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PTSD & Addiction - NIAAA Bibliography Of 03-02-02 

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Posted On: March 02, 2002          Updated On: March 02, 2002
© Terence T. Gorski, 2001

PTSD & Addiction - NIAAA Bibliography Of 03-02-02

The National Institute on Alcohol Abuse and Alcoholism thanks you for using ETOH. This search is displayed using the MAIN form on 3/1/2000 , at 3:47:27 AM using " FIND ("AB" ct PTSD) " as the search criteria. This report sorts by Year first (in reverse order) and then by the primary author. 230 records were found.

1. Delahanty, D.L.; Herberman, H.B.; Craig, K.J.; Hayward, M.C.; Fullerton, C.S.; Ursano, R.J.; Baum, A. Acute and chronic distress and posttraumatic stress disorder as a function of responsiblity for serious motor vehicle accidents. Journal of Consulting and Clinical Psychology, 65(4):560-567, 1997. (140137)

In this study on the effects of attributions of responsibility for traumatic events, stress, coping, and symptoms of posttraumatic stress disorder (PTSD) were measured, including intrusive thoughts among 130 victims of serious motor vehicle accidents (MVAs) 14-21 days and 3, 6, and 12 months after their accident. MVA victims and 43 control participants were categorized by accident and attribution of responsibility for their accidents (self-responsible, other-responsible, and control). Although initially all MVA victims reported higher levels of intrusive thoughts and were more likely to meet criteria for PTSD diagnoses, only other-responsible participants continued to demonstrate increased distress 6 and 12 months postaccident. Self-responsible participants used more self-blame coping than other-responsible participants, although within the self-responsible group, use of self-blame was associated with more distress. 34 Ref.
Copyright 1997 - American Psychological Association

2. Ford, J.D.; Fisher, P.; Larson, L. Object relations as a predictor of treatment outcome with chronic posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 65(4):547-559, 1997. (140136)

The role of object relations as a predictor of outcome was evaluated in inpatient posttraumatic stress disorder (PTSD) treatment. Cohort outcome at discharge on psychometric indices was mixed, with limited evidence of reliable or clinically significant change. Treatment was associated with an overall reduction in utilization of inpatient psychiatric and residential domiciliary services. However, moderate (vs. low) levels of object relations were predictive of reliable change outcome, independent of demographics, Axis II diagnosis, symptomatic severity, or early childhood or war zone trauma exposure. The findings suggest that consideration should be given both to the manner in which patients seeking treatment for PTSD are screened and matched with a range of treatment or rehabilitation services and to how treatment outcome is conceptualized beyond symptom reduction. Rehabilitation of chronic posttraumatic symptomatology and associated psychosocial impairment may be facilitated by assessment, treatment design, and client-treatment matching on the basis of multidimensional psychological indices. 73 Ref.
Copyright 1997 - American Psychological Association

3. Zanarini, M.C.; Frankenburg, F.R.; Dubo, E.D.; Sickel, A.E.; Trikha, A.; Levin, A.; Reynolds, V. Axis I comorbidity of borderline personality disorder. American Journal of Psychiatry, 155(12):1733-1739, 1998. (146406)

The purpose of this study was to assess the lifetime rates of occurrence of a full range of DSM-III-R axis I disorders in a group of patients with criteria- defined borderline personality disorder and comparison subjects with other personality disorders. The axis I comorbidity of 504 inpatients with personality disorders was assessed by interviewers who were blind to clinical diagnosis and who used a semistructured research interview of demonstrated reliability. Four new findings emerged from this study. First, anxiety disorders were found to be almost as common among borderline patients (N=379) as mood disorders but far more discriminating from axis II comparison subjects (N=125). Second, posttraumatic stress disorder (PTSD) was found to be a common but not universal comorbid disorder among borderline patients, a finding inconsistent with the view that borderline personality disorder is actually a form of chronic PTSD. Third, male and female borderline patients were found to differ in the type of disorder of impulse in which they "specialized." More specifically, substance use disorders were significantly more common among female borderline patients. Fourth, a lifetime pattern of complex comorbidity (i.e., met DSM-III-R criteria for both a disorder of affect and a disorder of impulse at some point before the patients' index admission) was found to have strong positive predictive power for the borderline diagnosis as well as a high degree of sensitivity and specificity. These results suggest that the lifetime pattern of axis I comorbidity characteristic of borderline patients and distinguishing for the disorder is a particularly good marker for borderline personality disorder. 48 Ref.
Copyright 1998 - American Psychiatric Association. Abstract reprinted by permission.

4. Back, S.E.; Brady, K.T.; Sonne, S.C. Gender differences in individuals with comorbid alcohol dependence and posttraumatic stress disorder. Drug and Alcohol Dependence, 63(suppl.1):s9, 2001. (160094)

Gender differences were investigated in outpatient, treatment-seeking individuals (N = 84) with comorbid alcohol dependence and posttraumatic stress disorder (PTSD). Assessments included substance use severity, trauma history, PTSD symptomatology, and comorhid psychiatric disorders. PTSD was most often primary among women (70.0 versus 37.5 percent), and alcohol dependence was most often primary among men (59.4 versus 23.3 percent). Women with this dual diagnosis were more likely than men to test positive for cocaine (20.6 versus 0.0 percent) and to meet criteria for another anxiety disorder (60.0 versus 37.2 percent). Women also reported greater frequency and intensity of PTSD avoidance symptoms (52.5 versus 27.3 percent), higher rates of sexual trauma (97.5 versus 54.8 percent), and greater social impairment due to PTSD (52.9 versus 26.8 percent). Men with this dual diagnosis showed greater intensity of alcohol use (more days of drinking to intoxication in the past month; 13.24 versus 8.73). Almost one-fourth (23.3 percent) of men and 7.5 percent of women reported consuming 10 or more drinks daily. Compared to women, men also scored higher on the Obsessive Compulsive Drinking Scale (19.93 versus 16.26) and evidenced greater social (29.5 versus 5.0 percent) and legal impairment because of their substance use. These findings may help inform gender-specific theories on the pathogenesis of comorbid alcohol dependence and PTSD, and may lead to more effective interventions for individuals with this dual diagnosis.

5. Brady, K.T. Comorbid posttraumatic stress disorder and substance use disorders. Psychiatric Annals, Vol. 31(5):313-319, 2001. (159903)

This article reviews the extent of the problem of comorbid posttraumatic stress disorder (PTSD) and substance use disorders in both epidemiologic and treatment-seeking samples. Theoretical issues concerning the relationship of these disorders to each other are discussed. Studies investigating the effect of PTSD on the presentation, course, and outcome of treatment for substance use disorders are reviewed and new developments in strategies to treat comorbid PTSD and substance use disorders are examined. Victimization, traumatization, and PTSD are common among individuals with substance use disorders. Conversely, it appears that individuals with PTSD are at risk for a substance use disorder. The relationship between these disorders is complex. There are clear biological connections between PTSD and substance use disorders, most likely mediated through the catecholaminergic system and the hypothalamic-pituitary-adrenal axis. Prospective data indicate that many individuals experience trauma and have PTSD before the onset of a substance use disorder, supporting the hypothesis of self-medication as one avenue for the development of comorbid PTSD and substance use disorders. Current studies are exploring psychotherapeutic approaches to the treatment of this complex comorbidity. Exposure therapy for PTSD in patients with substance use disorders is particularly interesting because it was previously thought to be contraindicated in this group. The study of pharmacotherapy for these patients is in its infancy, but recent pilot work demonstrates promise for serotonin reuptake inhibitors and other antidepressant agents. 38 Ref.

6. Brady, K.T.; Dansky, B.S.; Back, S.E.; Foa, E.B.; Carroll, K.M. Exposure therapy in the treatment of PTSD among cocaine-dependent individuals: Preliminary findings. Journal of Substance Abuse Treatment, 21(1):47-54, 2001. (161103)

This study evaluated the safety and effectiveness of exposure therapy as a treatment of comorbid post-traumatic stress disorder (PTSD) and cocaine dependence. Participants (n = 39) underwent one or two 90-minute outpatient exposure-based psychotherapy sessions per week, with 15 completing ten or more sessions. The sessions included imaginal and in vivo exposure therapy combined with cognitive-behavioral relapse prevention techniques. Subjects narrated their traumatic experience, including thoughts, emotions, and psychological sensations associated with the memory. Statistical analyses compared completers and noncompleters, and treatment completers were studied in regard to treatment outcome. Noncompleters had significantly higher avoidance symptoms and fewer years of education than completers. Treatment completers showed significant reductions in PTSD symptoms, cocaine use, and depressive symptoms that were maintained over a six-month follow-up period. Other treatment outcome measures were examined, including alcohol use. Despite limitations of the study, findings provide preliminary evidence that exposure therapy is safe and effective for treatment of comorbid PTSD and cocaine-dependent patients. 37 Ref.

7. Cottler, L.B.; Nishith, P.; Compton, W.M. Gender differences in risk factors for trauma exposure and post-traumatic stress disorder among inner-city drug abusers in and out of treatment. Comprehensive Psychiatry, 42(2):111-117, 2001. (159045)

This study examined gender differences in trauma exposure risk and posttraumatic stress disorder (PTSD) among drug users. Analyses were conducted of data from a study of 464 current urban drug users (89 percent African American) to determine the role of gender in (1) predicting the nature of the traumatic incident and comorbid PTSD symptoms, (2) drug use disorder patterns in relation to trauma exposure and PTSD symptoms, (3) comorbidity of other psychiatric disorders, and (4) the temporal association of drug use disorder, trauma exposure, and PTSD. Multivariate analyses and logistic regression were performed. Of subjects both in and out of treatment, 36 percent reported experiencing a traumatic event. Drug injection, polydrug use, and a drug abuse and dependence diagnosis were predictive of exposure to a traumatic event but not predictive of subsequent PTSD. Only schizophrenia and other anxiety disorder were predictive of PTSD. Women most often reported sexual assault and rape, while men reported physical assault. Results indicate that a history of adult antisocial behavior is associated with exposure to a traumatic event. Drug use onset also was associated with such exposure. Findings support an etiologic role of both antisocial personality disorder and alcohol and drug use for subsequent exposure to a traumatic event. The finding of a shorter interval between onset of drug use to PTSD event among women suggests a different etiologic role by gender of drug use behavior in increasing vulnerability to PTSD development. 25 Ref.

8. Deahl, M.P.; Srinivasan, M.; Jones, N.; Neblett, C.; Jolly, A. Evaluating psychological debriefing: Are we measuring the right outcomes? Journal of Traumatic Stress, 14(3):527-529, 2001. (161976)

The efficacy of critical incident stress debriefing (CISD) and psychological debriefing (PD) following potentially traumatizing events has recently been challenged after a number of recent randomized controlled trials (RCTs) failed to demonstrate that CISD or PD prevents or reduces the incidence of posttraumatic stress disorder (PTSD). These studies have used measures of PTSD as the principal outcome and have generally not measured comorbid psychopathology, behavioral or social dysfunction. In a recent RCT of group debriefing amongst British soldiers returning from peacekeeping operations in Bosnia, PD had a significant effect in reducing a worrying level of alcohol misuse in the sample. The findings of this study suggest that it is premature to conclude that debriefing is ineffective and that a broader range of outcome measures should be employed in future trials of debriefing. 8 Ref.

9. DeBellis, M.D. Developmental traumatology: The psychobiological development of maltreated children and its implications for research, treatment, and policy. Development and Psychopathology, 13(3):539-564, 2001. (161423)

In this review, a developmental traumatology model of child maltreatment and the risk for the intergenerational cycle of abuse and neglect using a mental health or posttraumatic stress model was described. Published data were reviewed that support the hypothesis that the psychobiological sequelae of child maltreatment may be regarded as an environmentally induced complex developmental disorder. Data to support this view, including the descriptions of both psychobiological and brain maturation studies in maltreatment research, emphasizing the similarities and differences between children, adolescents, and adults, were reviewed. Many suggestions for important future psychobiological and brain maturation research investigations as well as public policy ideas were offered. Section headings in this review of the literature include: (1) basic assumptions of developmental traumatology research; (2) is the PTSD model appropriate for studies of maltreated children; (3) impact of maltreatment on developmental achievements; (4) is childhood PTSD a "gateway illness" to serous comorbid disorders; (5) a brief review of biological stress systems; (6) is adult PTSD a risk factor for alterations in biological stress systems and brain morphometry; (7) is childhood trauma a risk factor for alterations of biological stress systems; (8) is childhood trauma a risk factor for adverse brain development; (9) cognitive functioning in maltreated children and adolescents; and (10) is there a psychobiology of hope. 181 Ref.

10. Jacobsen, L.K.; Southwick, S.M.; Kosten, T.R. Substance use disorders in patients with posttraumatic stress disorder: A review of the literature. American Journal of Psychiatry, 158(8):1184-1190, 2001. (160876)

The authors review studies of the epidemiology, clinical phenomenology, and pathophysiology of comorbid posttraumatic stress disorder (PTSD) and substance use disorders. Review of studies on the pathophysiology of PTSD and substance use disorders focuses on the hypothalamic-pituitary-adrenal axis and the noradrenergic system. A functional relationship between PTSD and substance use disorders is suggested by their high rates of comorbidity, and most published data support a pathway in which substance abuse or dependence is preceded by PTSD. Substances are initially used to modify PTSD symptoms, but as dependence on the substances develops, PTSD symptoms may be exacerbated by physiologic arousal resulting from withdrawal, thereby contributing to a relapse of substance use. It has been proposed, based on preclinical studies, that corticotropin-releasing hormone and noradrenergic systems may interact in PTSD to progressively augment stress response. Patients with PTSD may use sedatives, hypnotics, or alcohol in an effort to interrupt this progressive augmentation. It is concluded that withdrawal and PTSD-related arousal symptoms should be vigorously controlled when detoxifying patients with comorbid PTSD and substance use disorders. Development of effective treatments for this severely symptomatic population depends critically on including patients with comorbid PTSD and substance use disorders in neurobiologic research and clinical trials. 69 Ref.

11. Lapham, S.C.; Smith, E.; C'de Baca, J.; Chang, I.; Skipper, B.J.; Baum, G.; Hunt, W.C. Prevalence of psychiatric disorders among persons convicted of driving while impaired. Archives of General Psychiatry, 58(10):943-949, 2001. (161481)

This study of convicted drunk drivers estimates lifetime and 12-month prevalence of psychiatric disorders (alcohol and drug abuse/dependence, major depressive disorder, dysthymic disorder, generalized anxiety disorder, posttraumatic stress disorder [PTSD], and antisocial personality disorder) and compares rates with estimates from a U.S. population-based survey. Six hundred twelve women and 493 men, aged 23 to 54 years, convicted of driving while impaired, who had been referred to a screening program in Bernalillo County, New Mexico, were interviewed using the Diagnostic Interview Schedule between 25-Jan-1994 and 30-Jun-1997. Psychiatric diagnoses were compared with findings from the National Comorbidity Survey (NCS) for the western region of the United States, conducted between 14-Sep-1990 and 6-Feb-1992. Eighty-five percent of female and 91 percent of male offenders reported a lifetime alcohol-use disorder, compared with 22 and 44 percent respectively in the NCS sample. Thirty-two percent of female and 38 percent of male offenders had a drug-use disorder, compared with 16 and 21 percent respectively in the NCS sample. For offenders with alcohol-use disorders, 50 percent of women and 33 percent of men had at least one additional psychiatric disorder other than drug abuse or dependence, mainly PTSD or major depression. Thus drunk-driving offenders need assessment and treatment not only for alcohol problems but also for drug use and the other psychiatric disorders that commonly accompany alcohol-related problems. 67 Ref.
Copyright 2001 - American Medical Association

12. McLeod, D.S.; Koenen, K.C.; Meyer, J.M.; Lyons, M.J.; Eisen, S.; True, W.; Goldberg, J. Genetic and environmental influences on the relationship among combat exposure, posttraumatic stress disorder symptoms, and alcohol use. Journal of Traumatic Stress, 14(2):259-275, 2001. (160810)

The role of genetic and environmental influences on the relationship between combat exposure, posttraumatic stress disorder (PTSD) symptoms, and alcohol use were examined in 4072 male-male twin pairs who served in the United States military during the Vietnam era (1965-1975). Results indicate that the relationship between combat and alcohol use and between PTSD symptom factors and alcohol use were both substantially influenced by genetic factors. The findings are most consistent with a shared vulnerability model for the etiology of the association between PTSD symptoms and alcohol use. Specific unique environmental factors were more important than genetic factors for PTSD symptoms, and both factors were equally important for alcohol use. Further support is also found for the role of the unique environment in PTSD symptoms. 43 Ref.

