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. 2022 Aug 4;7(1):e000913.
doi: 10.1136/tsaco-2022-000913. eCollection 2022.

Post-traumatic stress disorder (PTSD) symptoms and alcohol and drug use comorbidity at 25 US level I trauma centers

Jefferson Nguyen  1 , Lauren K Whiteside  2 , Eileen M Bulger  3 , Laura Veach  4 , Kathleen Moloney  1 , Joan Russo  1 , Deepika Nehra  3 , Jin Wang  1 , Douglas F Zatzick  1
Affiliations

Post-traumatic stress disorder (PTSD) symptoms and alcohol and drug use comorbidity at 25 US level I trauma centers

Jefferson Nguyen et al. Trauma Surg Acute Care Open. .

Abstract

Background: Questions regarding the extent to which post-traumatic stress disorder (PTSD) is comorbid with alcohol and drug use are particularly germane in an era when the American College of Surgeons Committee on Trauma (ACS-COT) is considering policy requiring screening, intervention and/or referral services for patients presenting with psychological sequalae of traumatic injury. Literature review revealed few multisite trauma-center-based investigations that have assessed the association between PTSD symptoms and alcohol and drug use comorbidities in injured patients.

Methods: This investigation was a secondary analysis of baseline data collected prior to randomization in a 25-site trauma center pragmatic clinical trial. All 635 patients included in the investigation had elevated PTSD symptom levels at the time of trauma center admission. Self-report questionnaire screening, laboratory toxicology results, and electronic health record data were combined to assess the frequencies of alcohol, stimulant (i.e., amphetamine and cocaine), opioid and marijuana use comorbidities for injured patients. Logistic regression was used to assess the associations between demographic and injury characteristics and alcohol and drug use comorbidity.

Results: The frequency of patients with one or more alcohol or substance use comorbidity was between 62% and 79%. Over 50% of patients were positive for one or more alcohol or cannabis comorbidity. Approximately 26% of patients were positive for stimulants and 10% for opioid comorbidity.

Discussion: This multisite investigation suggests that between 62% and 79% of hospitalized injury survivors with elevated PTSD symptoms have one or more alcohol or drug use comorbidity. Orchestrated ACS-COT policy and trauma center service delivery development should incorporate the key finding that a substantial majority of patients with high levels of psychological distress (eg, elevated PTSD symptoms) may have alcohol and drug use comorbidities.

Level of evidence: Level II (epidemiological investigation of untreated controls from a multisite randomized clinical trial).

Trial registration number: NCT02655354.

Keywords: alcoholism; policy; stress disorders, post-traumatic; substance-related disorders.

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Conflict of interest statement

Competing interests: DFZ has provided forensic expert consultation/testimony related to post-traumatic stress disorder for the Washington State Attorney General, the City of Seattle, and other agencies/firms.

Figures

Figure 1
Figure 1
Breakdown of alcohol, stimulant, opioid and cannabis comorbidity for all patients (N=635).
See this image and copyright information in PMC

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