PTSD symptoms and substance use problems in traumatic injury patients: A 24-month follow-up

People who experience traumatic injuries may be at risk for a variety of post-injury emotional and behavioral sequalae. In particular, the level of trauma experienced in relation to those injuries may place individuals at increased risk for substance use-related problems. Given the lack of research directly investigating the impact of injury-related PTSD on substance use problems post-injury, we conducted a secondary analysis of a study of injured patients to explore this issue.

To address the hypothesis that those experiencing more trauma at baseline were at increased risk for substance use problems at follow-up, this study utilized a prospective longitudinal design to investigate the relationship between traumatic injury, PTSD symptoms, and drug use problems over a 24-month follow-up period in 215 patients with traumatic injuries admitted for treatment to an urban Level 1 trauma center. The main study aim was to investigate whether the baseline major of trauma was associated with higher levels of substance use problems at follow-up, controlling for key background variables. Accordingly, we conducted mixed model longitudinal regression analysis where the 10-item DAST was regressed on time, demographic variables (age, sex, race, and income), and initial post-injury PTSD symptoms (as measured by the PCL-5 assessed two weeks post-injury). Separate analyses were conducted using continuous and binary measures of the DAST-10.

Forty-two percent of the sample exceeded the clinical threshold for PTSD. Elevated PTSD symptoms increased the risk for the emergence of substance use problems over the follow-up period. The impact of PTSD symptoms remained when we looked at continuous and binary indicators of substance use problems, and when we controlled for retrospectively reported substance use problems. Male sex, older age, and lower income were also associated with the emergence of substance use problems.

PTSD symptoms occurring immediately post-injury, when elevated, lead to an increased risk for the emergence of substance use problems at follow-up. Substance use problems at follow-up are not merely a continuation of problems experienced before the injury. These findings underscore the importance of screening and of psychologically focused interventions soon after the traumatic injury experience.