Posttraumatic stress disorder symptoms and risky behaviors among trauma-exposed inpatients with substance dependence: The influence of negative and positive urgency

Abstract

Background Posttraumatic stress disorder (PTSD) among inpatients with substance use disorders (SUDs) is associated with heightened engagement in a variety of risky, self-destructive, and health-compromising behaviors (e.g., risky sexual behavior, aggression). Extant research provides support for the role of emotion dysregulation in the PTSD-risky behavior relation among inpatients with SUD; however, this research has been limited by a focus on emotion dysregulation involving negative (versus positive) emotions. The goal of the current study was to extend past research on the PTSD-risky behavior relation by examining the potential mediating roles of negative and positive urgency (two domains of emotion dysregulation defined by the tendency to engage in risky behavior in the context of negative and positive emotions, respectively). Methods Participants were 158 trauma-exposed inpatients with (n = 91) and without (n = 67) lifetime PTSD consecutively admitted to a residential SUD treatment facility (M age = 34.34; 59.5% White, 50.6% female). Patients were administered diagnostic interviews and completed self-report questionnaires. Results Significant positive associations were found among lifetime PTSD symptoms, negative and positive urgency, and risky behaviors. Moreover, findings revealed significant indirect effects of lifetime PTSD symptoms on risky behaviors through the pathways of both negative and positive urgency. Conclusions Results provide initial support for the mediating roles of both negative and positive urgency in the PTSD-risky behavior relation, highlighting the potential utility of teaching trauma-exposed inpatients with PTSD-SUD skills for tolerating negative and positive emotional states without engaging in maladaptive behaviors.

PTSD's risky behavior criterion: Relation with DSM-5 PTSD symptom clusters and psychopathology

“…Further, our findings are consistent with the broader literature on the link between PTSD and risky behaviors. PTSD diagnosis (present versus absent) and symptom severity are associated with greater engagement in risky behaviors (Weiss et al, 2012, 2015e). Several theoretical explanations for this association have been proposed.…”

The intervening role of urgency on the association between childhood maltreatment, PTSD, and substance-related problems

“…The literature on how these impulsivity traits are related to opioid use and SRP lags behind the study of other substances (Mitchell and Potenza, 2014; Verdejo-García et al, 2007), partly due to including opioid use as part of generic “substance use” or “illicit drug use” measures rather than as a specific outcome. Prior work has indicated that positive and negative urgency may be most relevant to psychopathology and substance use (Peters et al, 2012; Weiss et al, 2015). Others have suggested that urgency may be more strongly related to SRP than other impulsivity-related constructs.…”

“…Indeed, estimates of the comorbidity between PTSD and those with a history of substance use disorder for opioids is as high as 62% (Dore et al, 2012; Mills et al, 2006). Furthermore, PTSD is associated with more severe substance-related impairment and poorer response to substance use disorder treatment (Mills et al, 2007; Weiss et al, 2015). …”

Intimate Partner Violence and HIV-Risk Behaviors: Evaluating Avoidant Coping as a Moderator

“…For these women, sexual behavior may, at times, function to alleviate or distract attention away from negative affective states (30), thereby facilitating stress relief (31) and cognitive escape (32). Trauma-exposed populations may be particularly prone to these emotion-regulating effects (33, 34). Indeed, sexual behavior has been theorized to modulate trauma-related distress (35, 36).…”