Violence, trauma, and post‐traumatic stress disorder among women drug users

Abstract

INTRODUCTIONNumerous studies have established that exposure to violent traumatic events is associated with a variety of psychiatric disorders, the most obvious of which is post-traumatic stress disorder (PTSD). Persons who have been sexually abused (Briere and Zaidi, 1989) Women who abuse drugs are among those who are likely to be victims of violence (Ladwig and Andersen, 1992). In a study examining violence during pregnancy, women who were victims of a violent attack were more likely than nonvictims to be alcohol or drug users and to have partners who used marijuana and cocaine (Amaro et al., 1990). Other studies have demonstrated a significant association between substance abuse and being a victim of sexual abuse, both during childhood and adulthood (Wallace, 1991; Paone et aZ., 1992; Dembo et af., 1988). Given the prevalence of such victimization among women substance abusers, comorbidity of addictive disorders and PTSD would appear to be highly likely.A number of studies have examined rates of comorbidity of PTSD and substance abuse (Boudewyns et al., 1991; Hyer et aI., 1991; McFafl et al., 1991;Breslau et al., 1991;Breslau and Davis, 1987;Druley and Pashko, 1988;Hryvniak and Rosse, 1989;Kulka et al., 1990). Several findings emerge from these studies. First, the rates of comorbidity vary widely from study to study, ranging from a high of 91% (Boudewyns et af., 1991) to a low of 11% (McFall et af., 1991). Second, for the most part, the highest rates of comorbidity were reported in studies conducted with subjects who were in treatment, while lower rates were observed in studies of the general population. Third, there appear to be no published studies that specifically examine the comorbidity of PTSD and substance abuse among women in treatment for addiction.In the study presented here, women in treatment for substance abuse in a New York City hospital located in the South Bronx were interviewed in order to examine the association between self-reported history of violent and non-violent traumatic events and a diagnosis of PTSD. The reasons for assessing PTSD were twofold. First, women drug users who live in the neighborhoods that are served by this clinic are at particular risk for exposure to violence, and a pilot study conducted at this clinic by the authors (Fullilove er al., 1992) suggested that the rate of PTSD might be quite high. Second, because those who seek drug treatment are very likely to exhibit comorbidity (Regier et a.!, 1990; Wallace, 1991), it becomes imperative that ITSD Among Women Drug Users 53s the characteristics of such comorbidity be assessed so that appropriate diagnostic and treatment programs might be created (Kolb, 1989). METHODS Recruitment of Study ParticipantsThe study was conducted at the Lincoln Medical and Mental Health Center Substance Abuse Division (SAD). The SAD is located in the Mott Haven section of the South Bronx, an inner-city area characterized by extensive loss of housing and high rates of violent crime, substance abuse, and AIDS (Wallace, 1988;. Occupying a former N...

Alcohol abuse in individuals exposed to trauma: A critical review.

“…Asking participants to describe their traumatic experience through the use of leading questions or "probes" may increase the likelihood that they report experiencing a trauma that they did not experience, leading to an overestimate of the prevalence of traumatic experiences. In fact, the use of probes has been shown to increase the frequency of reporting of sexual abuse (Fullilove et al, 1993). This issue appears particularly important given emerging concerns about the possibility ofa "thlse memory syndrome."…”

“…Second is the possibility that participants may underreport their actual levels of exposure to certain traumatic events because of feelings of shame, fear, or discomfort with the subject matter, lack of trust in the interviewer, reticence to share personal information with a stranger (Fullilove et al, 1993 ), or all of the above. Researchers hav e argued that this reporting bias is characteristic of individuals exposed to abuse (e.g., Briere & Zaidi, 1989), but it might also be characteristic of individuals exposed to other forms of trauma.…”

Risk and Protective Factors in Mothers With a History of Incarceration: Do Relationships Buffer the Effects of Trauma Symptoms and Substance Abuse History?

“…Researchers have shown that women with PTSD comprise 33% to 59% of substance-abusing females and that symptoms are more severe for these women than for women who experience only one disorder. This percentage is twice as high for women as for men, whose range is from 12% to 34% (Brown et al, 1995;Dansky, Saladin, Brady, Kilpatric, & Resnick, 1995;Fullilove et al, 1993;Ouimette, Brown, & Najavits, 1998).…”

“…For example, alcohol has been shown to compensate for a deficiency in endorphin levels in the brain caused by the traumatic event; thus, a victim may drink in an attempt to control subsequent emotional pain (Volpicelli, Balaraman, Hahn, Wallace, & Bux, 1999). Researchers have suggested that social-contextual factors (e.g., the interpersonal trauma of childhood sexual abuse, domestic violence, and abusive relationships resulting in PTSD) contribute to women's substance abuse at a rate of 32% to 66% (Browne et al, 1999;Dansky, Bume, & Brady, 1999;Fullilove et al, 1993;Volpicelli et al, 1999).…”

“…Childhood sexual abuse is increasingly recognized as a significant risk factor for the development of adult psychological problems, such as PTSD, and survivors are more likely to face later substance abuse challenges (Fullilove et al, 1993;Grayson & NolenHoeksema, 2005;Najvaits et al, 1999;Stewart et al, 2000;Volpicelli et al, 1999).…”