Academic journal article Violence and Victims

Correlates of Comorbid PTSD and Polysubstance Use in Sexual Assault Victims

Academic journal article Violence and Victims

Correlates of Comorbid PTSD and Polysubstance Use in Sexual Assault Victims

Article excerpt

A diverse sample of community-residing women in a large metropolitan area who had experienced adult sexual assault was surveyed using standardized measures in an NIAAA-funded study (2003-2004). Four groups ( N = 503) of victims: (1) post-traumatic stress disorder (PTSD)-only, (2) PTSD and illicit drug use, (3) PTSD and drinking problems, and (4) PTSD and polysubstance use were compared using bivariate analyses. Victims with PTSD/polysubstance use had lower socioeconomic status, more extensive trauma histories, worse current psychological functioning, more problematic post-assault psychosocial experiences, and more sexual revictimization at follow-up than those with PTSD only. Implications for future research are discussed.

Keywords: sexual assault; comorbidity; polysubstance use; PTSD; survey; women

Researchers have identified numerous effects of sexual assault on women, including post-traumatic stress disorder (PTSD), alcohol problems, and drug use (Foa & Riggs, 1993; Stewart & Israeli, 2000; Thompson, Arias, Basile, & Desai, 2002; Ullman, 2003). Sexual violence is related to one of the highest rates of PTSD in civilian samples (see review in Norris, Foster, & Weisshaar, 2002), with one-third of female rape victims developing PTSD at some time in their lives compared with 5% of nonvictims (Kilpatrick, Edmunds, & Seymour, 1992). Having a sexual assault history is also associated with a greater risk of drinking problems or drug abuse/dependence in women (Burnam et al., 1988; Kilpatrick, Acierno, Resnick, Saunders, & Best, 1997; Wilsnack, Vogeltanz, Klassen, & Harris, 1997) than not having such experiences. For example, in a recent longitudinal analysis of a national sample of women, those assaulted during the two-year study period were 2.8 times more likely to be diagnosed with alcohol abuse than nonassaulted women (Kilpatrick et al., 1997). In addition, child sexual abuse was found to be associated with 2.93 times greater odds of drug dependence for adult women from a large nonclinical sample than for nonabused controls (Kendler et al., 2000).

In addition, recent reviews suggest significant comorbidity (e.g., co-occurrence) of PTSD and substance abuse/drinking problems, particularly in female trauma survivors (Stewart, 1996; Stewart & Israeli, 2000). Theories such as the self-medication hypothesis (Cappell & Greeley, 1987) posit that victims suffering from PTSD may use alcohol to reduce reexperiencing and intrusive symptoms of PTSD. While this form of coping may dampen trauma symptoms in the short run, in the long run this coping strategy may result in chronic PTSD (Chilcoat & Breslau, 1998; Stewart, Pihl, Conrod, & Dungies, 1998). In support of this model, Epstein, Saunders, Kilpatrick, and Resnick's (1998) longitudinal study of U.S. women showed that PTSD symptoms developing after childhood rape were followed by twice the number of alcohol abuse symptoms. Studies of community samples (not of victims specifically) show that, in most cases (65.1% to 84.3%), PTSD predates substance use disorders (SUDs) in women experiencing both disorders (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995) and that once PTSD remits, the increased risk of a secondary SUD disappears (Kessler, 2000). It is likely that various trauma-related factors and post-trauma social cognitive variables are related to PTSD, drinking problems, and drug use in complex ways. Factors that have been studied include trauma histories, post-assault social support, coping, self-blame, alcohol expectancies, and substance use to cope with distress. However, these variables have typically been studied in relationship to single outcomes (e.g., PTSD, drinking, or drug use) in individual studies, not all three in various combinations within a given study.

For instance, separate investigations have shown that trauma histories and child sexual abuse in particular are related to greater risk of both PTSD, drinking problems, and drug abuse in women (Kendler et al. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.