Childhood Trauma, PTSD, and Substance Use

"The present study is the first to compare the clinical profiles of SUD+PTSD [Substance Use Disorder + Post Traumatic Stress Disorder] individuals with a history of CT [Childhood Trauma] to those with a history of adulthood only trauma. In line with previous research in the substance use literature, participants reported alarmingly high rates of CT exposure (77%) and childhood sexual abuse (55%) (Karadag et al., 2005; Medrano et al., 1999; Plotzker et al., 2007; Wu et al., 2010). Nonetheless, it is possible that these are actually underestimates of the true prevalence as these data are based on retrospective recall. Studies that have compared retrospective self-report against court records of abuse have shown that people often underreport histories of childhood sexual and physical abuse (Widom & Morris, 1997); (Widom & Shepard, 1996).

"The median age of onset of trauma exposure was 8 years, highlighting the importance of screening for trauma exposure in children by health care providers. Early detection is necessary so that early interventions may be implemented that may prevent that development of subsequent trauma-related mental health problems.

"The mental health of participants in the present study was poor. Consistent with previous studies of SUD+PTSD samples, there were high rates of depression (Brady, Killeen, Saladen, Dansky, & Becker, 1994; Tarrier & Sommerfield, 2003), anxiety (Najavits et al., 1998; Tarrier & Sommerfield, 2003) and BPD (Van Den Bosch, Verheul, Langeland, & Van Den Brink, 2003). Important differences were observed in relation to trauma, PTSD and substance use. The CT+ group experienced more trauma types in their lifetime compared to the CT− group. This finding is in accordance with a large body of literature that has found associations between CT, particularly CSA, and risk of re-traumatisation in adulthood (Arata, 2002; Desai, Arias, Thompson, & Basile, 2002; Jankowski, Leitenberg, Henning, & Coffey, 2002; Messman & Long, 1996). This is of clinical importance, as re-traumatisation has been associated with more complex PTSD symptom presentation (Briere, Kaltman, & Green, 2008; Cloitre et al., 2009; Gibson & Leitenberg, 2001), and other co-occurring anxiety disorders, such as generalised anxiety disorder, simple phobia and social phobia, as well as higher rates of suicide attempts and depression (Cloitre, Scarvalone, & Difede, 1997).

"As expected, the CT+ group had also experienced PTSD symptoms for a longer period of time, highlighting the chronic and pervasive nature of PTSD associated with CT. Despite having suffered PTSD for an average of 10 years very few had accessed treatment, highlighting an area of unmet need.

"Individuals with a history of CT presented with a more severe clinical profile in relation to a number of substance use characteristics when compared to those who experienced trauma confined to adulthood. The CT+ group had an earlier age of onset of substance use, had more extensive polydrug use histories, and a greater severity of dependence. These findings emphasise the long term effects and clinical implications associated with early trauma experiences and substance use. Given these findings it is not surprising that participants in the CT+ group also had higher rates of previous drug treatment episodes, which may indicate that current treatment programs are not addressing the needs of those who have a history of CT (Mills et al., 2005). The additional service utilisation among CT+ individuals translates into higher costs for the health care system, emphasising the need for appropriate treatment to be provisioned to this group (Hidalgo & Davidson, 2000)."