Alcohol problems and posttraumatic stress disorder in female crime victims

Abstract

Comorbidity between alcohol use and posttraumatic stress disorder (PTSD) has been well documented. However, there are few longitudinal studies with acute trauma samples. The present study examined symptoms of alcohol use disorders (AUDs) and PTSD longitudinally after assault. Female sexual (n = 69) and physical assault victims (n = 39) were assessed 2 to 4 weeks and 3 months post trauma. Women who had lifetime AUD had higher intrusive and avoidance symptoms than those who did not have AUD. Women who had any alcohol problems had higher PTSD symptoms. Participants who had alcohol problems had the same pattern of symptom recovery as those who did not have alcohol problems but remained more symptomatic over the 3 months. These findings suggest that early intervention strategies for women who have previous histories of alcohol problems and seek medical attention early post trauma may be indicated.Exposure to traumatic stressors has been associated with development of posttraumatic stress disorder (PTSD), elevated rates of alcohol use disorders (AUDs) (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995), and frequent comorbidity of the two disorders (Breslau, Davis, Peterson, & Schultz, 1997;Stewart, Pihl, Conrod, & Dongier, 1998). AUDs have been associated with more severe PTSD symptoms, such as elevated avoidance and hyperarousal symptoms (Back, Sonne, Killeen, Dansky, & Brady, 2003;Stewart, Conrod, Pihl, & Dongier, 1999) and more reexperiencing symptoms (Read, Brown, & Kahler, 2004).Research examining temporal relationships between AUD and PTSD has yielded mixed results (Acierno, Resnick, Kilpatrick, Saunders, & Best, 1999;Breslau et al., 1997;Cottler, Compton, Mager, Spitznagel, & Janca, 1992;Darves-Bornoz et al., 1998;Sonne, Back, Zuniga, Randall, & Brady, 2003). Several studies have found PTSD increases risk of first onset of AUD in women Stewart et al., 1999) (Brady, Back, & Coffey, 2004;Stewart, 1996). Other studies have found AUD may increase risk of development of PTSD or be associated with a more severe and chronic course of symptoms (Acierno et al., 1999;Conrod & Stewart, 2003;Cottler et al., 1992). Additionally, women appear more vulnerable to alcohol-related consequences at lower levels of alcohol exposure than men (Nolen-Hoeksema, 2004). However, the impact of this vulnerability on the course of PTSD in women has not been examined to date.Despite general consensus that the combination of PTSD and AUD is associated with worse outcomes for both disorders (Stewart et al., 1998), few longitudinal studies have been conducted soon after trauma exposure. Because the impact of previous AUD on development of PTSD has been relatively understudied, the purpose of this study is to examine the impact of AUD on the course of PTSD symptoms in female crime victims early post trauma. Our results represent a secondary set of analyses from a larger study designed to examine postassault changes in functioning and factors affecting recovery (Kaysen, Scher, Mastnak, & Resick, 2005). For the present study we hypothesize...

Drinking motives moderate daily relationships between PTSD symptoms and alcohol use.

“…Consistent with this finding, early work by Brown and colleagues (1998) found that individuals with comorbid PTSD and AD were of the opinion that increases in their PTSD symptoms led to increases in their drinking, but that their drinking did not increase their PTSD and instead, mitigated it. In contrast, Kaysen and colleagues (2006) found that while women with recent trauma exposure who were problem drinkers prior to the trauma reported lower PTSD symptom severity initially than did moderate drinkers and abstainers, these women failed to recover at the same rate as non-heavy drinkers and remained more symptomatic with regard to their PTSD. It is possible that in the immediate aftermath of trauma, heavy drinking interferes with natural recovery, thereby helping to maintain elevated PTSD symptomatology that might otherwise resolve.…”

“…If the self-medication model is robust and the best explanation for the relationship between PTSD and drinking, we would expect that a large majority of those with comorbid PTSD and AD would be primarily motivated to drink to cope with negative affect, especially if they perceive that alcohol is an effective means of managing distress. There is a consistent body of literature demonstrating that those with comorbid PTSD and AUD report being motivated to drink to cope with negative affect (Dixon, Leen-Feldner, Ham, Feldner, & Lewis, 2009; Grayson, & Nolen-Hoeksema, 2005; Kaysen, Dillworth, Simpson, Waldrop, Larimer, & Resick, 2007; Miranda, Meyerson, Long, Marx, & Simpson, 2002; Nugent, Lally, Brown, Knopik, & McGeary, 2012; Simpson, 2003; Ullman, Filipas, Townsend, & Starzynski, 2005). However, the extant literature on drinking motives among those with comorbid PTSD and AUD also suggests that enhancement drinking motives (e.g., drinking to increase positive affect) may be salient for this group (Grayson, & Nolen-Hoeksema, 2005; Miranda et al, 2002; Nugent et al, 2012; Simpson, 2003; Ullman et al, 2005), and this may have clinical and conceptual implications for our understanding of the relationship between PTSD and AUD.…”

The Role of Alcohol Consumption in Female Victimization: Findings from a French Representative Sample

“…For example, in a longitudinal study of 3,000 women, those who were assaulted over the course of the study were more likely to have abused alcohol at follow-up (Kilpatrick, Acierno, & Resnick, 1997). Various other studies suggest an increase of alcohol drinking following trauma exposure (Burnam, Stein, & Golding, 1988;Kaysen et al, 2006;Kilpatrick et al, 1997).…”

Are patients after severe injury who drop out of a longitudinal study at high risk of mental disorder?

“…Recent longitudinal studies of PTSD have included many different groups of subjects, such as exposed disaster workers (1), refugees (2), a community sample (3), survivors of terrorists attacks (4), soldiers hospitalized following serious combat injury (5), patients with myocardial infarction (6), and victims of sexual and physical assault (7). Above all, longitudinal studies of patients following severe injury, especially those involved in motor vehicle accidents (MVAs), comprise one of the largest number of population samples studied (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”