Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population

Abstract

Objective: Exposure to traumatic experiences, especially those occurring in childhood, has been linked to substance use disorders (SUDs), including abuse and dependence. SUDs are also highly comorbid with Posttraumatic Stress Disorder (PTSD) and other mood-related psychopathology. Most studies examining the relationship between PTSD and SUDs have examined veteran populations or patients in substance treatment programs. The present study further examines this relationship between childhood trauma, substance use, and PTSD in a sample of urban primary care patients.

Method: There were 587 participants included in this study, all recruited from medical and OB/GYN clinic waiting rooms at Grady Memorial Hospital in Atlanta, GA. Data were collected through both screening interviews as well as follow-up interviews.

Results: In this highly traumatized population, high rates of lifetime dependence on various substances were found (39% alcohol, 34.1% cocaine, 6.2% heroin/opiates, and 44.8% marijuana). The level of substance use, particularly cocaine, strongly correlated with levels of childhood physical, sexual, and emotional abuse as well as current PTSD symptoms. In particular, there was a significant additive effect of number of types of childhood trauma experienced with history of cocaine dependence in predicting current PTSD symptoms, and this effect was independent of exposure to adult trauma.

Conclusions: These data show strong links between childhood traumatization and SUDs, and their joint associations with PTSD outcome. They suggest that enhanced awareness of PTSD and substance abuse comorbidity in high-risk, impoverished populations is critical to understanding the mechanisms of substance addiction as well as in improving prevention and treatment.

1

Substance use across childhood trauma quartiles. Of these four substances, alcohol (F = 5.97, P<.001), cocaine (F = 3.90, P<.01) and marijuana use (F = 9.18, P<.001) increased significantly across the four childhood trauma quartiles. Significant group differences in KMSK scores between specific quartiles are indicated on each graph. These data suggest a dosage effect of childhood trauma load on substance exposure, particularly alcohol, cocaine, and marijuana, later on. KMSK, Kreek–McHugh–Schluger–Kellogg.

2

PTSD symptoms between substance dependence groups. These graphs show differences between PTSD symptom level between alcohol, cocaine, and marijuana-dependent and non-dependent groups. While the differences for cocaine and marijuana dependence applied across all symptom clusters, those for alcohol dependence applied to all but intrusive symptoms. PTSD, Posttraumatic Stress Disorder.

3

Current PTSD level between cocaine dependence groups across childhood trauma quartiles. This graph indicates an additive effect of childhood trauma load and past cocaine dependence in predicting current PTSD symptom level. Across all four quartiles, the cocaine-dependent group had significantly higher PSS scores than the non-dependent group (F = 13.50, P<.001). Significant group differences at the second, third and fourths quartiles are also indicated. PTSD, Posttraumatic Stress Disorder; PSS, PTSD Symptom Scale.