13. Nishith, P.; Resick, P.A.; Mueser, K.T. Sleep difficulties and alcohol use motives in female rape victims with posttraumatic stress disorder. Journal of Traumatic Stress, 14(3):469-479, 2001. (161975)

The purpose of this study was to assess the relationship between sleep difficulties and drinking motives in female rape victims with posttraumatic stress disorder (PTSD). Seventy-four participants were assessed for PTSD symptoms, depression, sleep difficulties, and drinking motives. Results demonstrated that neither PTSD symptoms nor depression were related to any motives for using alcohol. On the other hand, after controlling for education, sleep difficulties were significantly related to drinking motives for coping with negative affect, but not pleasure enhancement or socialization. The findings suggest that sleep difficulties may be an important factor contributing to alcohol use in rape victims with PTSD. 35 Ref.

14. Ouimette, P.; Humphreys, K.; Moos, R.H.; Finney, J.W.; Cronkite, R.; Federman, B. Self-help group participation among substance use disorder patients with posttraumatic stress disorder. Journal of Substance Abuse Treatment, 20(1):25-32, 2001. (158624)

This study examined associations between engagement and specific indices of treatment outcome for substance use disorder (SUD) patients with posttraumatic stress disorder (PTSD). Male SUD-PTSD patients (n = 159) and male SUD-only patients (n = 1,429) were compared on participation in a 12-step program after an index episode of treatment. Participation in the 12-step program was similar for both groups. PTSD patients who believed in certain disease models that more closely matched the 12-step philosophy participated more in the program. Greater participation was associated with better concurrent functioning, but participation did not prospectively predict outcomes after case mix adjustment. Greater participation did predict decreased stress among PTSD patients who held worldviews more consistent with the 12-step philosophy. Implications for treatment approaches are discussed. 29 Ref.

15. Rosen, C.S.; Murphy, R.T.; Chow, H.C.; Drescher, K.D.; Ramirez, G.; Ruddy, R.; Gusman, F. Posttraumatic stress disorder patients' readiness to change alcohol and anger problems. Psychotherapy, 38(2):233-244, 2001. (162074)

Recovery from combat-related posttraumatic stress disorder (PTSD) is often complicated by unacknowledged problems with alcohol and anger. Male combat veterans (N = 102) entering a residential PTSD rehabilitation program completed University of Rhode Island Change Assessment (URICA) and process-of-change questionnaires based on Prochaska and DiClemente's transtheoretical model (TTM; Prochaska, DiClemente, and Norcross, 1992). Separate assessments were made for alcohol abuse and anger control. Four motivational subtypes were identified for both problems. Motivation to change alcohol problems was independent of that for anger. Relative to less-motivated peers, highly motivated patients were more likely to spontaneously identify alcohol or anger as problems in their life and made greater use of change strategies specified by the TTM. These results support extension of the TTM to anger management and to PTSD management. Treatment implications-are discussed. 45 Ref.

16. Ross, R.J.; Book, H.W.; Sanford, L.D.; Silver, S.M.; Ford, N.M.; Huff, R.M.; Morrison, A.R. REM activity increase in PTSD does not depend on a depressive diathesis and alcoholism. Sleep, 24(suppl):A118, 2001. (160428)

Repetitive, stereotypical anxiety dreams characterize posttraumatic stress disorder (PTSD). Increase in rapid eye movement (REM) activity during sleep in PTSD has been reported. However, such a change has also been described in major depression (DP) and alcohol dependence (AD), which are commonly associated with PTSD and thus are potential confounders in polysomnographic (PSMG) studies. To assess whether elevated REM activity can be observed in the absence of these frequently co-occurring conditions, this PSMG study compared non-DP PTSD subjects who had no history of major DP prior to developing PTSD, and no familial DP diathesis, with controls matched on AD. Male combat veterans (N = 10) with chronic PTSD, without current major DP, without DP preceding the onset of PTSD, and with no family history of a mood disorder, were compared with 10 age-matched male control subjects without a history of primary DP, without a family history of a mood disorder, and with AD (N = 5; recent or in stable remission). The remaining controls (N = 5) had never been AD. The PTSD group had an equivalent distribution of AD diagnoses. This group showed increases in average REM activity and average REM density. AD diagnosis had no effect on either measure. There were no significant main effects for group in any tonic REM sleep measure, nor in any sleep continuity or non-REM sleep architectural measure. Even when DP and AD are minimized as possible confounders, subjects with PTSD show increased REM activity, which may be a sensitive marker of the disorder. 3 Ref.

17. Saxon, A.J.; Davis, T.M.; Sloan, K.L.; McKnight, K.M.; McFall, M.E.; Kivlahan, D.R. Trauma, symptoms of posttraumatic stress disorder, and associated problems among incarcerated veterans. Psychiatric Services, 52(7):959-964, 2001. (160779)

To help improve treatment for incarcerated veterans, the study examined exposure to trauma, symptoms of posttraumatic stress disorder (PTSD), functional status, and treatment history in a group of incarcerated veterans. A convenience sample of 129 jailed veterans who agreed to receive outreach contact completed the Life Event History Questionnaire, the PTSD Checklist-Civilian Version (PCL-C), and the Addiction Severity Index. Participants who had scores of 50 or above on the PCL-C, designated as screening positive for PTSD, were compared with those whose scores were below 50, designated as screening negative for PTSD. Some 112 veterans (87 percent) reported traumatic experiences. A total of 51 veterans (39 percent) screened positive for PTSD, and 78 veterans (60 percent) screened negative. Compared with veterans who screened negative for PTSD, those who screened positive reported a greater variety of traumas; more serious current legal problems; a higher lifetime use of alcohol, cocaine, and heroin; higher recent expenditures on drugs; more psychiatric symptoms; and worse general health despite more previous psychiatric and medical treatment as well as treatment for substance abuse. The findings encourage the development of an improved treatment model to keep jailed veterans with PTSD from repeated incarceration. 26 Ref.
Copyright 2001 - American Psychiatric Association

18. Teusch, R. Substance abuse as a symptom of childhood sexual abuse. Psychiatric Services, 52(11):1530-1532, 2001. (162053)

This study discusses the recovery process of a 37-year-old woman with adult onset posttraumatic stress disorder (PTSD). The patient had suffered childhood sexual abuse and had self-medicated for many years with drugs and alcohol to maintain the dissociation of memories of abuse and to facilitate interpersonal functioning. Upon onset of PTSD, the patient's substance abuse became a full-blown addiction that was highly resistant to treatment. It became evident that her substance abuse symbolically repeated her traumatization. In re-experiencing the affects associated with her earlier trauma (despair, denial, shame, and helplessness) as part of her substance abuse and in the transference, the patient was able to gain mastery over these affects and, subsequently, was able to achieve a stable recovery from both illnesses. 7 Ref.

19. Volkow, N.D. Drug abuse and mental illness: Progress in understanding comorbidity. American Journal of Psychiatry, 158(8):1181-1183, 2001. (160875)

This editorial discusses evidence suggesting that the high rate of comorbidity between mental illness and substance abuse reflects common contributing factors and brain substrates. Stress plays an important role in both substance abuse and mental illness and is especially prominent in posttraumatic stress disorder (PTSD). The accentuated stress responses in PTSD could explain comorbid abuse of drugs, particularly sedative-hypnotics such as alcohol, as a way of relieving PTSD symptoms temporarily. It has been proposed that enhanced noradrenergic function in abnormal response to stress in PTSD is disrupted by drug withdrawal, causing stress symptoms to return and drug abuse to be resumed. Drug abuse and PTSD share other processes such as sensitization and conditioned responses. In PTSD the individual is conditioned to an aversive stimulus (the stressor), whereas in drug abuse the individual is conditioned to a rewarding stimulus (the drug). An unresolved question is how drugs of abuse trigger psychosis in people with no previous psychiatric histories. An association has been reported between the loss of dopamine transporters and positive symptoms in methamphetamine abusers with histories of methamphetamine-induced psychosis. Loss of dopamine transporters could result in high levels of extracellular dopamine even when methamphetamine is no longer present, which could explain the persistence of psychosis. Evidence that drugs of abuse, particularly cocaine, may damage the brain through their cerebrovascular effects is briefly discussed. 5 Ref.

20. Back, S.; Dansky, B.S.; Coffey, S.F.; Saladin, M.E.; Sonne, S.; Brady, K.T. Cocaine dependence with and without post-traumatic stress disorder: A comparison of substance use, trauma history and psychiatric comorbidity. American Journal on Addictions, 9(1):51-62, 2000. (153357)

This study examined the relationship between substance use, trauma history, post-traumatic stress disorder (PTSD), and psychiatric comorbidity in a treatment seeking sample of cocaine dependent individuals (N = 91). Structured clinical interviews revealed that 42.9 percent of the sample met DSM-III-R criteria for lifetime PTSD. Comparisons between individuals with and without lifetime PTSD revealed that individuals with PTSD had significantly higher rates of exposure to traumatic events, earlier age of first assault, more severe symptomatology, and higher rates of Axis I and Axis II diagnoses. The results illustrate a high incidence of PTSD among cocaine dependent individuals. Routine assessment of trauma history and PTSD may assist in the identification of a subgroup of cocaine users in need of special prevention and treatment efforts. 59 Ref.
Copyright 2000 - American Academy of Addiction Psychiatry (AAAP)

21. Bonin, M.F.; Norton, G.R.; Asmundson, G.J.G.; Dicurzio, S.; Pidlubney, S. Drinking away the hurt: The nature and prevalence of PTSD in substance abuse patients attending a community-based treatment program. Journal of Behavior Therapy and Experimental Psychiatry, 31(1):55-66, 2000. (156509)

This study estimated the prevalence of posttraumatic stress disorder(PTSD) in a community-based treatment program for substance abuse, determined if patients having PTSD and substance abuse differ from those without PTSD on demographic measures and general measures of psychopathology, and assessed the accuracy of PTSD classification based on common self-report measures of psychopathology. Participants were patients in treatment programs who attended the Addictions Foundation of Manitoba for substance abuse or substance dependence treatment. A prevalence rate of 52.8 percent was found for full or possible PTSD. Participants classified as having PTSD experienced more traumatic events when compared with those without PTSD. Patients with PTSD reported greater scores on measures of anxiety and depression. Using discriminant function analysis, self-report measures correctly classified a majority of PTSD groups. Implications of these results are presented. 27 Ref.

22. Brown, P.J. Outcome in female patients with both substance use and post-traumatic stress disorders. Alcoholism Treatment Quarterly, 18(3):127-135, 2000. (157599)

The present study examines six-month treatment outcomes for substance use disordered (SUD) female patients with a comorbid diagnosis of Post-Traumatic Stress Disorder (PTSD). Patients completed a baseline assessment while receiving inpatient substance use treatment and were reinterviewed six-months post-treatment. Approximately one-half the women had relapsed on alcohol and/or drugs during the follow-up period. One-quarter had remitted from PTSD at follow-up. Logistic regressions showed that baseline severity of PTSD reexperiencing symptoms is a significant predictor of both alcohol/drug relapse and PTSD status (remitted/unremitted). No baseline measure of substance use emerged as a significant predictor of PTSD remitted/unremitted status at follow-up. The results suggest that treatment targeting comorbid PTSD might result in improved outcomes for both disorders. 20 Ref.
Copyright 2000 - The Haworth Press, Inc.

23. Calhoun, P.S.; Sampson, W.S.; Bosworth, H.B.; Feldman, M.E.; Kirby, A.C.; Hertzberg, M.A.; Wampler, T.P.; Tate-Williams, F.; Moore, S.D.; Beckham, J.C. Drug use and validity of substance use self-reports in veterans seeking help for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 68(5):923-927, 2000. (156842)

The present study assessed drug use and the validity of self-reports of substance use among help-seeking veterans referred to a specialty clinic for the assessment of posttraumatic stress disorder (PTSD). Patients (n = 341) were asked to provide a urine sample for use in drug screening as part of an evaluation of PTSD. Self-reports of substance use were compared with same-day supervised urine samples for 317 patients who volunteered to participate in a drug screening. Results suggested that self-reports were generally quite valid. Only 8 percent of the cases involved patients not reporting substance use detected by urine screens. A total of 42 percent of the participants were identified as using drugs of abuse (excluding alcohol) through self-report and urine drug screens. Among participants using drugs, PTSD diagnosis was significantly associated with greater marijuana and depressant use as compared with stimulant (cocaine and amphetamines) use. 31 Ref.
Copyright 2000 - the American Psychological Association, Inc.

24. Dansky, B.S.; Brewerton, T.D.; Kilpatrick, D.G. Comorbidity of bulimia nervosa and alcohol use disorders: Results from the national women's study. International Journal of Eating Disorders, 27(2): 180-190, 2000. (151867)

This study examined the prevalence of bulimia nervosa (BN) and alcohol use disorder (AUD) and the relationship between the two in a national sample of women (n = 3,006), also considering possible mediating effects of major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). The original sample from the National Women's Study was generated by a multistage geographic sampling technique. The new sample was weighted to ensure representativeness of women nationally. Analysis of the data indicates that alcohol abuse was higher in women with BN, but only when the data were controlled for MDD and PTSD. Women with BN, MDD, and PTSD had similar prevalences of alcohol abuse and alcohol dependence. Statistical analyses suggested that the relationship between BN and AUDs may be indirect, and mediated by MDD and PTSD. Women with or without alcohol abuse in addiiton to BN showed no differences on most variables relating to victimization, family of origin, and eating disorders. Findings suggest that MDD and PTSD should be evaluated in women undergoing treatment for BN and/or AUDs. 39 Ref.

25. Den Bleyker, K. Dual diagnosis of posttraumatic stress disorder and substance abuse: A literature review and treatment protocol. Dissertation Abstracts International, 60(8):4215-B, 2000. (153264)

The dual diagnosis of posttraumatic stress disorder (PTSD) and substance abuse is discussed, with a focus on a treatment protocol and including a review of the literature. Therapy for clients who have been diagnosed with both PTSD and abuse of alcohol and other drugs must deal with the issues of each diagnosis as well as the issues created by the interplay between the two diagnoses. Since treatment in both areas must occur simultaneously, an integrative treatment approach is required. Topics discussed include treatment issues of each diagnosis, interaction between the two diagnoses, the therapeutic alliance, positive coping skills, self esteem, and substance abuse triggers.

26. Giaconia, R.M.; Reinherz, H.Z.; Hauf, A.C.; Paradis, A.D.; Wasserman, M.S.; Langhammer, D.M. Comorbidity of substance use and post-traumatic stress disorders in a community sample of adolescents. American Journal of Orthopsychiatry, 70(2):253-261, 2000. (154649)

The comorbidity of substance use and post-traumatic stress disorder (PTSD) was studied in a community sample of adolescents. The research sample included 384 male and female adolescents, the majority of whom were white and of working class or lower-middle class families. The current analyses draw on data from a longitudinal, community-based study that has traced the psychosocial development of a single-age cohort since age 5 in 1977. The present report focuses on data collected when the children were 18 years old in 1990. The subjects were administered structured clinical interviews to assess substance use disorder (SUD), trauma, and PTSD. Self-administered standardized questionnaires evaluated current psychosocial functioning. School records of academic and behavioral problems were also obtained. The following results of the study were seen: (1) high rates of co-occurring lifetime SUD and trauma; (2) to a lesser degree, co-occurring lifetime SUD and PTSD; (3) males were significantly more likely than females to have experienced a qualifying trauma prerequisite for PTSD; (4) males were more likely than females to meet criteria for alcohol abuse or dependence; (5) females had a fivefold greater risk of developing PTSD; and (6) no significant differences between males and females were seen in rates of co-occurring SUD and trauma/PTSD. It is concluded that multiple pathways appear to lead to this comorbidity, which is associated with psychological impairment that may have serious developmental consequences. 37 Ref.

