Walsh Kate, Elliott Jennifer C, Shmulewitz Dvora, Aharonovich Efrat, Strous Rael, Frisch Amos, Weizman Abraham, Spivak Baruch, Grant Bridget F, Hasin Deborah
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA.
Department of Psychiatry, Columbia University Medical Center, New York, New York 10032, USA; New York State Psychiatric Institute, New York, New York 10032, USA.
Compr Psychiatry. 2014 Apr;55(3):621-30. doi: 10.1016/j.comppsych.2013.11.016. Epub 2013 Nov 27.
Substance dependence is more common among trauma-exposed individuals; however, most studies suggest that Posttraumatic Stress Disorder (PTSD) accounts for the link between trauma exposure (TE) and substance dependence.
This study examined associations between TE and substance dependence (alcohol, nicotine, and marijuana), and whether PTSD accounted for this association.
1317 Jewish Israeli household residents completed in-person structured interviews assessing TE, PTSD, and substance (alcohol, nicotine, marijuana) dependence between 2007 and 2009. Regression analyses examined associations among TE, PTSD, and substance dependence.
In the full sample, mean number of traumatic events was 2.7 (sd=2.2), with 83.7% experiencing at least one event. In the full sample, mean number of PTSD symptoms was 2.5 (sd=3.4), with 13.5% meeting PTSD diagnostic criteria. Prevalence of alcohol dependence was 13.4%; nicotine dependence 52.8%; and marijuana dependence 12.1%. Number of traumatic events was associated with increased odds of alcohol (OR=1.3; 95% CI=1.2-1.4) and nicotine (OR=1.2; 95% CI=1.1-1.3) dependence. Similarly, any traumatic event exposure was associated with increased odds of alcohol (OR=3.1; 95% CI=1.6-6.0) and nicotine (OR=1.9; 95% CI=1.2-2.9) dependence. PTSD symptoms were associated with increased odds of alcohol (OR=1.2; 95% CI=1.1-1.3), nicotine (OR=1.1; 95% CI=1.1-1.2), and marijuana (OR=1.1; 95% CI=1.04-1.2) dependence; similarly, a PTSD diagnosis was associated with increased odds of alcohol (OR=3.4; 95% CI=2.1-5.5), nicotine (OR=2.2; 95% CI=1.4-3.4), and marijuana (OR=2.6; 95% CI=1.2-5.9) dependence. PTSD symptoms accounted for a sizeable proportion of the TE effect on alcohol (46%) and nicotine dependence (31%).
Individuals with more traumatic events had heightened risk for alcohol and nicotine dependence, and PTSD symptoms partially accounted for this risk. However, marijuana dependence was only significantly related to PTSD symptoms. Clinicians and researchers should separately assess different types of dependence among trauma-exposed individuals both with and without PTSD symptoms.
物质依赖在经历过创伤的个体中更为常见；然而，大多数研究表明创伤后应激障碍（PTSD）是创伤暴露（TE）与物质依赖之间的联系所在。
本研究考察了TE与物质依赖（酒精、尼古丁和大麻）之间的关联，以及PTSD是否能解释这种关联。
2007年至2009年期间，1317名以色列犹太家庭居民完成了面对面的结构化访谈，评估TE、PTSD以及物质（酒精、尼古丁、大麻）依赖情况。回归分析考察了TE、PTSD和物质依赖之间的关联。
在整个样本中，创伤事件的平均数量为2.7（标准差=2.2），83.7%的人经历过至少一次事件。在整个样本中，PTSD症状的平均数量为2.5（标准差=3.4），13.5%的人符合PTSD诊断标准。酒精依赖的患病率为13.4%；尼古丁依赖为52.8%；大麻依赖为12.1%。创伤事件的数量与酒精（比值比=1.3；95%置信区间=1.2 - 1.4）和尼古丁（比值比=1.2；95%置信区间=1.1 - 1.3）依赖几率的增加相关。同样，任何创伤事件暴露都与酒精（比值比=3.1；95%置信区间=1.6 - 6.0）和尼古丁（比值比=1.9；95%置信区间=1.2 - 2.9）依赖几率的增加相关。PTSD症状与酒精（比值比=1.2；95%置信区间=1.1 - 1.3）、尼古丁（比值比=1.1；95%置信区间=1.1 - 1.2）和大麻（比值比=1.1；95%置信区间=1.04 - 1.2）依赖几率的增加相关；同样，PTSD诊断与酒精（比值比=3.4；95%置信区间=2.1 - 5.5）、尼古丁（比值比=2.2；95%置信区间=1.4 - 3.4）和大麻（比值比=2.6；95%置信区间=1.2 - 5.9）依赖几率的增加相关。PTSD症状在TE对酒精（46%）和尼古丁依赖（31%）的影响中占相当大的比例。
经历更多创伤事件的个体酒精和尼古丁依赖风险更高，PTSD症状部分解释了这种风险。然而，大麻依赖仅与PTSD症状显著相关。临床医生和研究人员应分别评估有和没有PTSD症状的创伤暴露个体中不同类型的依赖情况。
