Parallel process modeling of posttraumatic stress disorder symptoms and alcohol use severity in returning veterans.

Mahoney, Colin T.; Livingston, Nicholas A.; Wong, Maria M.; Rosen, Raymond C.; Marx, Brian P.; Keane, Terence M.

doi:10.1037/adb0000569

Cited by 9 publications

(6 citation statements)

References 77 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On the other hand, we found that avoidance differentially predicted future high-risk alcohol use, as measured by the AUDIT total score, and that it was the avoidance of distressing trauma memories, thoughts, and feelings specifically that accounted for the overall effect. This association is highly consistent with the self-medication hypothesis (Berke et al, 2019; Khantzian, 2003, 2012; Lane et al, 2019; Mahoney et al, 2020) and suggests the possibility that specific PTSD symptoms might be primary in predicting some patterns of substance use relative to others.…”

Section: Discussionsupporting

confidence: 80%

“…The self-medication hypothesis, which is the theoretical model invoked most often to account for PTSD-substance use co-occurrence, postulates that substance use becomes a negatively reinforced behavior to the extent that it provides relief from PTSD symptoms (Berke et al, 2019;Khantzian, 2012Khantzian, , 2003Lane et al, 2019;Mahoney et al, 2020). However, PTSD represents a complex and heterogeneous disorder, comprised of both internalizing and externalizing symptoms with unknown associations with substance use risk, or use of particular substances.…”

mentioning

confidence: 99%

See 1 more Smart Citation

The role of PTSD symptom clusters and criterion in predicting future high-risk drug and alcohol use among returning veteran men and women.

Livingston¹,

Farmer²,

Mahoney³

et al. 2022

Psychological Services

Self Cite

View full text Add to dashboard Cite

The prevalence of co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) remains exceptionally high among returning veterans, with numerous studies linking PTSD, but not specific PTSD symptoms, to future SUD risk. Further explication of PTSD symptom effects on future SUD risk will likely promote intervention development and refinement while offsetting SUD risk. Accordingly, In this study we explored the prospective associations between PTSD symptom clusters, symptoms, and future SUD risk and use of specific drug classes. Returning veterans (N = 1,295; M age = 42.3, SD = 9.89; 51% female; 66.8% White) completed structured diagnostic interviews to assess PTSD symptoms and self-report measures of substance use 14-36 months later (M = 24.59, SD = 2.97). Hyperarousal and reckless/selfdestructive symptoms specifically predicted future high-risk drug use and binge drinking behavior, and avoidance of internal stimuli (i.e., of trauma memories, thoughts, and feelings) differentiated individuals classified as high-risk for alcohol use based on their AUDIT total score. Further, negative alterations in cognition and mood predicted future opioid (i.e., nightmares) and stimulant use (i.e., flashbacks), whereas concentration difficulties were inversely associated with future binge drinking. This longitudinal study identified prospective and enduring associations between specific PTSD symptom clusters, symptoms, and future high-risk substance use patterns among returning veterans. Accordingly, careful assessment of specific PTSD criteria and differential motivations for substance use is warranted, along with tailored interventions to offset risk for opioid, stimulant, and alcohol use among returning veterans. Impact StatementWe found that PTSD clusters predicted future high-risk substance use among returning veterans, as well as specific patterns of substance use longitudinally (e.g., opioid use). In addition to identifying future research directions, study findings highlight specific PTSD symptoms to consider in assessment and treatment in order to offset risk for hazardous substance use.

show abstract

Section: Discussionsupporting

confidence: 80%

mentioning

confidence: 99%

The role of PTSD symptom clusters and criterion in predicting future high-risk drug and alcohol use among returning veteran men and women.

Livingston¹,

Farmer²,

Mahoney³

et al. 2022

Psychological Services

Self Cite

View full text Add to dashboard Cite

show abstract

“…It is possible that cannabis use operates differently than other substances with respect to the maintenance of PTSD symptom severity over time. For example, using four waves from the same data set, Mahoney et al (2020) found that, although more severe baseline PTSD symptoms predicted accelerated declines in both PTSD symptom severity and alcohol use, baseline alcohol use did not predict changes in PTSD symptom severity over time. Conversely, in the present study, we found that a previously documented diagnosis of CUD resulted in decelerated improvements in PTSD symptoms and alcohol use.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal course of mental health symptoms among veterans with and without cannabis use disorder.