27. Handelsman, L.; Stein, J.A.; Bernstein, D.P.; Oppenheim, S.E.; Rosenblum, A.; Magura, S. A latent variable analysis of coexisting emotional deficits in substance abusers: Alexithymia, hostility, and PTSD. Addictive Behaviors: An International Journal, 25(3):423-428, 2000. (154157)

The emotional disturbance of substance abusers is often described as an inability to identify and express feelings coupled with an excess vulnerability to experience negative affect. However, there is limited empirical support for this perspective. To validate this description, the authors first defined components of alexithymia, hostility, and posttraumatic stress disorder (PTSD) derived from established measures of each by conducting confirmatory factor analyses based on a self-report data set from a clinical sample of 253 alcoholics and drug addicts. The authors then fashioned and tested overarching latent variables representing the three aspects of emotional dysfunction (i.e., alexithymia, hostility, and PTSD) and finally tested the correlations among these overarching variables. The authors found a strong association between a factor labeled Bottled-Up Emotions and another labeled Neurotic Hostility as well as an association between PTSD and Bottled-up Emotions. The structure, magnitude, and intercorrelation of the latent variables did not depend on the type of psychoactive substance abused. These results support the view that features of alexithymia and hostility coexist in substance abusers and that this joint deficit is part of a broad disturbance across multiple psychological domains including pathological response to traumatic stress. 17 Ref.
Copyright 2000 - Elsevier Science Ltd.

28. Kessler, R.C. Posttraumatic stress disorder: the burden to the individual and to society. Journal of Clinical Psychiatry, 61(suppl.5)4-14, 2000. (153824)

Little is known about the total population prevalence and societal costs of post-traumatic stress disorder (PTSD); this report reviews relevant literature on these topics. A literature search of computerized databases for published reports on trauma and PTSD was conducted. This literature was reviewed to find data on general population exposure to trauma, conditional risk of PTSD among those exposed to trauma both in focused samples of trauma victims and in general population samples, and the adverse consequences of PTSD. PTSD was found to be a common disorder that often has a duration of many years and is frequently associated with exposure to multiple traumas. The impairment associated with PTSD in U.S. samples, where the majority of research on these consequences has been carried out, is comparable to, or greater than, that of other seriously impairing mental disorders. Risk of suicide attempts is particularly high among people with PTSD. The odds ratio [OR] for alcohol abuse is 2.0 for men (95 percent confidence interval [CI], 1.3-2.9) and 2.1 for women, and the OR for alcohol dependence is 3.0 for men (CI, 2.1-4.2) and 3.2 for women (CI, 2.5-4.2). Available evidence suggests that the prevalence of PTSD and the adverse emotional and psychological consequences of PTSD are much greater in the many countries around the world that are in the midst of armed conflicts involving political, racial, or ethnic violence. In conclusion, PTSD is a highly prevalent and impairing condition. Only a minority of people with PTSD obtain treatment. 74 Ref.

29. Kosten, T.R.; Fontana, A.; Sernyak, M.J.; Rosenheck, R. Benzodiazepine use in posttraumatic stress disorder among veterans with substance abuse. Journal of Nervous and Mental Disease, 188(7):454-459, 2000. (155560)

Veterans with posttraumatic stress disorder (PTSD) and substance abuse may abuse benzodiazepines and develop violent dyscontrol when using them. A total of 370 veterans were compared by substance abuse diagnosis (50 percent), benzodiazepine use (36 percent), and their interaction on 1-year outcomes after inpatient discharge. Substance abusers were less likely to be prescribed benzodiazepines (26 percent versus 45 percent). No outcome showed a differential worsening by substance abuse or benzodiazepines, although some baseline differences were noted. Outpatient health care utilization was lower in benzodiazepine users (47 versus 33 visits). Among PTSD patients with comorbid substance abuse, benzodiazepine treatment was not associated with adverse effects on outcome, but it may reduce health care utilization. 31 Ref.

30. Lipschitz, D.S.; Grilo, C.M.; Fehon, D.; McGlashan, T.M.; Southwick, S.M. Gender differences in the associations between posttraumatic stress symptoms and problematic substance use in psychiatric inpatient adolescents. Journal of Nervous and Mental Disease, 188(6):349-356, 2000. (154829)

This study examined gender differences in the associations between posttraumatic stress symptoms and problematic substance use in psychiatrically hospitalized adolescents. Ninety-five adolescent inpatients (38 boys, 57 girls) were systematically evaluated with a battery of psychometrically well-established self-report measures to assess trauma exposure, posttraumatic stress symptoms, problematic alcohol and drug use, and internalizing and externalizing psychopathology. Twenty-three percent (N=22) of patients met DSM-IV-based symptom criteria for PTSD, and 37 percent (N=35) and 34 percent (N=32) of patients endorsed problematic levels of drug and alcohol use, respectively. Posttraumatic stress symptoms were significantly associated with problematic drug and alcohol use in girls but not in boys. There were no significant gender differences in posttraumatic stress symptoms and/or problematic substance use, to account for the gender differences in the association between PTSD and substance use. The authors's findings suggest that the link between substance abuse and PTSD may be especially salient for female adolescents. 43 Ref.
Copyright 2000 - Williams & Wilkins

31. Ortega, A.N.; Rosenheck, R. Posttraumatic stress disorder among Hispanic Vietnam veterans. American Journal of Psychiatry, 157(4):615-619, 2000. (154208)

Posttraumatic stress disorder (PTSD) in Hispanics who served in the Vietnam War was studied. The authors conducted a secondary data analysis of the National Vietnam Readjustment Study. This study, which is a national epidemiologic study completed in 1988, included a representative sample of 1,195 Vietnam-era veterans. The following results were found after adjustment for premilitary and military experiences: (1) significantly more severe PTSD symptoms in Hispanic, particularly Puerto Rican, veterans; (2) a higher probability of experiencing PTSD in Hispanic than in nonminority veterans; (3) no greater risk for other mental disorders in Hispanic veterans; (4) no relationship between acculturation and increased risk for PTSD in Hispanics; (5) despite more severe symptoms, no greater functional impairment in Hispanics than in non-Hispanics; (6) lower odds for alcohol abuse or dependence in black veterans than in white veterans; (7) higher odds for alcohol abuse or dependence for Puerto Rican veterans; and (8) higher odds for Mexican American veterans for alcohol abuse or dependence and any DIS disorder except PTSD. It is concluded that Hispanic Vietnam veterans, particularly Puerto Rican Vietnam veterans, have a higher risk for PTSD and experience more severe PTSD symptoms than non-Hispanic white Vietnam veterans. These differences are not explained by exposure to stressors or acculturation. It is suggested that the difference in symptoms may reflect features of expressive style rather than different levels of illness. 24 Ref.

32. Ouimette, P.C.; Moos, R.H.; Finney, J.W. Two-year mental health service use and course of remission in patients with substance use and posttraumatic stress disorders. Journal of Studies on Alcohol, 61(2):247-253, 2000. (155422)

Comorbid diagnoses of substance abuse/dependence and posttraumatic stress disorder (SUD-PTSD) adversely affect substance abuse patients' treatment outcomes. This study examines the association between outpatient PTSD treatment and the long-term course of SUD-PTSD patients. Male substance abuse/dependence patients (N = 125) with a comorbid diagnosis of PTSD completed 1- and 2-year follow-ups. Based on these reports, 26 patients were stably remitted from substance abuse, 39 were partially remitted and 60 were not remitted at either follow-up. These three groups were compared on mental health service use indices gathered from patients' self-reports of inpatient treatment and nationwide Veterans Affairs (VA) databases abstracting outpatient visits. SUD-PTSD patients who attended more outpatient substance abuse, psychiatric and PTSD services in the first year following treatment (and cumulatively over the 2-year follow-up) were more likely to maintain a stable course of remission from substance use in the 2 years following inpatient SUD treatment. When the three types of sessions were examined in regression analyses, PTSD sessions in the second year and the total number of PTSD sessions over the 2 years following the index treatment episode emerged as the most significant predictors of remission. Self-help group participation was also associated with a remitted course for SUD-PTSD patients. These data suggest that PTSD-focused treatment services are essential for substance abuse/dependence patients with PTSD. 19 Ref.
Copyright 2000 - Alcohol Research Documentation, Inc.

33. Robert, O. Serdulokori szuicid veszelyeztetettseg, a trauma es a szuloi alkoholfogyasztas (Adolescent suicide, trauma, parental alcohol abuse) Szenvedely-Betegsegek: Addictologia Hungarica, 8(2): 114-120, 2000. (155331)

The author summarizes the scientific concepts regarding to the phenomenon of adolescent suicide. The empirical findings underline the correlation between parental substance abuse, child abuse, and adolescent suicide. The author presents the results of a research survey, a screening study, tending to show a relationship between alcohol consumption of parents and suicidal ideation in their children. The survey sample contains 200 high school students at age 18. The author applied a modified Alcohol Use Disorders Identification Test (AUDIT) to assess parental drinking patterns and a Los Angeles posttraumatic stress disorder (PTSD) checklist to determine the frequency and severity of PTSD symptomatology in the research subjects. The main research findings are under publication. The current article focuses on the relationship between adolescent suicidal ideation, trauma-related symptomatology, and parental drinking habits. The survey confirmed the connection between adolescent suicidal ideation and parental alcohol abuse. The symptoms of depression are most significantly correlated with suicidal ideation. 29 Ref.
Copyright 2000 - Hungarian Association of Addictologists

34. Schnurr, P.P.; Paris, A.H.; Spiro, A. Physician-diagnosed medical disorders in relation to PTSD symptoms in older male military veterans. Health Psychology, 19(1):91-97, 2000. (158881)

The association between physician-diagnosed medical disorders and combat-related posttraumatic stress disorder (PTSD) symptoms was examined in 605 male combat veterans of World War II and the Korean conflict. Physician exams were performed at periodic intervals beginning in the 1960s. PTSD symptoms were assessed in 1990. Cox regression was used to examine the onset of each of 12 disorder categories as a function of PTSD symptoms, controlling for age, smoking, alcohol use, and body weight at study entry. Even with control for these factors, PTSD symptoms were associated with increased onset of arterial, lower gastrointestinal, dermatologic, and musculoskeletal disorders. There was only week evidence that PTSD mediated the effects of combat exposure on morbidity. Possible mediators of the relationship between combat exposure, PTSD, and physical morbidity are discussed. 30 Ref.

35. Semple, W.E.; Goyer, P.F.; McCormick, R.; Donovan, B.; Muzic, R.F. Jr.; Rugle, L.; McCutcheon, K.; Lewis, C.; Liebling, D.; Kowaliw, S.; Vapenik, K.; Semple, M.A.; Flener, C.R.; Schulz, S.C. Higher brain flow at amygdala and lower frontal cortex blood flow in PTSD patients with comorbid cocaine and alcohol abuse compared with normals. Psychiatry, 63(1):65-74, 2000. (154630)

Brain blood flow at the amygdala and lower frontal cortex in post-traumatic stress disorder (PTSD) patients who abused both cocaine and alcohol was compared to that of normal subjects. The research sample included seven male patients and six male normal controls. Positron emission tomography (PET) scans with super 15 O-butanol were used to compare the regional cerebral blood flow (rCBF) during rest and during an auditory continuous performance task. The study results indicated that the PTSD patients had higher rCBF in the right amygdala and left parahippocampal gyrus than did normals during the performance task. The normal subjects had higher rCBF at the frontal cortex during the resting scan as well as during the performance task. Several suggestions are made: (1) the role of the amygdala in attention and fear conditioning suggests that increased amygdala rCBF may be related to the clinical features of PTSD; (2) cocaine use may be associated with increased amygdala rCBF in PTSD patients; and (3) amygdala and frontal cortex attention system components may be reciprocally related with a disturbed relative contribution to the processing of neutral stimuli in these PTSD patients. 30 Ref.

36. Semple, W.E.; Goyer, P.F.; McCormick, R.; Donovan, B.; Muzic, R.F.; Rugle, L.; McCutcheon, K.; Lewis, C.; Liebling, D.; Kowaliw, S.; Vapenik, K.; Semple, M.A.; Flener, C.R.; Schulz, S.C. Higher brain blood flow at amygdala and lower frontal cortex blood flow in PTSD patients with comorbid cocaine and alcohol abuse compared with normals. Psychiatry, 63(1):65-74, 2000. (156911)

Brain blood flow at the amygdala and lower frontal cortex in post-traumatic stress disorder (PTSD) patients with comorbid cocaine and alcohol abuse (CA-PTSD) was compared to that of normal subjects. Positron emission tomography (PET) scans with super 15 O-butanol were used to compare regional cerebral blood flow (rCBF) between the groups during rest and during an auditory continuous performance task (ACPT). The following results of the study were seen: (1) higher rCBF in CA-PTSD patients in right amygdala and left parahippocampal gyrus than normals during the ACPT; (2) higher rCBF in normal subjects at the frontal cortex during the resting scan and during the ACPT; and (3) a suggestion that increased amygdala rCBF may be related to clinical features of PTSD. It is concluded that cocaine use may be associated with increased amygdala rCBF in PTSD patients, that amygdala and frontal cortex attention system components may be reciprocally related, and that their relative contributions to the processing of neutral stimuli perturbed in CA-PTSD. 29 Ref.

37. Steele, C.T. Providing clinical treatment to substance abusing trauma survivors. Alcoholism Treatment Quarterly, 18(3):71-82, 2000. (157595)

Research and clinical observation have shown that women seeking substance abuse treatment are more likely to be victims of interpersonal violence than those in the general population. Such research clearly marks a close association between early interpersonal violence and subsequent development of substance abuse and dependency. Survivors of violence are likely to become dependent upon chemicals as a way to reduce tension rather than learn other ways of managing stress. To produce successful treatment outcomes, both disorders must be treated together. Some of the theoretical models that help to explain the causes, consequences, and clinical implications of interpersonal abuse are described. A classification system is described to understand the timing issues involved for treatment planning. Descriptions of a developmental model of treatment for unresolved PTSD and addictions is offered. Concluded remarks include notations from the author's experience in working with this dual model and diagnosis. 18 Ref.
Copyright 2000 - The Haworth Press, Inc.

38. Stewart, S.H.; Conrod, P.J.; Samoluk, S.B.; Pihl, R.O.; Dongier, M. Posttraumatic stress disorder symptoms and situation-specific drinking in women substance abusers. Alcoholism Treatment Quarterly, 18(3):31-48, 2000. (157592)

Posttraumatic stress disorder (PTSD) and alcohol use disorders are frequently comorbid conditions. Alcohol use may serve a "negatively-reinforcing" function among traumatized individuals with PTSD. The heavy drinking behavior of those with PTSD should be relatively situation-specific (i.e., more frequent in "negative" discriminative contexts than in other types of contexts). To test this "situation-specificity" hypothesis, the PTSD Symptom Self-Report Scale, and the 42-item Inventory of Drinking Situations were administered to 294 adult women substance abusers. At the level of specific drinking situations, PTSD symptoms were significantly positively correlated with frequency of heavy drinking in the negative situations of Unpleasant Emotions, Physical Discomfort, and Conflict with Others. PTSD symptoms were unrelated to frequency of heavy drinking in the positive situations of Pleasant Times with Others and Social Pressure to Drink, or in the temptation situations of Testing Personal Control and Urges and Temptations. Additionally, PTSD symptoms were significantly negatively correlated with frequency of heavy drinking in positive situations involving Pleasant Emotions. Anxiety sensitivity (fear of anxiety-related sensations) but not Neuroticism (tendency to experience negative affect), mediated the observed associations between PTSD symptoms and situation-specific heavy drinking in negative contexts in general, and Conflict with Others and Physical Discomfort situations in particular. 37 Ref.
Copyright 2000 - The Haworth Press, Inc.

