Post-traumatic Stress Disorder in Victims of Sexual Assault With Pre-assault Substance Consumption: A Systematic Review

Abstract

Background: Post-traumatic stress disorder (PTSD) and substance consumption commonly co-occur in victims of sexual assault. Substance consumption can occur pre- andi/or post-assault. Pre-assault substance consumption may have an impact on the subsequent development of PTSD. This review aims to provide an overview of current understanding of the effects of acute substance intoxication and chronic pre-assault problematic substance use on symptoms of PTSD amongst individuals who were victims of sexual assault.Methods: PsycINFO, EMBASE, and MEDLINE were searched using terms related to PTSD, sexual assault, and substance consumption. These yielded 2,121 articles, 268 of which were retrieved for more detailed evaluation and 13 of these met inclusion criteria and were appraised in full.Results: Overall, the reviewed papers supported our hypothesis that acute substance intoxication and chronic pre-assault problematic substance use are associated with fewer initial PTSD symptoms but less improvement over time, resulting in slower overall PTSD recovery. They also highlighted post-assault characterological self-blame and negative social reactions as mediators of recovery in the context of pre-assault substance consumption.Conclusions: Acute substance intoxication and chronic pre-assault problematic substance use appear to have an impact on the development of PTSD symptoms amongst victims of sexual assault. The importance of developing early interventions and routine screening and assessment for PTSD and pre-assault substance consumption is emphasized. The limited research on male victims and on substances other than alcohol is highlighted.

Cognitive Processing Therapy for Substance‐Involved Sexual Assault: Does an Account Help or Hinder Recovery?

“…Specifically, at the 6‐month posttreatment assessment, substance‐involved SA was associated with a higher level of residual PTSD symptom severity compared to non–substance‐involved SA. This finding builds upon prior research in samples unselected for treatment (Gong et al., 2019) and suggests that although evidence‐based treatment works to substantially reduce PTSD symptoms following substance‐involved SA, residual PTSD symptoms can be relatively more persistent when substances are involved in sexual trauma.…”

“…Given that alcohol is the most common substance involved in SA (Kilpatrick et al., 2007), a survivor's memory of a substance‐involved SA may also be impaired (White, 2003). Finally, recovery following substance‐involved SA may follow a unique pattern, with fewer initial PTSD symptoms but a slower recovery relative to non–substance‐involved SA (Gong et al., 2019).…”

Sex and context differences in the effects of trauma on comorbid alcohol use and post‐traumatic stress phenotypes in actively drinking rats

“…The blunted drinking phenotype of NOV males here may model the subpopulation of individuals who drink less alcohol following PTSD onset (McFarlane, 1998). In fact, in some human studies, alcohol use before trauma was found to be associated with lower PTSD symptoms acutely post-trauma (Gong et al, 2019;Kaysen et al, 2011;McFarlane et al, 2009). The reduced drinking of alcohol-experienced NOV males might reflect anhedonia, decreased ethanol reward, or diminished instrumental conditioning.…”

Drug-facilitated sexual assault, impaired trauma memory, and implications for mental health treatment

“…The greater duration of treatment, in combination with the findings of a number of longitudinal studies, suggests that PTS arising from DFSA may be treatment refractory. Consistent findings indicate that DFSA may be associated with less severe acute stress symptomatology (Jaffe, Blayney, Bedard-Gilligan, & Kaysen, 2019 ; Jaffe, Hahn, & Gilmore, 2019 ) and shows a pattern of initially lower PTSD severity but a more chronic course of symptoms (Gong, Kamboj, & Curran, 2019 ). In their longitudinal study, Kaysen et al ( 2010 ) assessed PTSD symptom clusters in a community sample of 60 women at 2–5 weeks post-assault.…”

“…Research has demonstrated the treatment-refractory nature of DFSA PTS, including that survivors require significantly more sessions of MH treatment than NDFSA and have more severe residual PTSD post-treatment (Gong et al, 2019 ; Jaffe et al, 2021 ; Kaysen et al, 2010 ; Richer et al, 2017 ; Russell & Curran, 2002 ). The first aim of the present study was to explore reasons for DFSA being treatment-refractory by (1) quantitatively comparing DFSA-I, DFSA-V, and NDFSA survivors to see whether specific differences in sociodemographics, assault characteristics, prior sexual trauma, and substance use exist between groups; (2) quantitatively comparing post-trauma PTSD and depression symptoms (PTS) among the three SA groups, with hypotheses of fewer symptoms for DFSA given the early post-assault assessment timeframe in the present study and prior research indicating fewer PTS early on for DFSA; and (3) qualitatively identifying and comparing among the three SA groups, emergent treatment themes in trauma cognitions and treatment foci from the study clinic’s psychotherapy records.…”