Livingston¹,

Farmer²,

Mahoney³

et al. 2022

Psychology of Addictive Behaviors

Self Cite

View full text Add to dashboard Cite

Objective: Cannabis use disorder (CUD) is the most common non-alcohol related substance use disorder (SUD) in the United States and is especially prevalent among returning veterans. The long-term mental health correlates of CUD remain unknown, which is significant given the rise in legalization and also recreational and medicinal cannabis use nationally. Method: Using a gender-balanced, national sample of 1,649 veterans (n = 115 with CUD; 75.2% White; M age = 37.49, SD = 9.88), we used latent growth curve modeling to examine posttraumatic stress disorder (PTSD) symptom severity, depressive symptoms, generalized anxiety, alcohol use, and psychosocial functioning between veterans with versus without a prior diagnosis of CUD over five time points, spanning an average of 7 years. Results: Returning veterans with CUD compared to those without reported higher alcohol use, depression, anxiety, PTSD symptom severity, and worse psychosocial functioning at baseline. We observed nonlinear change across each outcome. We also found that CUD moderated change in alcohol use (quadratic: b = −.129, p < .001) and PTSD symptoms (quadratic: b = −.280, p = .019), such that individuals with CUD evidenced decelerated change and worse outcomes relative to veterans without a previously documented CUD diagnosis. Trajectories of depression, anxiety, and psychosocial functioning were similar across individuals with versus without CUD. Conclusions: In the first longterm and longitudinal evaluation of mental health and alcohol use course among returning veterans, CUD was associated with worse and more persistent alcohol use and PTSD symptom severity over time. These data have implications for clinical assessment, case conceptualization, and treatment of veterans and may inform efforts to offset risk for hazardous drinking and PTSD following a diagnosis of CUD. Public Health Significance StatementThis study indicates that returning veterans with a diagnosis of cannabis use disorder (CUD) report worse depression, anxiety, posttraumatic stress disorder (PTSD), alcohol use, and psychosocial functioning. Findings also indicate that CUD was associated with more severe and persistent alcohol use and PTSD symptom severity long term. This information may be immediately useful for assessment and treatment planning purposes, prevention, and could inform much needed research efforts to examine the long-term effects of CUD on the mental health of returning veterans.

show abstract

“…This was because we wanted to examine the effect of substance-involved trauma on mental health outcomes controlling for the effect of current substance use. Prior literature has shown that individuals with more severe symptoms often report heavier alcohol use (Boschloo et al, 2011; Conner et al, 2009; Mahoney et al, 2020; Tripp et al, 2020). Trait neuroticism also was included as a covariate to control for the general tendency toward negative emotionality and isolate the unique risk pathway between peritraumatic substance involvement and later mental health outcomes.…”

Section: Methodsmentioning

confidence: 99%

Substance-involved trauma is associated with worse mental health outcomes among college students.

Rodriguez¹,

Shaw²,

Radomski³

et al. 2024

Traumatology

View full text Add to dashboard Cite

Following exposure to a potentially traumatic event (PTE), some individuals experience negative mental health outcomes such as posttraumatic stress disorder (PTSD), depression, and anxiety. Substance-involved trauma-substance use that occurs immediately before or during a PTE-may confer a unique risk for these complications. Yet, current research on the role of substance use in response to PTEs is sparse, and the existing literature has focused predominantly on alcohol-involved sexual assault. The present study examined associations among substance-involved trauma and poorer mental health functioning with the following aims: (a) descriptively characterize substance-involved trauma in a college sample and (b) examine the effect of substance-involved trauma on PTSD, depression, and anxiety symptoms. Trauma-exposed college students (N = 194) completed a structured clinical interview and self-report questionnaires. Findings revealed that 43% of the sample reported exposure to at least one substance-involved traumatic event in their lifetime. Notably, 86% of traumas were interpersonal (e.g., sexual trauma, physical assault). A history of substanceinvolved trauma was associated with heavier and more problematic drinking, more severe PTSD and anxiety symptoms, but not more severe depressive symptoms, compared to those without substance-involved trauma. Results of this study suggest that substance involvement during trauma is prevalent and contributes to harmful psychological and behavioral outcomes. These findings point to the potential value of eliciting information on substance use proximal to PTE exposure and incorporating this information into individualized treatment plans to enhance clinical care efforts. Future research should assess and include information about substance use in PTEs when modeling trauma outcomes.

show abstract

Parallel process modeling of posttraumatic stress disorder symptoms and alcohol use severity in returning veterans.

Cited by 9 publications

References 77 publications

The role of PTSD symptom clusters and criterion in predicting future high-risk drug and alcohol use among returning veteran men and women.

The role of PTSD symptom clusters and criterion in predicting future high-risk drug and alcohol use among returning veteran men and women.

Longitudinal course of mental health symptoms among veterans with and without cannabis use disorder.

Substance-involved trauma is associated with worse mental health outcomes among college students.

Contact Info

Product

Resources

About