39. Triffleman, E. Gender differences in a controlled pilot study of psychosocial treatments in substance dependent patients with post-traumatic stress disorder: Design considerations and outcomes. Alcoholism Treatment Quarterly, 18(3):113-126, 2000. (157598)

Co-existing substance dependence and post-traumatic stress disorder (PTSD) is a common comorbidity, lacking a standard treatment. This paper reports gender-related findings from an N=19 controlled clinical trial using methadone maintained and primary-cocaine abusing subjects. Treatments contrasted were Substance Dependency-Post-Traumatic Stress Disorder Therapy (SDPT), an integrated, two-phase cognitive-behavioral therapy which uses existing treatment techniques including coping skills treatment for addictions, stress inoculation therapy and in vivo exposure; and Twelve-Step Facilitation Therapy. Female subjects at baseline differed from males in having higher Addiction Severity Index (ASI), psychiatric composite severity scores. No differences were seen between genders at end of treatment or follow-up. Improvement was observed across the sample in current PTSD severity, number of PTSD symptoms, ASI psychiatric, drug composite severity scores and number of days using substances in the past 30 days. The absence of gender-based differences in baseline differences and treatment outcomes suggests that recruitment, assessment and treatment processes were applied equally and were equally effective to both genders. 42 Ref.
Copyright 2000 - The Haworth Press, Inc.

40. Xian, H.; Chantarujikapong, S.I.; Scherrer, J.F.; Eisen, S.A.; Lyons, M.J.; Goldberg, J.; Tsuang, M.; True, W.R. Genetic and environmental influences on posttraumatic stress disorder, alcohol and drug dependence in twin pairs. Drug and Alcohol Dependence, 60(3):95-102, 2000. (157578)

The effects of genetic and environmental factors on posttraumatic stress disorder (PTSD), alcohol dependence (AD) and drug dependence (DD) were evaluated in a twin study. The research sample included 3304 monozygotic and dizygotic male-male twin pair members of the Vietnam Era Twin Registry. The subjects participated in a 1992 telephone administration of the Diagnostic Interview Schedule Version 3 Revised (DIS-3R) and genetic model fitting was performed. The following results of the study were seen: (1) liability for PTSD with a 15.3 percent genetic contribution common to AD and DD and a 20 percent genetic contribution specific to PTSD; (2) a risk for AD due in part to a 55.7 percent genetic contribution common to PTSD and DD; (3) genetic influences common to PTSD and AD accounting for 25.2 percent of the total risk for DD; (4) family environmental influence accounting for 33.9 percent of the total variance in risk for DD; and (5) remaining variance for all three disorders due to unique environmental factors that are both common and specific to each phenotype. It is suggested that PTSD, AD and DD each have etiologically distinct components and also significant genetic and unique environmental factors in common. 48 Ref.

41. Acierno, R.; Resnick, H.; Kilpatrick, D.G.; Saunders, B.; Best, C.L. Risk factors for rape, physical assault, and posttraumatic stress disorder in women: Examination of differential multivariate relationships. Journal of Anxiety Disorders, 13(6):541-563, 1999. (154768)

Data from the National Women's Study, a 2-year, three-wave longitudinal study of a national probability sample of 3,006 adult women, were used to identify separate risk factors for rape and physical assault, and to identify separate risk factors associated with posttraumatic stress disorder (PTSD) after rape or physical assault. Unlike previous studies, this investigation prospectively examined risk factors at the multivariate level rather than the univariate level. Women's risk of being raped was increased by past victimization, young age, and a diagnosis of active PTSD. In contrast, risk of physical assault was associated with past victimization, belonging to an ethnic minority, active depression, and drug use. Risk factors for PTSD after rape included history of depression, alcohol abuse, or injury experienced during the rape. Risk factors for PTSD after physical assault included only a history of depression and lower educational level. 34 Ref.

42. Brown, P.J.; Ouimette, P.C. Introduction to the special section on substance use disorder and posttraumatic stress disorder comorbidity. Psychology of Addictive Behaviors, 13(2):75-77, 1999. (149383)

A body of two complementary, albeit independent, research literatures has emerged that documents a strong relationship between substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) in both community and clinical samples. Research on the concomitants and consequences of PTSD has found that substance abuse is a frequent comorbid problem among individuals diagnosed with PTSD. Researchers from the substance abuse field are now investigating the interrelationship between PTSD and SUDs and finding that PTSD has a notable effect on SUD course and treatment response. Here, a brief summary of the prevalence of SUD- PTSD comorbidity is provided and the five articles of the special section are introduced. 13 Ref.
Copyright 1999 - Educational Publishing Foundation

43. Brown, P.J.; Stout, R.L.; Mueller, T. Substance use disorder and posttraumatic stress disorder comorbidity: Addiction and psychiatric treatment rates. Psychology of Addictive Behaviors, 13(2):115-122, 1999. (149388)

This study compares substance use disorder (SUD) patients with and without a comorbid diagnosis of posttraumatic stress disorder (PTSD) on their use of addiction and psychiatric services over the 6-month period before an inpatient substance abuse admission. Compared with non-PTSD patients, PTSD patients had a greater number of hospital overnights for addiction treatment. Given no significant between-groups differences on any substance use indexes, PTSD patients apparently overuse costly inpatient addiction services. Despite their greater rates of psychiatric comorbidity, PTSD patients did not receive treatment for psychiatric problems at greater rates than did non-PTSD patients. Among PTSD patients, use of PTSD treatment was low. Assessment of psychiatric comorbidity and referral to treatment targeting co-occurring PTSD and other disorders are suggested as possible ways to reduce the high treatment costs associated with SUD-PTSD comorbidity. 23 Ref.
Copyright 1999 - Educational Publishing Foundation

44. Creamer, M.; Morris, P.; Biddle, D.; Elliott, P. Treatment outcomes in Australian veterans with combat-related posttraumatic stress disorder: A cause for cautious optimism? Journal of Traumatic Stress, 12(4):545-558, 1999. (153704)

Treatment outcome was studied in a cohort of Australian veterans with combat-related posttraumatic stress disorder (PTSD). The research sample included 419 Australian Vietnam veterans who were consecutive admissions to accredited PTSD treatment programs. The study protocol assessed PTSD, comorbidity, and social functioning at admission and at follow-up 3 and 9 months after the completion of treatment. A battery of questionnaires relating to demographic characteristics, military history, and use of health services was administered. The results of the treatment showed overall improvements in core PTSD symptoms, anxiety, depression, alcohol abuse, social dysfunction, and anger. It was noted that the most significant although small change occurred between admission and the 3-month follow-up assessment. These changes were, however, maintained at the 9-month follow-up assessment. Patients and their partners indicated that they perceived the improvement and that they were satisfied with the treatment, although the improvement was variable and for most of the patients significant pathology remained following treatment. It is noted that the results of treatment in these cases support findings of the chronicity and severity of PTSD and highlights the need for ongoing case management and support for these patients. 29 Ref.

45. Dansky, B.S.; Byrne, C.A.; Brady, K.T. Intimate violence and post-traumatic stress disorder among individuals with cocaine dependence. American Journal of Drug and Alcohol Abuse, 25(2):257-268, 1999. (148748)

Intimate physical assault and post-traumatic stress disorder (PTSD) were assessed in a sample of 91 adults seeking treatment for cocaine dependence. Physical assault included self-report of aggravated assault with a weapon, aggravated assault without a weapon, and simple assault. PTSD was assessed with a structured interview. Overall, 85.7 percent of the participants reported having been physically assaulted at least once during their lifetime. Slightly less than half of these individuals (46.2 percent) reported physical assault by an intimate partner. Close to half also met criteria for PTSD at some point in their lives. Women were more likely than men to be physically assaulted by an intimate partner and to report PTSD. Men who experienced physical assault by an intimate were more likely to report PTSD than men assaulted by others. Male victims of intimate violence had higher scores on certain subscales measuring addiction severity than male victims assaulted by others. Findings suggest careful assessment of intimate violence is essential given its high prevalence among cocaine-dependent women and men and its association with PTSD. 27 Ref.
Copyright 1999 - Marcel Dekker, Inc.

46. David, D.; Kutcher, G.S.; Jackson, E.I.; Mellman, T.A. Psychotic symptoms in combat-related posttraumatic stress disorder. Journal of Clinical Psychiatry, 60(1):29-32, 1999. (147043)

Posttraumatic stress disorder (PTSD) is known often to be comorbid with other anxiety, mood, and substance use disorders. Psychotic symptoms have also been noted in PTSD and have been reported to be more common in Hispanic veterans. This study assessed DSM-III-R psychotic symptoms in patients with a primary diagnosis of combat-related PTSD and determine the associations of those symptoms with psychiatric comorbidity and ethnicity. 53 male combat veterans admitted to a PTSD rehabilitation unit were assessed for psychotic symptoms and Axis I disorders. 91 percent were Vietnam veterans; 72 percent were white, 17 percent were Hispanic, and 11 percent were black. Associations between psychotic symptoms and comorbid depression, substance use disorders, and minority status were compared by chi-square analyses; associations between psychotic symptoms and both PTSD and dissociative symptom severity were compared by t-test analysis. 40 percent of patients reported one or more psychotic symptoms in the preceding six months which typically featured auditory hallucinations, reflected combat-themes and guilt, were nonbizarre, and were not usually associated with formal thought disorder or flat or inappropriate affect. Psychotic symptoms were significantly associated with current major depression, but not with alcohol or drug abuse or with self-rated PTSD and dissociation severity. Psychotic symptoms and current major depression were more common in black and Hispanic veterans than white veterans. Psychotic symptoms can be a feature of combat-related PTSD and appear to be associated with major depression; association with minority status may be a function of comorbidity. 7 Ref.
Copyright 1999 - Physicians Postgraduate Press, Inc.

47. Davis, T.M.; Wood, P.S. Substance abuse and sexual trauma in a female veteran population. Journal of Substance Abuse Treatment, 16(2):123-127, 1999. (147911)

Substance abuse and sexual trauma were studied in a population of female veterans (n=28) who participated in outpatient treatment for post-traumatic stress disorder (PTSD) and/or substance abuse in a veterans' hospital. The patients underwent a diagnostic interview and chart review was conducted by a licensed psychologist. The results of the study indicate a high incidence of PTSD related to sexual trauma and a high incidence of substance abuse by those who represented questing help for sexual trauma in this substance-abusing population. The subjects were at high risk for substance use within the last year, with alcohol the most common primary substance, followed by marijuana, cocaine, and narcotic pain medications. The results of the study suggested that after a period of six months, there was a clinically significant trend for alcohol use to decline below the cut-off level of problematic use. The majority of subjects reporting experiencing some sexual assault maintained that the assault continued to affect them, although the average time since last assault was as long past as 16 years previous. Finally, the majority of the subjects had been subjected to some form of sexual assault or harassment during their military service. Suggestions for prevention of sexual harassment in the military is discussed. 35 Ref.

48. Gelernter, J.; Southwick, S.; Goodson, S.; Morgan, A.; Nagy, L.; Charney, D.S. No association between D2 dopamine receptor (DRD2) "A" system alleles, or DRD2 haplotypes, and posttraumatic stress disorder. Biological Psychiatry, 45(5):620-625, 1999. (155827)

Some research studies have indicated that there may be an association between marker alleles of the D sub 2 dopamine receptor gene (DRD2) and alleles associated with alcoholism and other disorders such as posttraumatic stress disorder (PTSD). This current study examined the allele frequency of the DRD2 TaqI "A," "B," and "D" system markers in 52 European-Americans with a diagnoses of PTSD. Results of these analyses did not support an allelic association between DRD2 TaqI "A" system alleles and PTSD. Haplotype frequencies, including data from three polymorphic DRD2 loci, did not find any difference in haplotype frequency between PTSD and control subjects. Most of the PTSD subjects had comorbid alcohol or substance abuse, or both; the last of increased DRD2 TaqI "A" or "B1" allele frequency in a largely substance-dependent group is consistent with previous data. The largest difference in the phenotypes measured (PTSD in this case) should be seen in a comparison of opposite homozygotes, regardless of whether the polymorphism assessed is directly responsible for the phenotypic effect of if it is a marker for it. It was concluded that the present results do not confirm that genetic variation at the DRD2 locus influences risk for PTSD. 37 Ref.

49. Gruden, V.; Gruden, V., Jr.; Gruden, Z. PTSD and alcoholism. Collegium Antropologicum, 23(2):607-610, 1999. (151921)

The relationships between posttraumatic stress disorder (PTSD) and alcoholism are discussed, with a focus on patients seen during the Croatian wars. It is noted that PTSD is the development of symptoms after an extreme stress and is thought to be related to a failure to find an emotional solution to the closeness of death. PTSD does not belong to problems of everyday stress, but is indicative of mind and body responses that are known to be extreme. Alcoholism is understood as the loss of control over alcoholic beverages. The results of the study are as follows: (1) 52.20 percent of PTSD respondents used to drink either moderately or excessively during the war, although some of their alcoholism may originate in the prewar period; (2) 22.92 percent of PTSD respondents now consume more alcohol than they used to during the prewar period; (3) PTSD is frequently associated with chronic alcoholism as a kind of self-medication or self-healing; (4) the problems of alcoholism are particularly difficult for the families of PTSD patients, whose quality of life is already poor; (5) treatment of patients with PTSD and alcoholism is demanding; (6) treatment success will be greater if PTSD and alcoholism are treated together; (7) treatment purpose is a re-conceptualization of self; and (8) treatment objective is to build up the ego and self-protecting functions. It is noted that the integrity of the therapist's self is a basic prerequisite for successful therapy of associated PTSD and alcoholism. 21 Ref.

50. Howard, W.T.; Loberiza, F.R.; Pfohl, B.M.; Thorne, P.S.; Magpantay, R.L.; Woolson, R.F. Initial results, reliability, and validity of a mental health survey of Mount Pinatubo disaster victims. Journal of Nervous and Mental Disease, 187(11):661-672, 1999. (152737)

This report presents the initial results of a mental health survey of 351 tribal and non-tribal Mount Pinatubo disaster victims 6 years after they were displaced following the volcanic eruption in the Philippines on June 12, 1991. Mental illness prevalence rates in both Filipino ethnic groups were comparable to those found in a U.S. study using the same assessment instrument. Post-traumatic stress disorder (PTSD) and major depression were the two most frequent diagnoses. Diagnostic test-retest interviewer agreement was good for probable alcohol abuse and any mood disorder but was reduced for any anxiety disorder and separately evaluated PTSD. Diagnostic test-retest agreement was good among typical Filipinos but was reduced among tribal aborigines. Internal consistency of the PTSD rating scale was high within and across both ethnic groups, including total scale and DSM-IV Criteria B, C, and D sub-scales. With the exception of probable alcohol abuse, construct and criterion validity was demonstrated among both tribal and non-tribal Filipinos for all classes of psychiatric disorders by comparing diagnostic results with respondents' views of their physical and mental health and level of functional impairment. Overall, DSM-IV mood, anxiety, alcohol use, and PTSDs with adequate reliability and construct and criterion validity were made in this culturally diverse, non-Western, disaster victim population. However, test-retest diagnostic agreement was reduced for anxiety disorders and among aboriginal respondents, and validity was not demonstrated for probable alcohol abuse. 26 Ref.
Copyright 1999 - Williams & Wilkins

51. Linares, L.O.; Groves, B.M.; Greenberg, J.; Bronfman, E.; Augustyn, M.; Zuckerman, B. Restraining orders: Frequent marker of adverse maternal health. Pediatrics, 104(2 pt.1 of 2):249-257, 1999. (158152)

This study compared maternal health and child behavior in women who have filed a restraining order (RO) and those who have not, with control for differences between RO and non-RO groups in demographic background, partner characteristics, other types of past victimization, and use of alcohol and illicit drugs. A non-referred sample of mothers living in high-crime neighborhoods were interviewed, and four types of violence were coded: verbal harassment, verbal threats, physical assault, and property destruction. Outcomes for mothers were partner aggression, perception of health and bodily pain, distress symptoms, posttraumatic stress (PTS)-related symptoms, and partial posttraumatic stress disorder (PTSD) diagnosis. Child outcomes were partner aggression, behavior problems, and PTS-related symptoms. Patients (N = 160) 3.0 to 6.1 years old living in five Boston high-crime areas were drawn from a pediatric practice. Sixty-four (40 percent) of 160 mothers reported a history of filing a RO against a current boyfriend or husband, ex-boyfriend or husband, someone known, or other. Covariate analyses indicated that mothers in the RO group experienced higher current partner verbal aggression and physical violence, poorer health, and higher PTS-related symptoms than mothers in the non-RO group. More mothers in the RO group met partial lifetime PTSD diagnosis. A nonsignificant group effect was found in child outcomes. RO history may provide a marker of current partner relationship quality, maternal health, and maternal stress. 42 Ref.

