Concurrent and proximal associations among PTSD symptoms, prescription opioid use, and co-use of other substances: Results from a daily monitoring study.

Abstract

Objective: Posttraumatic stress disorder (PTSD) and nonmedical prescription opioid use (NMPOU) are linked. Much of the research documenting this association uses cross-sectional or longitudinal designs that describe patterns of use over extended intervals. The present study used a daily monitoring design to examine how daily fluctuations in PTSD symptoms predicted patterns of prescription opioid use (both medical and nonmedical) and co-use of other substances. This approach has distinct advantages for understanding proximal temporal relations between PTSD symptom variation and substance use patterns. Method: Forty adults with clinical or subclinical PTSD and past-month NMPOU completed daily measures of PTSD symptoms, physical pain, prescription opioid use, and other substance use for 28 days using a smartphone application. Results: Same day co-use of prescription opioids and at least one other substance was common. Higher-than-typical PTSD symptoms on a given day (within-person) was associated with an increased likelihood of reporting NMPOU (overall and with co-use of one or more additional substances) on the same day. This association was specific to PTSD alterations in arousal and reactivity symptoms (Criteria E). Neither total PTSD symptoms nor individual PTSD symptom clusters prospectively predicted next-day prescription opioid use (overall or with co-use). Use of prescription opioids also did not predict next-day PTSD symptom severity. Conclusion: This is the first study to demonstrate positive associations between day-to-day fluctuations in PTSD symptoms and NMPOU. Results from the current study also highlight the importance of examining polysubstance use patterns among individuals with PTSD who use prescription opioids. Clinical Impact StatementResults from this study have the potential to influence clinical assessment and treatment through improved understanding of patterns of substance use among individuals with PTSD who use opioids. Increased understanding of the nature of these relations has the potential to inform future research on intervention development and refinement.

The impact of substance use on posttraumatic stress disorder symptoms and treatment discontinuation

“…For other substance use, our results showed no association between using other substances, primarily cocaine and opioids, and subsequent PTSD symptom severity or the likelihood of discontinuing treatment, which is consistent with previous prospective examinations (Badour et al., 2023). Taken together, the present study and existing literature demonstrate mixed findings on the association between alcohol use and PTSD treatment, but the association between other substance use and PTSD treatment outcomes is more uniformly null.…”

“…(2021) noted that neither substance use (i.e., alcohol, cocaine, marijuana, benzodiazepines, opioids, amphetamines) nor the frequency of use were significant predictors of PTSD symptoms in the next session. The authors also found that opioid use, alone or with other substances, did not predict next‐day PTSD symptoms in a nontreatment study of daily monitoring of use and symptoms (Badour et al., 2023). Overall, some studies have shown a positive concurrent association between alcohol use and PTSD symptoms (Black et al., 2018; Possemato et al., 2015), one study found a prospective increase in PTSD symptoms (Tripp et al., 2020), and another found no association (Badour et al., 2021).…”

“…Overall, some studies have shown a positive concurrent association between alcohol use and PTSD symptoms (Black et al., 2018; Possemato et al., 2015), one study found a prospective increase in PTSD symptoms (Tripp et al., 2020), and another found no association (Badour et al., 2021). Studies on other substance use and PTSD symptoms have found no association (Badour et al., 2021, 2023). These results suggest that other substance use may not interfere with PTSD symptom response to treatment, but alcohol use possibly would, though the results are not consistent for alcohol.…”