Abstract

Objective: Many women receiving substance use treatment report histories of interpersonal violence (IV) victimization, including physical and sexual assault. IV is a risk factor for mental and behavioral health difficulties such as posttraumatic stress disorder (PTSD) and substance use disorder (SUD). Consistent with the self-medication hypothesis, PTSD may explain elevated SUD among IV survivors. Yet, few studies have investigated whether PTSD may have differential mediating effects for different substances, which has significant treatment implications. Methods: In 124 women (M age = 35.37, SD = 11.90) in substance use treatment, we examined PTSD symptoms as a mediator between IV and severity of different types of substance use, including alcohol, cannabis, cocaine, and opioid use. Participants completed self-report measures including the ASSIST, PCL-5, and LEC-5. Data were analyzed using path analysis in Mplus 8.3. Both dichotomous and continuous outcomes of problematic substance use outcomes were examined. Results: Most women (53.3%) reported problematic substance use with at least one substance, including opioids (39.7%), cocaine (13.0%), alcohol (9.6%), and cannabis (5.6%). Most (83.2%) of the sample reported at least one IV incident. On average, women reported clinically significant PTSD symptom severity. When problematic substance use was examined dichotomously, findings revealed significant indirect effects from IV exposure to opioid (β = 0.10, p = .010) and cocaine use (β = 0.07, p = .039) via elevated PTSD symptoms. There were no significant indirect effects for problematic alcohol (β = 0.03, p = .260) or cannabis use (β = 0.02, p = .562). When substance use was examined continuously, results revealed significant indirect effects from IV exposure to opioid (β = 0.09, p = .017), cocaine use (β = 0.09, p = .015), and alcohol use (β = 0.08, p = .020) via elevated PTSD symptoms. Indirect effects for cannabis use remained nonsignificant (β = 0.05, p = .100). Conclusions: IV survivors may be particularly at risk for opioid and cocaine misuse because of elevated PTSD symptoms. Treatments that integrate PTSD and SUD are needed to simultaneously target traumatic stress and substance use. Women with opioid and cocaine misuse may particularly benefit from trauma-focused exposure-based psychotherapy to reduce symptoms of PTSD, and thus, decrease opioid and cocaine misuse.

摘要

目标：许多接受药物滥用治疗的女性都有人际暴力 (IV) 受害史，包括身体攻击和性攻击。IV 是精神和行为健康困难的危险因素，例如创伤后应激障碍 (PTSD) 和物质使用障碍 (SUD)。与自我药疗假说一致，PTSD 可以解释 IV 幸存者中 SUD 升高的原因。然而，很少有研究调查创伤后应激障碍（PTSD）是否可能对不同物质产生不同的中介作用，这对治疗具有重要意义。方法： 124 名女性（M年龄 = 35.37，SD = 11.90）在物质使用治疗中，我们检查了 PTSD 症状作为不同类型物质使用（包括酒精、大麻、可卡因和阿片类药物使用）的 IV 和严重程度之间的中介因素。参与者完成了自我报告测量，包括 ASSIST、PCL-5 和 LEC-5。使用 Mplus 8.3 中的路径分析对数据进行分析。对有问题的物质使用结果的二分法和连续结果进行了检查。结果：大多数女性（53.3%）报告至少使用一种物质有问题，包括阿片类药物（39.7%）、可卡因（13.0%）、酒精（9.6%）和大麻（5.6%）。大多数（83.2%）样本报告了至少一起静脉注射事件。平均而言，女性报告的 PTSD 症状严重程度具有临床意义。当对有问题的物质使用进行二分法检查时，结果显示静脉注射阿片类药物（ β  = 0.10，p = .010）和可卡因使用（β  = 0.07，p = .039）通过升高 PTSD 症状产生显着的间接影响。有问题的酒精（β  = 0.03，p = .260）或大麻使用（β  = 0.02，p）没有显着的间接影响 = .562)。当连续检查物质使用时，结果显示静脉注射阿片类药物（ β  = 0.09，p = .017）、可卡因使用（β  = 0.09，p = .015）和酒精使用（β  = 0.08，p）产生显着的间接影响= .020) 通过升高的 PTSD 症状。大麻使用的间接影响仍然不显着（β  = 0.05，p = . 100）。结论：由于 PTSD 症状加重，静脉注射幸存者可能特别面临滥用阿片类药物和可卡因的风险。需要整合 PTSD 和 SUD 的治疗方法来同时针对创伤性应激和物质使用。滥用阿片类药物和可卡因的女性可能特别受益于以创伤为中心的暴露心理治疗，以减轻 PTSD 症状，从而减少阿片类药物和可卡因的滥用。