52. Najavits, L.M.; Weiss, R.D.; Shaw, S.R. Clinical profile of women with posttraumatic stress disorder and substance dependence. Psychology of Addictive Behaviors, 13(2):98-104, 1999. (149386)

To assess the clinical characteristics of women with posttraumatic stress disorder (PTSD) and substance dependence, 28 women with both disorders were compared with 29 women with PTSD alone on a wide battery of lifetime and current clinical measures. The dual-diagnosis women consistently had a more severe clinical profile, including worse life conditions (e.g., physical appearance, opportunities in life), both as children and as adults; greater criminal behavior; a higher number of lifetime suicide attempts; a greater number having a sibling with a drug problem; and fewer outpatient psychiatric treatments. One discrepant finding, however, was their lower rate of major depression. Interestingly, the two groups did not differ in number or type of lifetime traumas, PTSD onset or severity, family history of substance use, coping style, functioning level, psychiatric symptoms, or sociodemographic characteristics. Treatment implications and methodological limitations are discussed. 28 Ref.
Copyright 1999 - Educational Publishing Foundation

53. North, C.S.; Nixon, S.J.; Shariat, S.; Mallonee, S.; McMillen, J.C.; Spitznagel, E.L.; Smith, E.M. Psychiatric disorders among survivors of the Oklahoma City bombing. JAMA: Journal of the American Medical Association, 282(8):755-762, 1999. (150618)

This study examined the psychiatric impact of the bombing of the Alfred P. Murrah Federal Building in Oklahoma City on survivors of the direct blast, specifically examining rates of posttraumatic stress disorder (PTSD), diagnostic comorbidity, functional impairment, and predictors of postdisaster psychopathology. Of 255 eligible adult survivors selected from a confidential registry, 182 (71 percent) were assessed by interviews approximately 6 months after the disaster, between August and December 1995. Forty-five percent of the subjects had a postdisaster psychiatric disorder and 34.3 percent had PTSD. Predictors included disaster exposure, female sex (for any postdisaster diagnosis, 55 percent versus 34 percent for men), and predisaster disorder. Onset of PTSD was swift, with 76 reporting same-day onset. The relatively uncommon avoidance and numbing symptoms virtually dictated the diagnosis of PTSD (94 percent meeting avoidance and numbing criteria had full PTSD diagnosis) and were further associated with psychiatric comorbidity, functional impairment, and treatment received. Intrusive reexperience and hyperarousal symptoms were nearly universal, but by themselves were generally unassociated with other psychopathology or functional impairment. Alcohol use disorders were comorbid in 28.7 percent with PTSD. Data suggest that a focus on avoidance and numbing symptoms could have provided an effective screening procedure for PTSD and could have identified most psychiatric cases early in the acute postdisaster period. Psychiatric comorbidity further identified those with functional disability and treatment need. The nearly universal yet distressing intrusive reexperience and hyperarousal symptoms in the majority of nonpsychiatrically ill persons maybe addressed by nonmedical interventions of reassurance and support. 36 Ref.
Copyright 1999 - American Medical Association

54. Ouimette, P.C.; Finney, J.W.; Moos, R.H. Two-year posttreatment functioning and coping of substance abuse patients with posttraumatic stress disorder. Psychology of Addictive Behaviors, 13(2):105-114, 1999. (149387)

The 2-year posttreatment course of substance abuse patients with posttraumatic stress disorder (PTSD) was examined in a multisite evaluation of Veterans Affairs substance abuse treatment. Substance abuse patients with PTSD (SUD-PTSD) were compared with patients with only substance use disorder (SUD only) and patients with other comorbid psychiatric diagnoses (SUD- PSY) on outcomes during the 2 years after treatment. SUB-PTSD patients had a poorer long-term course on substance use, psychological symptom, and psychosocial outcomes than SUD-only and SUB-PSY patients. Coping methods were examined as mediators of the effect of PTSD on substance use outcomes. Greater use of avoidance coping styles and less use of approach coping at 1 year partially accounted for the association of PTSD with 2-year substance use. Treatments that address multiple domains of functioning and focus on alternative coping strategies are recommended for this population. 23 Ref.
Copyright 1999 - Educational Publishing Foundation

55. Santina, M.R. Object relations, ego development, and affect regulation in severely addicted substance abusers. Dissertation Abstracts International, 59(11):6077-B, 1999. (148672)

This study compared 50 severely addicted substance abusers to 50 nonaddicted controls on measures of object relations, alexythymia, ego development, psychopathology, and experienced level of childhood trauma. Substance abusers were selected from residents at a therapeutic community program, and were all diagnosed with severe chemical dependency. Controls were selected from volunteers, and were screened to eliminate subjects who reported substance abuse problems. Participants completed the Bell Object Relations and Reality Testing Inventory, the Sentence Completion Test for ego development, the Toronto Alexythymia Scale, the Symptom Checklist-90, and the Childhood Trauma Questionnaire. Using univariate ANOVAs and discriminant analysis, differences between groups were evaluated, and Pearson's r was used to determine correlations. Substance abusers displayed significant difficulties in several areas: ability to recognize, differentiate and ameliorate emotions; difficulties in forming secure, gratifying, and supportive relationships; chronic feelings of alienation and isolation; and egocentricity. Addicts reported significantly greater experienced level of childhood trauma and psychopathology than did controls. Alexythymia and level of childhood trauma were highly correlated with object relational deficits across the whole sample. Ego development was weakly correlated with some measures and not correlated with others. It was concluded that object relations theories of addiction received empirical support, and that object relational deficits should be addressed in the treatment of addicts. The high level of experienced childhood trauma reported by addicts raised the issue of prevalence of post-traumatic stress disorder (PTSD). It was suggested that PTSD and dissociative symptoms may cause clients to discontinue treatment if it is too confrontational.

56. Schnurr, P.P.; Spiro, A. III Combat exposure, posttraumatic stress disorder symptoms, and health behaviors as predictors of self-reported physical health in older veterans. Journal of Nervous and Mental Disease, 187(6): 353-359, 1999. (152087)

The authors used path analysis to model the effects of combat exposure, post-traumatic stress disorder (PTSD) symptoms, and health behaviors on physical health. Participants were 921 male military veterans from the Normative Aging Study. Their mean age at time of study was 65. Measures of combat exposure, PTSD symptoms, smoking, and alcohol problems were used to predict subsequent self-reported physical health status. Both combat exposure and PTSD were correlated with poorer health. In path analysis, combat exposure had only an indirect effect on health status, through PTSD, whereas PTSD had a direct effect. Smoking had a small effect on health status but did not mediate the effects of PTSD, and alcohol was unrelated to health status. It was concluded that PTSD is an important predictor of physical health and encourage further investigation of health behaviors and other possible mediators of this relationship. 36 Ref.
Copyright 1999 - Lippincott Williams & Wilkins

57. Sharkansky, E.J.; Brief, D.J.; Peirce, J.M.; Meehan, J.C.; Mannix, L.M. Substance abuse patients with posttraumatic stress disorder (PTSD): Identifying specific triggers of substance use and their associations with PTSD symptoms. Psychology of Addictive Behaviors, 13(2):89-97, 1999. (149385)

Although individuals with comorbid posttraumatic stress disorder (PTSD) and substance use diagnoses are at heightened risk for relapse after substance abuse treatment, little is known about the specific situations in which these individuals are likely to relapse. The present study was designed to test whether a PTSD diagnosis related to substance use in specific situations in which PTSD symptoms were likely to be present. Data were gathered from inpatients (n = 86) in a substance-abuse-treatment program, and relationships between PTSD diagnosis and frequency of substance use in high-risk situations were examined. As predicted, PTSD diagnosis was related to substance use in situations involving unpleasant emotions, physical discomfort, and interpersonal conflict, but not to substance use in other situations. 40 Ref.
Copyright 1999 - Educational Publishing Foundation

58. Simpson, T.L. Exploration of the functional roles of alcohol use among women drinkers. Dissertation Abstracts International, 60(4):1873-B, 1999. (152056)

The functional roles of alcohol use by women drinkers were assessed. The research sample included 141 women, who were divided into four groups and who were assessed regarding the functional roles of their alcohol consumption and treatment histories: women with and without histories of childhood sexual abuse (CSA) seeking treatment for alcohol-related problems and nonproblem drinking women with and without histories of CSA. The functional role of alcohol consumption was assessed with regard to expectancies, reasons for drinking, and reported effects obtained from drinking. The following results of the study were seen: (1) an association between a history of CSA with an increased risk of meeting criteria for posttraumatic stress disorder (PTSD); (2) a finding that CSA status is not a marker of other current distress; (3) no finding of the expected differences in function of drinking across CSA groups; (4) an association between current PTSD status and drinking to facilitate social interaction, positive experiences, and verbal expression of feelings, and to punish oneself; (5) a finding that PTSD status is more clearly associated with drinking to cope than is CSA status; (6) slightly less treatment for substance abuse and more for psychological services for women with CSA than for the nonabused women; (7) reports of more overall treatment for those women with PTSD than for those without; (8) variation in patterns of treatment use as a function of both PTSD status and CSA status.

59. Stewart, S.H.; Conrod, P.J.; Pihl, R.O.; Dongier, M. Relations between posttraumatic stress symptom dimensions and substance dependence in a community-recruited sample of substance-abusing women. Psychology of Addictive Behaviors, 13(2):78-88, 1999. (149384)

The factor structure of posttraumatic stress disorder (PTSD) symptoms, and correlations between PTSD dimensions and substance dependence, were examined in 295 substance-abusing women. Participants completed self-report measures of trauma exposure, PTSD symptoms, and alcohol;. Dependence and underwent interviews regarding dependence on prescription anxiolytics and analgesics. Overall, PTSD symptoms were moderate in intensity, and 46 percent of the sample met criteria for PTSD diagnoses. A principal-components analysis on PTSD item scores revealed a correlated 4-factor solution (i.e., Intrusions, Arousal, Numbing, and Avoidance factors). Alcohol dependence correlated with PTSD Arousal scores, anxiolytic dependence with Arousal and Numbing scores, and analgesic dependence with Arousal, Intrusions, and Numbing scores. Implications for understanding functional relations between PTSD and substance use disorders are discussed, as are suggestions for intervention with comorbid patients. 50 Ref.
Copyright 1999 - Educational Publishing Foundation

60. Volpicelli, J.; Balaraman, G.; Hahn, J.; Wallace, H.; Bux, D. Role of uncontrollable trauma in the development of PTSD and alcohol addiction. Alcohol Research and Health, 23(4):256-262, 1999. (157609)

After a traumatic event, people often report using alcohol to relieve symptoms of anxiety, irritability, and depression. Alcohol may relieve these symptoms because drinking compensates for deficiencies in endorphin activity following a traumatic experience. Within minutes of exposure to a traumatic event there in an increase in endorphin levels in the brain. During the time of the trauma, endorphin levels remain elevated and help numb the emotional and physical pain of the trauma. However, after the trauma is over, endorphin levels gradually decrease and this may lead to a period of endorphin withdrawal that can last from hours to days. This endorphin withdrawal may produce emotional distress and contribute to other symptoms of posttraumatic stress disorder (PTSD). Because alcohol use increases endorphin activity, drinking following trauma may be used to compensate the endorphin withdrawal and thus avoid the associated emotional distress. According to this model, victims of trauma later experience adverse consequences, such as PTSD and alcohol dependence, depending on the degree to which they were able to take control of the trauma event. The irony is that while alcohol use may temporarily relieve the symptoms of stress, alcohol withdrawal intensifies them. The patient then is caught in a cycle in which he or she must continue to drink to stave off the recurrence of increasingly worse symptoms. Implications for the treatment of PTSD and alcoholism include increasing one's sense of mastery over traumatic events when exposed to trauma reminders, and the use of opioid blockers such as naltrexone. 26 Ref.

61. Weinstein, D.W. Posttraumatic stress disorder, dissociation and substance abuse as long-term sequelae in a population of adult children of substance abusers. Dissertation Abstracts International, 59(7):2723-A, 1999. (147309)

This study examined the long term effects of parental substance abuse and a history of childhood abuse in 90 adult children of substance abusers (ACOSAs). Surveys consisted of: Dissociative Experiences Scale, Michigan Alcoholism Screening Test, Drug Abuse Screening Test, Mother/Father-Short Michigan Alcoholism Screening Test, Posttraumatic Stress questionnaire, and data related to family background, substance abuse and treatment history, and demographic data. Results indicated that 79 percent believe they were emotionally abused, 43 percent believed they were physically abused, 41 percent believed they were sexually abused, and 51 percent believed they were neglected. In addition, 62 percent reported a substance history, 24 percent reported a drug abuse history, 28 percent met the diagnostic criteria for posttraumatic stress disorder (PTSD) in the past and 21 percent currently met this criteria. Findings suggest that neglect, physical abuse and sexual abuse were significantly related to PTSD, and sexual abuse was correlated with dissociative symptoms. Relationships were also discovered between a history of neglect or physical abuse and subsequent drug or alcohol abuse, and between PTSD and alcohol or drug abuse. Furthermore, the greater the number of incidents of childhood abuse the more likely were symptoms of PTSD and dissociation, and the combination of both extra and intra-familial abuse was significantly associated with PTSD. Results underscore the importance of assessing for symptoms of PTSD and dissociation in clinical populations of ACOSAs where there are extensive histories of childhood trauma since these symptoms appear to persist and may contribute to substance abuse problems, relapse, and revictimization.

62. Problems of drug dependence 1997: Proceedings of the 59th Annual Scientific Meeting. The College on Problems of Drug Dependence, Inc. NIDA Research Monograph No. 178. Rockville, MD: National Institute on Drug Abuse, 1998. 514 p. (142299)

The papers presented at the 59th Annual Scientific Meeting review and assess problems of drug dependence, covering a wide range of basic research, treatment and prevention issues. Proceedings of the following symposia and workshops are presented: (1) opioids and neuropeptides in immune function and host defenses against retroviruses; (2) the effects of prenatal cocaine exposure on CNS development; (3) drugs of abuse, impulsivity and risk taking; (4) recent progress in transporter research; (3) drug dependence and the genome; (5) current HIV and drug abuse prevention research findings and future directions; (6) approaches to the molecular genetics of drug abuse; (7) ethical laboratory research with humans; (8) novel applications of human drug discrimination of understanding effects; (9) PTSD and substance abuse; (10) HIV and the brain; (12) combined cocaine and opioid abuse; (12) making audiences AMAZED, not GLAZED - techniques of improving presentations; (13) food, sex, and drug incentives; and (13) community intervention to reduce drug abuse. The oral communications section includes laboratory and clinical studies on nicotine; marijuana, benzodiazepines, cocaine, opioids, cannabinoids, CNS stimulants, and alcohol; psychiatric comorbidity in drug dependence; prenatal and perinatal issues of drug dependence; treatment for opioid dependence and stimulant addiction; and HIV/AIDS and risk behaviors. Abstracts of presentations made during the poster sessions and annual reports for 4 projects are also included.

