Associations between lifetime PTSD symptoms and current substance use disorders using a five-factor model of PTSD

Area of Science:

• Psychiatry
• Clinical Psychology
• Neuroscience

Background:

• Post-traumatic stress disorder (PTSD) is frequently comorbid with substance use disorders.
• Alcohol use disorder (AUD) and nicotine dependence (ND) are common among individuals with PTSD.
• The specific PTSD symptom clusters contributing to these comorbidities require further elucidation.

Purpose of the Study:

• To investigate the association between distinct PTSD symptom clusters (anxious arousal, dysphoric arousal, emotional numbing, re-experiencing) and AUD/ND.
• To examine the role of comorbidity in these associations.
• To differentiate the contributions of specific PTSD symptoms to the comorbidity with AUD and ND.

Main Methods:

• Cross-sectional study of 1483 recently deployed soldiers.
• Stratified, representative sampling.
• Standardized diagnostic interviews to assess PTSD symptoms, AUD, and ND.

Main Results:

• All PTSD symptom clusters were associated with current AUD and ND in crude models, except anxious arousal with AUD.
• Associations were attenuated when controlling for comorbidity.
• Emotional numbing and re-experiencing symptoms uniquely predicted ND, independent of other symptom clusters and comorbidity.

Conclusions:

• Comorbidity partially mediates the relationship between PTSD symptoms and substance use disorders (AUD/ND).
• Emotional numbing and re-experiencing symptoms are particularly implicated in the comorbidity between PTSD and ND.
• A distinction between anxious and dysphoric arousal PTSD symptoms is relevant for understanding AUD/ND comorbidity.