The intervening role of urgency on the association between childhood maltreatment, PTSD, and substance-related problems

Abstract

A range of risk factors lead to opioid use and substance-related problems (SRP) including childhood maltreatment, elevated impulsivity, and psychopathology. These constructs are highly interrelated such that childhood maltreatment is associated with elevated impulsivity and traumarelated psychopathology such as posttraumatic stress disorder (PTSD), and impulsivity—particularly urgency—and PTSD are related. Prior work has examined the association between these constructs and substance-related problems independently and it is unclear how these multifaceted constructs (i.e., maltreatment types and positive and negative urgency) are associated with one another and SRP. The current study used structural equation modeling (SEM) to examine the relations among childhood maltreatment, trait urgency, PTSD symptoms, and SRP in a sample of individuals with a history of opioid use. An initial model that included paths from each type of childhood maltreatment, positive and negative urgency, PTSD and SRP did not fit the data well. A pruned model with excellent fit was identified that suggested emotional abuse, positive urgency, and negative urgency were directly related to PTSD symptoms and only PTSD symptoms were directly related to SRP. Furthermore, significant indirect effects suggested that emotional abuse and negative urgency were related to SRP via PTSD symptom severity. These results suggest that PTSD plays an important role in the severity of SRP.

Factors Associated with Opioid Use Disorder Diagnosis and Treatment Progress

“…Psychological trauma, including physical, mental, emotional, and sexual abuse, has also been shown to increase the likelihood of developing a substance use disorder (Mirhashem, et al, 2017, Conroy, Degenhardt, Mattick, & Nelson, 2009Daigre et al, 2015;Dube et al, 2013;Heffernan et al, 2000), with just one additional traumatic event increasing a person's chances of developing a substance use disorder by 40% (Dube et al, 2013). Various studies have shown that the presence of emotional and physical abuse are the strongest predictors of developing a SUD, especially in men (Mirhashem, et al, 2017).…”

“…Psychological trauma, including physical, mental, emotional, and sexual abuse, has also been shown to increase the likelihood of developing a substance use disorder (Mirhashem, et al, 2017, Conroy, Degenhardt, Mattick, & Nelson, 2009Daigre et al, 2015;Dube et al, 2013;Heffernan et al, 2000), with just one additional traumatic event increasing a person's chances of developing a substance use disorder by 40% (Dube et al, 2013). Various studies have shown that the presence of emotional and physical abuse are the strongest predictors of developing a SUD, especially in men (Mirhashem, et al, 2017). Notably, while the experience of traumatic events in an individual's life can make him or her more susceptible to developing any SUD (Boscarino et al, 2010;McCauley et al, 2014), prescription opioid use, specifically, has been associated with higher scores on inventories measuring PTSD symptoms (Meier, Lambert-Harris, McGovern, Xie, & McLeman, 2014 Further, though trauma can occur at any point during a patient's life, the most marked effects are shown when traumatic events occur during childhood (Conroy et al, 2009;Dube et al, 2013;Heffernan et al, 2000;Barahmand, Khazaee, & Hashjin, 2016).…”

“…In addition to any type of abuse a child might experience, parental separation, parental conflict, and parental substance abuse exponentially increase the rates of developing a SUD in the future (Conroy et al, 2009;Barahmand et al, 2016). Opioid use disorder has been specifically associated with childhood emotional abuse (Mirhashem, et al, 2017). Other forms of neglect and household dysfunction have a similar effect at these children age (Dube et al, 2013;Barahmand et al, 2016).…”

“…One of the reasons trauma appears to have such a large impact on risk for SUD is due to the development of post-traumatic stress disorder (PTSD). It is common for patients with PTSD to also have diagnosis of general anxiety disorder and major depressive disorder, which are also positively correlated with the incidence of many substance use disorders (Skala et al, 2013;Boscarino et al, 2010;Mirhashem, et al, 2017;Daigre et al, 2015;Garami et al, 2017;Lai, Cleary, Sitharthan, & Hunt, 2015;Wilsey et al, 2008;Robinson, Sareen, Cox, & Bolton, 2009;Jacobsen, Southwick, & Kosten, 2001;Dore, Mills, Murray, Teesson, & Farrugia, 2012).…”

An Associated Research for Genetic Polymorphism of 5-HTTLPR with Post-Traumatic Stress Disorder

“…According to the diagnostic manual of the American Psychiatric Association, PTSD is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape, or other violent personal assault [2]. The 4 key symptoms of PTSD include: intrusion symptoms associated with the traumatic event(s); persistent avoidance of stimuli associated with the traumatic event(s) [3]; negative alterations in cognitions and mood associated with the traumatic event(s); and, marked alterations in arousal and reactivity associated with the traumatic event(s) [4]. Because of the higher incidence of PTSD after encountering a traumatic event [5] and the accompanying possibilities of serious detriments to the individual, family and society, this condition has become a popular topic for psychiatric and clinical psychological research in recent years [6].…”