63. Beresford, T.P.; Arciniegas, D.B. Alcohol and the pituitary in hippocampal volume loss. Psychosomatics, 39(2):182-183, 1998. (143283)

The authors performed magnetic resonance image (MRI) based volumetric analysis of the pituitary and hippocampus on 30 individuals, age 39 to 46 years. Of this sample, 10 had alcohol dependence alone, 10 had posttraumatic stress disorder (PTSD) and alcohol dependence, and 10 were normal control subjects. Subjects with alcoholism, with or without PTSD, tended to have significantly increased pituitary size compared to normal controls. Hippocampus to pituitary volume ratios were significantly smaller in subjects with alcoholism irrespective of PTSD, than in control subjects, with the effect most pronounced in the alcoholism alone group. It is concluded that reductions in the hippocampus to pituitary ratio confirmed the hypothesis that ethanol-induced increased pituitary activity produces corticosteroids cytotoxic to the hippocampus, resulting in volume loss. Alcohol stimulates pituitary corticotrophs which seems to result in hypertrophy measurable by MRI. This result may be attributed to the effect of comorbid alcoholism. Future studies investigating hippocampal volume in alcoholic subjects should consider the mechanisms by which this effect is mediated through the pituitary.

64. Blake, D.D.; Gomez, M.H. Scale for assessing sleep hygiene: Preliminary data. Psychological Reports, 83(3):1175-1178, 1998. (147578)

No reliable measure exists for assessing the nature and scope of adherence or nonadherence to effective sleep hygiene practices. Sleep hygiene is a term that refers to practices and behaviors that promote sleep quality and quantity. Interventions typically involve adopting stimulus control and relaxation methods, reducing the intake of caffeine, and establishing effective sleep routines. Ten items showed significant reductions as a result of the therapy, including drinking alcohol or alcohol-based beverages for sleep. This report details the creation and empirical validation of the Sleep Hygiene Self-test. Fifty-two combat veterans, patients in a treatment program for post-traumatic stress disorder (PTSD), completed the 30-item self-test prior to and after their participation in 5 weeks of groups therapy for sleep hygiene. Analysis indicated good internal consistency and suitability as a pre-posttest measure. 6 Ref.
Copyright 1998 - Psychological Reports

65. Bromet, E.; Sonnega, A.; Kessler, R.C. Risk factors for DSM-III-R posttraumatic stress disorder: Findings from the National Comorbidity Survey. American Journal of Epidemiology, 147(4):353-361, 1998. (141415)

The present study examined the association of childhood risk factors with exposure to traumas and posttraumatic stress disorder (PTSD). PTSD is a unique symptom configuration after exposure to an unusual, extreme event. Data were from the US National Comorbidity Study of 5877 respondents aged 15-54 years conducted between September 1990 and February 1992. The risk factors examined were preexposure affective, anxiety, and substance use disorders; parental mental and substance use disorders; parental aggression toward the respondent and toward the other parent; and a nonconfiding relationship with the mother during childhood. Analyses were stratified by gender and adjusted for demographic variables and traumatic experiences prior to the index trauma. The occurrence of trauma was associated with many risk factors in women but few in men. Similarly, more risk factors predicted PTSD in women than in men. Overall, when respondents were grouped into broad trauma categories, an increase in the number of risk factors was associated with higher rates of PTSD. However, in analyses of the trauma subsample that adjusted for individual type trauma (e.g., rape, physical attack), only one risk factor (history of affective disorder) predicted PTSD in women, and two (history of anxiety disorder and parental mental disorder) predicted PTSD in men. The results indicate that although these risk factors have an important association with PTSD, they operate largely by predicting trauma exposure rather than by predicting the onset of disorder after exposure. 33 Ref.
Copyright 1998 - The Johns Hopkins University School of Hygiene and Public Health

66. Brown, P.J.; Stout, R.L.; Gannon-Rowley, J. Substance use disorder-PTSD comorbidity: Patients' perceptions of symptom interplay and treatment issues. Journal of Substance Abuse Treatment, 15(5):445-448, 1998. (145383)

Substance use disorder (SUD) and concurrent post-traumatic stress disorder (PTSD) were studied, with a focus on patients' perceptions of symptom interplay and issues of treatment. The research sample included 42 patients with both an SUD and PTSD. The patients were administered two diagnostic interviews, the Clinician Administered PTSD scale and the Structured Clinical Interview for DSM-IV, and completed a questionnaire. The results of the study indicated that the patients perceived the two disorders to be functionally related, with one improving or worsening as the other improved or worsened. In addition, the patients preferred simultaneous treatment of both disorders, although the majority of the patients were never referred for PTSD treatment. Of those who were referred, three quarters complied with treatment, suggesting that counselors' recommendations can overcome the fears and concerns of most patients. The main reason for lack of patient follow-through with referral to PTSD treatment was found to be lack of trust. It is suggested that preliminary discussion of trust issues, along with other treatment concerns, may improve the follow-through rates. 17 Ref.

67. Chilcoat, H.D.; Breslau, N. Investigations of causal pathways between PTSD and drug use disorders. Addictive Behaviors: An International Journal, 23(6):827-840, 1998. (145907)

Although numerous studies have demonstrated an association between post-traumatic stress disorder (PTSD) and substance use disorders, little is known about the causal nature of this relationship. In this article, the authors put forth and test major causal hypotheses. Specific hypotheses to be tested include self-medication of PTSD symptoms, substance users' high risk of exposure to traumatic events, and drug users' increased susceptibility to PTSD following a traumatic exposure. The authors also examine the possibility of an indirect pathway linking drug use disorders and PTSD via a shared vulnerability. Evidence for these causal hypotheses are evaluated using Hill's criteria for causal inference: strength, consistency, specificity, temporality, gradient, plausibility, coherence, experimental evidence, and analogy. Data analytic strategies are presented that exploit information about the temporal order of PTSD and drug use disorders to shed light on their causal relationship. Finally, findings are presented on the PTSD/drug use disorder association from an epidemiologic study of young adults. 30 Ref.
Copyright 1998 - Elsevier Science, Ltd.

68. Dansky, B.S.; Brady, K.T.; Saladin, M.E. Untreated symptoms of PTSD among cocaine-dependent individuals: Changes over time. Journal of Substance Abuse Treatment, 15(6):499-504, 1998. (145923)

The symptomatology of post-traumatic stress disorder (PTSD) in 34 cocaine-dependent patients was studied over a 36-month period. Their treatment, which was pharmacological with the use of carbamazepine, targeted their cocaine use and depression, but not PTSD. The following results of the study were seen: (1) significant improvements in PTSD symptoms on global measures of PTSD; (2) no improvement on the Impact of Events Intrusion subscale; (3) significant improvement in drug use severity; and (4) a finding that subjects had been re-victimized over the time period of the study. It is suggested that careful evaluation of intrusive symptoms may be important when diagnosing PTSD in individuals with substance use disorders and repeated assessment of traumatic experiences may be necessary when studying individuals over time.39 Ref.

69. Engdahl, B.; Dikel, T.N.; Eberly, R.; Blank, A. Jr. Comorbidity and course of psychiatric disorders in a community sample of former prisoners of war. American Journal of Psychiatry, 155(12):1740-1745, 1998. (146407)

The authors assessed DSM-III-R disorders among American former prisoners of war. Comorbidity, time of onset, and the relationship of trauma severity to complicated versus uncomplicated posttraumatic stress disorder (PTSD) were examined. A community sample (N=262) of men exposed to combat and imprisonment was assessed by clinicians using the Structured Clinical Interview for DSM-III-R The rates of comorbidity among the men with PTSD were lower than rates from community samples assessed by lay interviewers. Over one-third of the cases of lifetime PTSD were uncomplicated by another axis I disorder; over one-half of the cases of current PTSD were uncomplicated. PTSD almost always emerged soon after exposure to trauma. Lifetime PTSD was associated with increased risk of lifetime panic disorder, major depression, alcohol abuse/dependence, and social phobia. Current PTSD was associated with increased risk of current panic disorder, dysthymia, social phobia, major depression, and generalized anxiety disorder. Relative to PTSD, the onset of the comorbid disorders was as follows: major depression, predominantly secondary; alcohol abuse/dependence and agoraphobia, predominantly concurrent (same year); social phobia, equal proportions primary and concurrent; and panic disorder, equal proportions concurrent and secondary. Trauma exposure was comparable in the subjects with complicated and uncomplicated PTSD. The types of comorbid diagnoses and their patterns of onset were comparable to the diagnoses and patterns observed in other community samples. The findings support the validity of the PTSD construct; PTSD can be distinguished from comorbid disorders. Uncomplicated PTSD may be more common than previous studies suggest, particularly in clinician-assessed subjects exposed to severe trauma. 35 Ref.
Copyright 1998 - American Psychiatric Association. Abstract reprinted by permission.

70. Epstein, J.N.; Saunders, B.E.; Kilpatrick, D.G.; Resnick, H.S. PTSD as a mediator between childhood rape and alcohol use in adult women. Child Abuse & Neglect, 22(3):223-234, 1998. (144018)

This study examined post-traumatic stress disorder (PTSD) symptomatology as a possible cause of emotional distress leading to alcohol abuse in women who were raped as children. A national probability sample of adult women was selected and interviewed on two occasions a year apart to obtain data on history of rape during childhood, lifetime symptoms of PTSD, and lifetime alcohol use. The mediating role of PTSD in alcohol abuse subsequent to childhood rape was evaluated by path analysis. The number of alcohol abuse symptoms was doubled in women with a history of childhood rape. Path analysis and cross-validation revealed significant pathways between childhood rape and PTSD symptoms and between PTSD symptoms and alcohol use. Thus PTSD symptomatology may be a variable that affects alcohol abuse patterns in women who were victims of sexual abuse during childhood. 34 Ref.

71. Farley, M.; Barkan, H. Prostitution, violence, and posttraumatic stress disorder. Women and Health, 27(3):37-49, 1998. (144247)

One hundred and thirty people working as prostitutes in San Francisco were interviewed regarding the extent of violence in their lives and symptoms of posttraumatic stress disorder (PTSD). Fifty-seven percent reported that they had been sexually assaulted as children and 49 percent reported that they had been physically assaulted as children. As adults in prostitution, 82 percent had been physically assaulted; 83 percent had been threatened with a weapon; 68 percent had been raped while working as prostitutes; and 84 percent reported current or past homelessness. A drug abuse problem was reported by 75 percent and an alcohol abuse problem by 27 percent of respondents. This study differentiated the types of like time violence as childhood sexual assault; childhood physical abuse; rape in prostitution; and other (non-rape) physical assault in prostitution. PTSD severity was significantly associated with the total number of types of lifetime violence (r = .21, p = .02); with childhood physical abuse (t = 2.97, p = .004); rape in adult prostitution (Student's t = 2.77, p - .01); and the total number of times raped in prostitution (Kruskal-Wallace chi square = 13.51, p = .01). Of the 130 people interviewed, 68 percent met DSM III-R criteria for a diagnosis of PTSD. Eighty-eight percent of these respondents stated that they wanted to leave prostitution, and described what they needed in order to escape. 31 Ref.
Copyright 1998 - The Haworth Press, Inc.

72. Goisman, R.M.; Allsworth, J.; Rogers, M.P.; Warshaw, M.G.; Goldenberg, I.; Vasile, R.G.; Rodriguez-Villa, F.; Mallya, G.; Keller, M.B. Simple phobia as a comorbid anxiety disorder. Depression and Anxiety, 7(3):105-112, 1998. (148357)

After a brief review of relevant recent literature, the authors report on descriptive and clinical characteristics of patients with DSM-III-R simple phobia, comorbid with one or more anxiety diagnoses. This paper draws upon data obtained in the Harvard/Brown Anxiety Disorders Research Program (HARP), a multicenter, longitudinal, naturalistic study of anxiety disorders where 115 of 711 adults with comorbid simple phobias were compared with 596 subjects without simple phobias. Factors examined were demographic data, comorbidity with other disorders, somatic and psychosocial treatment given, and quality of life. Subjects with simple phobia were more likely to have comorbid post- traumatic stress disorder (PTSD) than were those without simple phobia. Rates of obsessive-compulsive disorder (OCD), various forms of depression, histories of alcoholism, other substance abuse, or any of 11 personality disorders were not statistically significantly different for HARP subjects with or without simple phobia. Simple phobias may represent a phenomenological "marker" for one's degree of vulnerability to the development of other, more severe anxiety disorders which are defined by more widespread avoidance. 35 Ref.

73. Ilic, Z.; Lecic-Tosevski, D.; Jovic, V.; Florikic, D.; Draganic, S.; Drakulic, B.; Knezevic, G.; Dimic, S. Prevalence of psychiatric disorders in survivors of torture. European Psychiatry, 12(Suppl.2):193S, 1998. (146200)

The prevalence of psychiatric disorders in a sample of 30 victims of torture from concentration and prisoner camps in the Croatia and Bosnia (former Yugoslavia) was studied. The Symptom Checklist 90-Revised, Impact of Event Scale and Structured Clinical Interview were used for detecting psychiatric disorders. The Millon Multiaxial Interview and NEO-PI-R were used for personality assessment. The study results revealed that the most common diagnoses were post-traumatic stress disorder (PTSD), major depression, somatoform disorders, and alcohol abuse. PTSD showed the strongest association with the experience of having been tortured.

74. Inaba, R.K. Alcohol expectancies among substance abusing Vietnam veterans with post-traumatic stress disorder. Dissertation Abstracts International, 58(12):6811-B, 1998. (143537)

This study examined alcohol expectancies among 120 substance abusing Vietnam veterans with post-traumatic stress disorder (PTSD). Alcohol expectancies are the outcome effects attributed to alcohol that an individual anticipates experiencing while drinking. In order to investigate the potential relationship between PTSD and alcohol dependence, a theoretical framework based on a self-medication model was adopted. It was hypothesized that veterans with comorbid PTSD and alcohol dependence would report more positive alcohol expectancies in relationship to their symptoms of PTSD. It was predicted that veterans who were alcohol dependent would report more positive alcohol expectancies than non-alcoholics. The PTSD-Alcohol Expectancy Questionnaire was developed to assess positive and negative alcohol expectancies with regard to specific symptoms of traumatic stress. The 120 male veterans participating in this study were predominantly Caucasian (63.3 percent) and unmarried (70.0 percent) and were currently receiving medical or psychiatric treatment at a veterans center. To assess the primary hypotheses, 2 (alcoholic versus non-alcoholic) x 2 (PTSD versus non-PTSD) ANOVAs and ANCOVAs were performed. Subjects with both alcoholism and PTSD did not report significantly more PTSD-related alcohol expectancies than alcoholics without PTSD. However, as predicted, alcoholics did report significantly more positive alcohol expectancies than non-alcoholics. These results demonstrate the complexity in understanding and treating psychiatric and substance use disorders. Clinical implications may involve identifying individuals' beliefs about the effects of alcohol, alcohol/drug education, and behavioral interventions as options to substance use.

