Risk factors for revictimization during treatment in patients with co-occurring SUD and PTSD

Introduction: A host of cross-sectional studies have identified problematic substance use and post-traumatic stress symptoms as risk factors for repeated interpersonal violence (revictimization) in college samples. However, it remains unclear which factors are associated with revictimization for patients who meet diagnostic criteria for both substance use disorder (SUD) and post-traumatic stress disorder (PTSD). The identification of factors associated with revictimization is an important step towards preventing violence against people with psychiatric disorders and can inform treatment.Method: Data were based on the Treatment of PTSD and Addiction (TOPA) study, a randomized controlled trial including N = 209 patients that received inpatient and outpatient treatment for SUD and PTSD. We selected participants who had experienced interpersonal victimization at baseline (N = 203) and assessed revictimization across the 9-month follow-up period. Revictimization included: physical violence, violence with a gun, sexual violence, and 'other unwanted sexual experience'. The risk factors we investigated were severity of PTSD, severity of alcohol and drug use disorder, interpersonal difficulties, sex, and age. We analysed the data using logistic regression analyses with multiple imputation for missing data.Results: Physical violence was the most common type of revictimization during the study period (26.0%), closely followed by 'other unwanted sexual experience' (20.0%). The severity of PTSD and age were univariate predictors for revictimization; however, only age was robustly related to revictimization while accounting for other study variables. We conducted sensitivity analyses with complete cases and observed data.Discussion: Approximately two in five individuals experienced revictimization across the 9-month follow-up period, underscoring it as a clinically relevant issue. Since age emerged as the only risk factor for revictimization in our sample, future research should focus on identifying modifiable factors associated with age, e.g. impulsivity and novelty seeking. These factors may be addressed in interventions aimed at reducing the risk of revictimization.