of specific PTSD symptoms (hyperarousal, avoidance) in relation to substance use when identifying therapeutic targets among individuals presenting with comorbid PTSD-SUD. This multivariate approach provides a higher resolution and potentially more clinically informative representation of the complex clinical presentation of PTSD and SUD in a concurrent disorder population and could guide the development of more effective treatment paths.

Dissociative symptomatology mediates the relation between posttraumatic stress disorder severity and alcohol‐related problems

“…In a pattern inconsistent with our findings, Patel et al ( 2021 ) did not find any significant associations between PTSD symptom clusters and alcohol‐related problems among a sample of individuals seeking treatment for concurrent disorders. Notably, the sample in Patel et al ( 2021 ) was recruited from an outpatient clinic, where patients with primary alcohol use disorders were not treated, thus potentially accounting for the lack of any significant associations in this sample.…”

“…In a pattern inconsistent with our findings, Patel et al ( 2021 ) did not find any significant associations between PTSD symptom clusters and alcohol‐related problems among a sample of individuals seeking treatment for concurrent disorders. Notably, the sample in Patel et al ( 2021 ) was recruited from an outpatient clinic, where patients with primary alcohol use disorders were not treated, thus potentially accounting for the lack of any significant associations in this sample. Finally, McGlinchey et al ( 2021 ) conducted a network analysis between symptoms of PTSD and alcohol use disorder among a sample of Irish military veterans and found the “reckless behavior” symptom (part of alterations in arousal cluster) yielded the strongest associations with alcohol use disorder symptoms.…”

“…The exploratory model examining the mediating role of dissociation between PTSD symptom clusters and alcohol‐related problems follows prior literature closely (Dworkin et al, 2018 ; McGlinchey et al, 2021 ; Patel et al, 2021 ; Walton et al, 2018 ) which has pointed toward significant relations between the intrusion, NACM, and alterations in arousal clusters of PTSD and alcohol misuse (Walton et al, 2018 ) in the absence of dissociation. In the present study involving a large number of treatment‐seeking inpatients, however, only the alterations in arousal symptom cluster associated directly with alcohol‐related problems in the absence of dissociation.…”

“…Given the cross‐sectional nature of these data, an alternate model was also tested to examine PTSD severity as a mediator between dissociative symptomatology and alcohol‐related problems. Consistent with prior literature (Dworkin et al, 2018 ; McGlinchey et al, 2021 ; Patel et al, 2021 ; Walton et al, 2018 ), a secondary exploratory objective was to examine the mediating role of dissociation between specific PTSD symptom clusters and alcohol‐related problems.…”

Initial Insights from a Quality Improvement Initiative to Develop an Evidence-informed Young Adult Substance Use Program

“…MBC refers to a structured system of assessments to promote personalized and adaptive treatment. The YA-SUP assessment (called the "battery") evolved through literature reviews, discussion of clinically important outcomes with stakeholders, and previous batteries that have been successfully deployed in similar clinical settings (71)(72)(73).…”