75. Keane, T.M.; Kaloupek, D.G. Comorbid psychiatric disorders in PTSD: Implications for research. Annals of the New York Academy of Sciences, 821:24-34, 1998. (142971)

This study examines the high rates of comorbidity observed in posttraumatic stress disorder (PTSD) and evaluates the extent to which the high rates of comorbidity are a function solely of concurrent problems in military veterans or if they are more pervasive. This literature review on PTSD concludes that high rates of comorbidity have been found with respect to PTSD across populations (i.e., males, females, veterans, sexual assault victims, criminal assault victims, and the general population), stressors (i.e., military combat, rape, physical assault, childhood sexual abuse, and violence), patient and nonpatient status (help-seeking patients versus community- residing subjects), diagnostic measures (i.e., SCID, DIS, and self-report measures), and the level of interviewer training (lay interviewers versus doctoral level clinicians). These high rates of comorbidity appear to be most salient in the following disorders: (1) alcohol abuse, (2) drug abuse, (3) depression, (4) anxiety disorders, and (5) personality disorders, especially antisocial and borderline. Research on PTSD must begin to contend with the comorbidity issue in systematic ways through the use of carefully selected comparison groups, statistical procedures to control for difference in levels of comorbidity, and global measures of functioning such as the Global Assessment of Functioning to equate subjects within a study. These research suggestions presuppose the careful measurement of comorbidity in studies of PTSD, a recommendation that requires serious consideration for researchers operating in this field. 30 Ref.

76. Keane, T.M.; Kaloupek, D.G.; Blanchard, E.B.; Hsieh, F.Y.; Kolb, L.C.; Orr, S.P.; Thomas, R.G.; Lavori, P.W. Utility of psychophysiological measurement in the diagnosis of posttraumatic stress disorder: Results from a Department of Veterans Affair cooperative study. Journal of Consulting and Clinical Psychology, 66(6):914-923, 1998. (146403)

This multisite study tested the ability of psychophysiological responding to predict posttraumatic stress disorder (PTSD) diagnosis (current, lifetime, or never) in a large sample of male Vietnam veterans. Predictor variables for a logistic regression equation were drawn from a challenge task involving scenes of combat. The equation was tested and cross-validated, demonstrating correct classification of approximately 2/3 of the current and never PTSD participants. Results replicate the finding of heightened psychophysiological responding to trauma-related cues by individuals with current PTSD, as well as differences in a variety of other domains between groups with and without the disorder. Follow-up analyses indicate that veterans with current PTSD who do not react physiologically to the challenge task manifest less reexperiencing symptoms, depression, and guilt. Discussion addresses the value of psychophysiological measures for assessment of PTSD. 34 Ref.
Copyright 1998 - American Psychological Association

77. Kilpatrick, D.G.; Resnick, H.S.; Saunders, B.E.; Best, C.L. Victimization, posttraumatic stress disorder, and substance use and abuse among women. In: C.L. Wetherington, A.B. Roman, Eds., Drug addiction research and the health of women, Rockville, MD: National Institute on Drug Abuse, 1998. 581 p. (pp. 285-307) (143562)

The authors of this chapter describe their National Women's Study, a longitudinal study of a nationally representative sample of women that was designed to provide descriptive information about the prevalence of violent assault, substance use or abuse, and post-traumatic stress disorder (PTSD) among women; examine data on age of onset of critical variables to evaluate chronology factors; and describe the violent assault and PTSD history of women from this sample who have received substance abuse treatment. Three hypotheses were tested: (1) a history of violent assault increases the risk of alcohol dependence; (2) a history of substance use or abuse increases the risk of violent assault; and (3) risk of alcohol dependence at follow-up is predicted by a history of violent assault, substance abuse, past-year violent assault, and PTSD. Data were consistent with the three stated hypotheses. The chapter concludes with discussion of implications for prevention and future research. 23 Ref.

78. Kindras, G.; Golub, D.; Kondratenko, R. Adaptation problems in Afghanistan war veterans. European Psychiatry, 12(Suppl.2):194S, 1998. (146201)

Problems in adapting, socially and professionally, were studied in a sample of 120 veterans of the Afghanistan War. The subjects had been in clinics from two to eight years after returning from service in the war ranging from one month to two years. All had been exposed to factors including lasting physiological and emotional stress, wounds, infections, and disease. In this population, 25 percent were addicted to alcohol and drugs. In addition, 68 percent had lost 10 kg in weight over a short period. All had nonpsychotic mental disorders and the structure of the disorders and development characteristics were consistent with post-traumatic stress disorder (PTSD). Soon after demobilization, the adaptation disorders appeared. In some patients, more favorable environmental conditions promoted progress to social adaptation.

79. Leyba, C.M.; Wampler, T.P. Risperidone in PTSD. Psychiatric Services, 49(2):245-246, 1998. (141652)

The authors of this letter to the editor present four cases (two with alcohol dependence) in which patients with chronic, disabling post-traumatic stress disorder (PTSD) who had vivid flashbacks and nightmares were treated successfully with risperidone. These cases indicate that risperidone is a viable and effective treatment for the vivid flashbacks and nightmares often found in patients with PTSD. Better control of these symptoms allows more effective treatment of the disorder. Many questions remain to be answered, but the potential of risperidone in the treatment for this chronic and highly debilitating disorder deserves careful study. 2 Ref.

80. Liljequist, L.; Kinder, B.N.; Schinka, J.A. Investigation of malingering posttraumatic stress disorder on the personality assessment inventory. Journal of Personality Assessment, 71(3):322-336, 1998. (153400)

Patterns of responding indicative of an attempt to malinger posttraumatic distress disorder (PTSD) were studied using the Personality Assessment Inventory (PAI). The research sample included 116 male participants, whose PAI profiles were examined. Subsequently, the profiles of 29 alcohol-abusing veterans with a primary Axis I diagnosis of PTSD and a group of 30 alcohol-abusing veterans with no other diagnoses were compared to those of 27 undergraduate men instructed to feign PTSD. The study results revealed that seven scales of the PAI profiles of the student malingerers were significantly different from those of the veterans with PTSD. Specifically, the malingerers tended to overexaggerate pathology, inflating their scores on many clinical scales. The malingerers also scored higher on the 8-item Malingering Index (Morey, 1993). Only two scales reliably differentiated the alcohol-abusing veterans with PTSD with the alcohol-abusing veterans without PTSD. 26 Ref.

81. Macready, N. Stress disorder is common among prostitutes. BMJ: British Medical Journal, 317(7158):558, 1998. (144903)

This newsnote reports results of a survey in South Africa, Thailand, Turkey, Zambia, and the U.S., indicating that prostitutes are at high risk for post-traumatic stress disorder (PTSD). Interviews were conducted with 475 prostitutes, 67 percent of whom met the criteria for PTSD. Most had histories of childhood abuse, as well as alcoholism and drug abuse.

82. Marshall, R.P.; Jorm, A.F.; Grayson, D.A.; O'Toole, B.I. Posttraumatic stress disorder and other predictors of health care consumption by Vietnam veterans. Psychiatric Services, 49(12):1609-1611, 1998. (144803)

This study examined the relationship between the number of specific health-care diagnoses reported by Australian Vietnam War veterans and their health care services consumption. The relative effects of mental health and other factors on health care consumption also were studied. A total of 641 randomly selected Vietnam War veterans were interviewed to determine what factors contributed to health care consumption during the previous two weeks. Seventy- three variables were examined by univariate linear regression, and then grouped into seven categories relating to age, physical and mental health, predisposition to posttraumatic stress disorder (PTSD), deployment and repatriation experiences, and membership in veterans groups. PTSD was associated with an additional cost of 79 dollars in health care for the two-week period. Each physical diagnosis was associated with an additional 28 dollars. Alcohol consumption was not related to health care costs. Other important variables contributing to costs were depression, educational status, the quality of repatriation experience, and social support. 10 Ref.

83. McFarlane, A.C. Epidemiological evidence about the relationship between PTSD and alcohol abuse: The nature of the association. Addictive Behaviors: An International Journal, 23(6):813-825, 1998. (145906)

This article uses the Bradford Hill criteria for assessing causal associations to examine the nature of the relationship between post-traumatic stress disorder (PTSD) and alcohol abuse. A series of studies are presented which examine this relationship. A cross-sectional study of 2,501 subjects in a community sample examined the relationship between at-risk drinking and 11 types of traumatic events. The traumatic events associated with at-risk drinking were involvement in life threatening accidents, witnessing severe injury, rape, being the victim of serious physical assault using the Composite International Diagnostic Interview (CIDI). In a longitudinal study of 469 firefighters exposed to a natural disaster, PTSD was associated with both and increase and decrease in alcohol consumption and PTSD rather than exposure accounted for the changes in drinking behavior. In three other populations, psychiatric inpatients, motor accident victims, and female prisoners, the association between PTSD and alcohol abuse emphasized the clinical and public health importance of this relationship. The available evidence does nevertheless support the causal nature of this relationship. Other risk factors are necessary to predict alcohol abuse following exposure to traumatic events, although exposure to traumatic events can be caused by alcohol abuse. 49 Ref.
Copyright 1998 - Elsevier Science, Ltd.

84. Mellman, T.A.; Ramos, J.; David, D.; Williams, L.; Augenstein, J.S. Possible inhibition of early PTSD symptoms by alcohol intoxication. Depression and Anxiety, 7(3):145, 1998. (152202)

An evaluation of factors associated with the early development of post-traumatic stress disorder (PTSD) is described in a peer-reviewed letter to the editor. The subjects were 41 patients in a trauma center with severe and typically multiple injuries. All were alert, had no postconcussive symptoms or cognitive impairment, and had received blood screening for alcohol and illicit substances on admission. After medical/surgical stabilization, they were given a structured interview to probe their initial reactions and recall of the accident and to assess lifetime disorders and new-onset psychiatric symptoms using DSM-III-R criteria. Fifty-six percent met criteria for acute re-experiencing symptoms (cluster B), 29 percent for avoidance or numbing (cluster C), and 44 percent for heightened arousal (cluster D). For preliminary exploration of relationships to early PTSD symptoms, a positive categorization was based on the presence of criteria for re-experiencing symptoms and additional criteria for the C or D cluster. Follow-up at 3 months in 51 percent of the original subjects revealed continuing accident-related symptoms in 75 percent of those categorized positively versus 20 percent of those categorized negatively. None of the 11 subjects who met legal criteria for alcohol intoxication met the early PTSD criteria. The findings suggest that alcohol inhibits the early development of PTSD symptoms, possibly by interfering with an aversive conditioning process that would otherwise deter driving while intoxicated. 5 Ref.

85. Najavits, L.M.; Gastfriend, D.R.; Barber, J.P.; Reif, S.; Muenz, L.R.; Blaine, J.; Frank, A.; Crits-Christoph, P.; Thase, M.; Weiss, R.D. Cocaine dependence with and without PTSD among subjects in the National Institute on Drug Abuse Collaborative Treatment Study. American Journal of Psychiatry, 155(2):214-219, 1998. (141953)

This study examined the prevalence of lifetime traumatic events and current symptoms of posttraumatic stress disorder (PTSD) among 122 adult treatment-seeking cocaine-dependent outpatients. It also compared patients with and without PTSD on current substance use, psychopathology, and sociodemographic characteristics. In addition to self-report and interview measures of psychopathology and substance use, the subjects completed the Trauma History Questionnaire and the PTSD Checklist before entering treatment. These patients experienced a large number of lifetime traumatic events (mean, 5.7); men experienced more general disasters and crime-related traumas than women, and women experienced more physical and sexual abuse than men. According to self-report measures, 20.5 percent of the subjects currently met standard diagnostic criteria for PTSD; the rate of PTSD was 30.2 percent among women and 15.2 percent among men. Patients with PTSD has significantly higher rates of co-occurring axis I and axis II disorders, interpersonal problems, medical problems, resistance to treatment, and psychopathology symptoms than patients without PTSD. Psychopathology symptoms represented the most consistent difference between the two groups and provided the best prediction of PTSD status in a logistic regression. However, the groups did not differ significantly in current substance use or sociodemographic characteristics. The findings underscore the value of screening substance abusers for PTSD. Further studies of the relationship between PTSD and substance abuse appear warranted. 37 Ref.
Copyright 1998 - American Psychiatric Association. Abstract reprinted by permission.

86. Najavits, L.M.; Weiss, R.D.; Shaw, S.R.; Muenz, L.R. "Seeking safety": Outcome of a new cognitive-behavioral psychotherapy for women with posttraumatic stress disorder and substance dependence. Journal of Traumatic Stress, 11(3):437-456, 1998. (147655)

Women with posttraumatic stress disorder (PTSD) comprise 30 to 59 percent of substance abuse treatment samples and experience a more severe course than women with either disorder alone. As yet, no effective treatment for this population has been identified. This paper reports the outcome results on 17 women who completed a new manual-based 24 session cognitive behavioral group therapy protocol, based on assessments at pretreatment, during treatment, posttreatment, and at three month follow-up. Results show significant improvements in substance use, trauma-related symptoms, suicide risk, suicidal thoughts, social adjustment, family functioning, problem solving, depression, cognitions about substance use, and didactic knowledge related to the treatment. Patients' treatment attendance, alliance, and satisfaction were also very strong. Treatment completers were more impaired than dropouts, yet more engaged in the treatment. Overall, the data suggest that women with PTSD and substance abuse can be helped when provided with a treatment designed for them. All results are clearly tentative, however, due to the lack of a control group, multiple comparisons, and absence of assessment of dropouts. 48 Ref.
Copyright 1998 - International Society for Traumatic Stress Studies

87. Neylan, T.C.; Marmar, C.R.; Metzler, T.J.; Weiss, D.S.; Zatzick, D.F.; Delucchi, K.L.; Wu, R.M.; Schoenfeld, F.B. Sleep disturbances in the Vietnam generation: Findings from a nationally representative sample of male Vietnam veterans. American Journal of Psychiatry, 155(7):929-933, 1998. (144521)

This study compared the frequency of nightmares and difficulties with sleep onset and sleep maintenance in male Vietnam theater veterans with male Vietnam era veteran and male civilian comparison subjects. It focused on the role of combat exposure, non-sleep post-traumatic stress disorder (PTSD) symptoms, comorbid psychiatric and medical disorder, and substance abuse in accounting for different domains of sleep disturbance. The authors undertook archival analysis of the National Vietnam Veterans Readjustment Study database using correlations and linear statistical models. Frequent nightmares were found exclusively in subjects diagnosed with current PTSD at the time of the survey (15 percent). In the sample of veterans who served in Vietnam (n = 1167), combat exposure was strongly correlated with frequency of nightmares, moderately correlated with sleep onset insomnia, and weakly correlated with disrupted sleep maintenance. A hierarchical multiple regression analysis showed that in Vietnam theater veterans, 57 percent of the variance in the frequency of nightmares was accounted for by war zone exposure and non-sleep-related PTSD symptoms. Alcohol abuse, chronic medical illnesses, panic disorder, major depression, and mania did not predict the frequency of nightmares after controlling for non-sleep PTSD symptoms. Frequent nightmares appear to be virtually specific for PTSD. The nightmare is the domain of sleep disturbance most related to exposure to war zone traumatic stress. 31 Ref.
Copyright 1998 - American Psychiatric Association

88. Ouimette, P.C.; Brown, P.J.; Najavits, L.M. Course and treatment of patients with both substance use and posttraumatic stress disorders. Addictive Behaviors: An International Journal, 23(6):785-795, 1998. (145904)

Posttraumatic stress disorder (PTSD) is a common co-occurring diagnosis in patients with substance use disorders (SUDs). Despite the documented prevalence of this particular dual diagnosis, relatively little is known about effect treatment for affected patients. The authors of this article review empirical research on the course and treatment of PTSD patients with comorbid SUD and highlight clinically relevant findings. Based on this review, they conclude that PTSD is highly prevalent in SUD patients, is consistently associated with poorer SUD treatment outcomes, and is related to distinct barriers to treatment. Specific treatment practices are recommended for substance abuse treatment providers: (1) all patients should be carefully screened and evaluated for trauma and PTSD; (2) referrals should be provided for concurrent treatment of SUD and PTSD, if available, or for psychological counseling with the recommendation that trauma/PTSD be addressed; and (3) increased intensity of SUD treatment should be offered in conjunction with referrals for family treatment and self-help group participation. 22 Ref.
Copyright 1998 - Elsevier Science, Ltd.

89. Ouimette, P.C.; Ahrens, C.; Moos, R.H.; Finney, J.W. During treatment changes in substance abuse patients with post traumatic stress disorder: The influence of specific interventions and program environments. Journal of Substance Abuse Treatment, 15(6):555-564, 1998. (145928)

Changes during treatment in patients with the dual diagnosis of post-traumatic stress disorder (PTSD) and substance abuse (SA) were studied. The research sample included 140 patients with both PTSD and SA, 1,262 patients with only SA disorders, and 228 patients with other Axis I diagnoses. Diagnoses were determined through chart review. The patients responded to questionnaires assessing coping, cognition, and psychological distress. The following results of the study were seen: (1) improvement on outcome during treatment for SA-PTSD patients; (2) less benefit for SA-PTSD patients compared to SA-only patients; (3) less use of effective coping styles by SA-PTSD patients compared to SA-only patients at discharge; (4) more positive beliefs about substance use in SA-PTSD patients compared to SA-only patients at discharge; (5) more psychological problems for SA-PTSD patients than for the other two groups; and (6) partial effectiveness for PTSD patients of more counseling sessions devoted to substance abuse and family problems and increased involvement in 12-step activities. It is concluded that programs high in support and order/organizations may result in fewer psychological symptoms at discharge for SA-PTSD patients. 36 Ref.

90. Peniston, E.G. Comments by Peniston. Applied Psychophysiology and Biofeedback, 23(4):273-275, 1998. (154650)

The author discusses the rationale and the method of treatment procedures that constitute the basic literature for electroencephalograph (EEG) neurofeedback therapy for alcoholism and post-traumatic stress disorder (PTSD). The author and others have reported that research findings showed promise of therapeutic effectiveness of the alpha-theta brainwave neurofeedback therapy (ATBWNT) protocol with moderately long-term prevention of alcoholism and PTSD relapse. It is noted that the authors have not advocated that biofeedback alone is the efficacious component of the treatment. The major criticism of the EEG ATBWNT protocol is confounding of treatment effects. It is not yet clear whether the temperature training, the visualizations, the ATBWNT, the therapist, placebo or Hawthorne effects are the cause of the beneficial effects of the protocol. Research is needed to isolate the effects of pretraining phases and to codify the protocol procedures. Clarifications and corrections for earlier published works are provided in detail. Additional experimental studies are described that replicate the ATBWNT protocol. 8 Ref.

91. Resnick, H.S.; Yehuda, R.; Acierno, R. Acute post-rape plasma cortisol, alcohol use, and PTSD symptom profile among recent rape victims. Annals of the New York Academy of Sciences, 821:433-436, 1998. (142972)

This study examined the interaction between a history of assault, rape stress characteristics, and initial post-rape plasma cortisol values in 37 rape victims. Two principal questions were addressed: (1) What is the relation between reported alcohol use by the victim and post-rape cortisol, as a function of prior assault history? (2) Is there an association between initial cortisol levels and posttraumatic stress disorder (PTSD) symptoms at 3 months post-rape? Forensic examination included questions about the victim's use of alcohol during or just before assault. Fifteen (41 percent) women reported alcohol use proximal to the time of assault. Reported alcohol use was not related to PTSD status. Cortisol was significantly negatively associated with time post-rape. Among women with no prior history of rape, those using alcohol had higher plasma cortisol levels than did nonusers, whereas little difference was noted between users and nonusers in women with histories of assault. There was a significant main effect for a history of assault, with lower cortisol levels associated with a history of assault. Elevated cortisol levels were observed in newly assaulted women, especially in women who were using alcohol. Levels of cortisol were relatively low in women with histories of assault irrespective of alcohol use. Of the 31 women completing the Structured Clinical Interview for DSM-III-R (PTSD symptom scale), 22 (71 percent) met cutoff criteria for PTSD. Only a history of assault was a significant predictor of PTSD at interviews conducted 3 months post-rape. 5 Ref.

92. Rosenheck, R.; Seibyl, C.L. Homelessness: Health service use and related costs. Journal of Medical Care, 36(8):1256-1264, 1998. (147465)

In order to determine service use and health care costs among the homeless, temporarily homeless, and not-homeless, this study examined data from a nationwide, 1-day, cross-sectional sample of patients hospitalized in acute care inpatient psychiatric and substance abuse programs of the Department of Veterans Affairs (VA). Also examined were the sociodemographic and clinical characteristics of homeless patients and their service utilization patterns and costs. For FY 1995, 10,434 veterans were identified in acute psychiatric and substance abuse beds in VA facilities. Of the 9,108 discharged veterans with complete data, 1,797 were homeless at the time of admission and 1,380 were doubled up with family (temporarily homeless) for a total homelessness rate of 34.9 percent. Mean age was 47.8 years: 98 percent were male; 63 percent were white, 30 percent black and 5 percent Hispanic. Marital status indicated 22 percent married, 49 percent separated or divorces, 25 percent never married and 4 percent widowed. Average income was 9,259 dollars/year and 36 percent received VA compensation for service-related disabilities. Diagnostically, 21 percent were schizophrenic, 29 percent with alcohol abuse/dependence; 11 percent with drug abuse/dependence; 13 percent with major affective/bipolar disorder and 10 percent with Posttraumatic Stress Disorder (PTSD). The average annual cost of care for homeless veterans was 27,206 dollars. These findings, coupled with the prospect of falling public sector health care resources and an increase in the number of homeless mentally ill persons portend a difficult future for both homeless persons with mental illness and for their health care organizations. 16 Ref.

93. Sloan, K.L.; Rowe, G. Substance abuse and psychiatric illness: Treatment experience. American Journal of Drug and Alcohol Abuse, 24(4):589-601, 1998. (146669)

The purpose of this paper is to describe an outpatient dual-diagnosis treatment program and 1-year clinical outcome and hospital utilization data. Subjects were 118 consecutive admissions to the Seattle Veterans Affairs (VA) Medical Center's Dual Disorders program over the period from June 1, 1992, to August 31, 1994. Program eligibility requirements included having a current substance use disorder and an active non-substance-related major Axis I disorder (typically major depression, post-traumatic stress disorder [PTSD], bipolar disorder, or schizoaffective disorder). The treatment frame involved group-based programming (including support, medications management, and psychoeducation), routine urine drug screening, and crisis interventions. Results showed that subjects averaged 1.5 non-substance-related Axis I psychiatric disorders (54 percent involving psychotic symptoms) and 1.8 active substance use disorders. Patients stayed engaged in treatment for a median of 217 days, with 60 percent of patients having no positive drug screens, and the overall sample having a 40 percent reduction in the number of inpatient bed days in the year after intake. Conclusions were that, for a number of patients with comorbid disorders, psychiatric stabilization and cessation of substance use can be accomplished within an outpatient treatment frame that averages two completed clinical contacts per week. 23 Ref.
Copyright 1998 - Marcel Dekker, Inc.

94. Sprang, G.; McNeil, J. Post-homicide reactions: Grief, mourning and post-traumatic stress disorder following a drunk driving fatality. OMEGA, 37(1):41-58, 1998. (147575)

This article examines the impact of gender, religious beliefs, subjective health status, individuals' past experience with death, social support, and time since the death on the extent of mourning, the extent of grieving, and Post-traumatic Stress Disorder (PTSD) symptomatology. It is proposed that the mode of death complicates the nature and course of bereavement after the death of a primary family member in a drunk driving collision. The unnecessary and violent nature of the death of drunk driving victims adds to the depth and extent of the psychological response to trauma. It is proposed that the models of grief utilized to conceptualize the grieving process are inadequate as a sole measure of the response of this type of death. Therefore, the inclusion of Post-traumatic Stress Disorder was provided for a more comprehensive understanding of this type of grief response. Survey data were collected on 171 primary family members of drunk driving victims (spouses, parents, siblings, or children) randomly selected from support groups and social service agencies throughout Texas. Results provide a greater understanding of the factors influencing the responses of the surviving family members after a drunk driving fatality and demonstrate that the grief and PTSD response share common predictors. 34 Ref.
Copyright 1998 - Baywood Publishing Co., Inc.

95. Stewart, S.H.; Pihl, R.O.; Conrod, P.J.; Dongier, M. Functional associations among trauma, PTSD, and substance-related disorders. Addictive Behaviors: An International Journal, 23(6):797-812, 1998. (145905)

This review article presents several potential functional pathways that may explain the frequent co-occurrence of post-traumatic stress disorder (PTSD) and substance abuse disorders in traumatized individuals. Emerging empirical studies that have examined these potential pathways are reviewed, including on relative order of onset. PTSD patients' perceptions of various drug effects, comparisons of PTSD patients with and without comorbid substance use disorders, and correlational studies examining the relations between severity of specific PTSD symptom clusters and substance disorder symptoms. Research on the acute and chronic effects of alcohol and other drugs on cognitive and physiological variables relevant to PTSD intrusion and arousal symptoms is reviewed to highlight ways in which these two sets of PTSD symptoms might be functionally interrelated with substance abuse. Finally, based on these findings, recommendations are made for the treatment of individuals with comorbid PTSD and substance use disorders. 88 Ref.
Copyright 1998 - Elsevier Science, Ltd.

96. Strakowski, S.M.; Sax, K.W.; McElroy, S.L.; Keck, P.E. Jr.; Hawkins, J.M.; West, S.A. Course of psychiatric and substance abuse syndromes co-occurring with bipolar disorder after a first psychiatric hospitalization. Journal of Clinical Psychiatry, 59(9):465-471, 1998. (144868)

Patients with bipolar disorder frequently meet criteria for other psychiatric and substance abuse diagnoses. To clarify relationships among these disorders, the authors examined the course of syndromes co-occurring with bipolar disorder for 12 months after a first hospitalization. Seventy-seven patients were recruited from consecutive inpatient admissions who met DSM-III-R criteria for bipolar disorder, manic or mixed with psychosis. The 12-month syndromal course of co-occurring DSM-III-R alcohol and drug abuse disorders, posttraumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), and other anxiety disorders were longitudinally recorded. The rates of all syndromes, except other anxiety disorders, were elevated. OCD demonstrated an interval course that frequently mirrored the course of the bipolar disorder. The courses of PTSD and substance abuse syndromes were separate from that of the bipolar disorder in many of those with both syndromes. Alcohol and drug abuse syndromes were strongly correlated. The obsessive compulsive syndrome may represent an alternative expression of bipolar disorder in some patients. In contrast, PTSD appears to represent a truly separate disorder, which is possibly more prevalent in bipolar patients due to a shared risk factor. Substance abuse does not appear to simply result from attempts at self-medication or from the impulsivity of mania. These results suggest that future studies examining the course of syndromes co-occurring with bipolar disorder are warranted. 25 Ref.
Copyright 1998 - Physicians Postgraduate Press, Inc.

97. Yehuda, R.; Schmeidler, J.; Wainberg, M.; Binder-Brynes, K.; Duvdevani, T. Vulnerability to posttraumatic stress disorder in adult offspring of Holocaust survivors. American Journal of Psychiatry, 155(9):1163-1171, 1998. (144744)

This study sought to obtain empirical data on trauma exposure and psychiatric disorder in second generation family members of Holocaust survivors. The authors examined the prevalence of stress and exposure to trauma, current and lifetime posttraumatic stress disorder (PTSD), and other psychiatric diagnoses in a group of adult offspring of Holocaust survivors (n = 100) and a demographically similar comparison group (n = 44). Subjects were recruited from both community and clinical populations and evaluated with the use of structured clinical instruments. Stress and trauma history were evaluated with the Antonovsky Life Crises Scale and the Trauma History Questionnaire. PTSD was diagnosed with the Clinician Administered PTSD Scale, and other psychiatric disorders with the Structured Clinical Interview for DSM-IV. Results show that although adult offspring did not experience more traumatic events, they had a greater prevalence of current and lifetime PTSD and other psychiatric diagnoses than the comparison subjects. A 5 percent prevalence rate was found for substance abuse disorders, considerably lower than reported national estimates. Findings demonstrate an increased vulnerability to PTSD and other psychiatric disorders among offspring of Holocaust survivors, identifying them as a possible high-risk group. 33 Ref.
Copyright 1998 - American Psychiatric Association. Abstract reprinted by permission.

98. Beckham, J.C.; Kirby, A.C.; Feldman, M.E.; Hertzberg, M.A.; Moore, S.D.; Crawford, A.L.; Davidson, J.R.T.; Fairbank, J.A. Prevalence and correlates of heavy smoking in Vietnam veterans with chronic posttraumatic stress disorder. Addictive Behaviors: An International Journal 22(5):637-647, 1997. (140165)

A study was conducted to investigate smoking patterns in 445 Vietnam veterans with and without posttraumatic stress disorder (WFSD). Combat veterans with PTSD reported similar occurrence of smoking (53 percent) compared to combat veterans without PTSD (45 percent). For those who smoked, combat veterans with PTSD reported a significantly higher rate of heavy smoking (equal to or greater than 25 cigarettes daily); 28 percent of combat veterans without PTSD were heavy smokers and 48 percent of combat veterans with PTSD were heavy smokers. PTSD diagnosis and heavy smoking status were independently and differentially related to motives for smoking. In combat veterans with PTSD, heavy smoking status was positively related to total health complaints, lifetime health complaints, health complaints in the past year, negative health behaviors, total PTSD symptoms, DSM-IV C cluster (avoidance and numbing) and D cluster (hyperarousal) PTSD symptoms. Heavy smoking status was also associated with fewer positive health behaviors. 50 Ref.
Copyright 1997 - Elsevier Science Ltd.

99. Beckham, J.C.; Feldman, M.E.; Kirby, A.C.; Hertzberg, M.A.; Moore, S.D. Interpersonal violence and its correlates in Vietnam veterans with chronic posttraumatic stress disorder. Journal of Clinical Psychology, 53(8):859-869, 1997. (140339)

The authors conducted two studies on interpersonal violence in Vietnam veterans with posttraumatic stress disorder (PTSD). In the first study, 57 percent of combat veterans with PTSD reported significantly more violent behavior over the past year (22 acts) compared with combat veterans without PTSD (2 acts). There was an independent positive association between combat exposure and interpersonal violence. In the second study, variables (including occurrence of childhood physical abuse, current alcohol problems, socioeconomic status, and hostility) related to current interpersonal violent behavior were investigated in 118 combat veterans with PTSD. Factors related to interpersonal violence were, in order of importance, lower socioeconomic status, increased aggressive responding, and increased PTSD severity. Current alcohol problems and childhood physical abuse were unrelated to interpersonal violence. The findings suggest that combat veterans with PTSD show more interpersonal violence than those without PTSD and that violent behavior in this population is determined by multiple factors. 42 Ref.

100. Bland, R.C.; Newman, S.C.; Orn, H. Help-seeking for psychiatric disorders. Canadian Journal of Psychiatry, 42(9):935-942, 1997. (140482)

The objective of this study was to examine demographic and clinical determinants of seeking help for mental or emotional problems, to determine the proportion of those people with a disorder who sought help, and to determine what categories of professionals are sought by those who get care. A two-stage random sample of 3956 adult residents of Edmonton, Alberta, Canada was interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS). After adjusting for age and sex, a re-interview sample was representative of those with and without a diagnosis at the first interview. Of the 1964 subjects, 570 met criteria for a DIS/DSM-III diagnosis in the year preceding the interview. These diagnoses included generalized anxiety disorder (GAD) and post-traumatic stress disorder (PTSD). For those with a diagnosis, sex, age, marital status, education, employment, and income were examined as determinants of help-seeking. Only sex (female) and age (under 45) were significant predictors. Comorbidity was highly significant: the help- seeking rate for those with one diagnosis was 20.3 percent; for those with more than one diagnosis, the rate was 42.8 percent. A specific diagnosis made a difference: 46.7 percent of those with a major depressive episode sought help, but only 16.0 percent of those with alcohol abuse or dependence sought care. Major determinants of help-seeking are sex (female), age (under 45), severity of the illness, and comorbidity. A surprisingly high proportion of those with a disorder do not seek help, and over one-third of those seeking help do not have a current DIS/DSM-III disorder. 29 Ref.
Copyright 1997 - Canadian Psychiatric Association

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