Penk W E, Peck R F, Robinowitz R, Bell W, Little D
Psychology Service, Veterans Administration Medical Center, Boston, Massachusetts.
Recent Dev Alcohol. 1988;6:69-88. doi: 10.1007/978-1-4615-7718-8_4.
A review of the literature on coping processes in addiction disorders yields at least two notions: one, that substance abuse is associated with less efficient, avoidant ways of coping with problems in living; and two, that substance abusers with a background of traumatic and stressful experiences are readily distinguishable by even more avoidant coping styles. These notions were tested in the form of three hypotheses: (1) substance abusers in general employ more avoidant coping styles than do nonaddicted groups; (2) Vietnam combat veterans meeting DSM-III criteria for both substance use disorder and posttraumatic stress disorder (PTSD) evidence significantly more avoidant coping styles than do Vietnam combat veterans meeting criteria only for substance use disorder but not PTSD--particularly when dealing with internal states of anxiety; and (3) for those meeting both substance use disorder and PTSD criteria, black Vietnam combat veterans (who presumably have encountered more stress, as minority group members) evidence more avoidant coping styles than do white Vietnam combat veterans. These three hypotheses were tested with Peck's (1981) newly developed Individual Styles of Coping, measuring four stages in the coping process for five behavioral contexts. All three hypotheses were confirmed. Results were discussed as confirming recent changes in DSM-III-Revised (1987) criteria, emphasizing generalized avoidance manuevers as criterial, in part, for diagnosing PTSD (in addition to behaviors of specific avoidance of traumatic memories). Theoretical implications about a traumatogenic dimension for substance abuse among some Vietnam combat veterans were discussed, as well as ramifications for treatment programming.
其一，物质滥用与应对生活问题的低效、回避方式相关；其二，有创伤和压力经历背景的物质滥用者，其回避应对方式更为明显，这一点很容易区分。这些观点通过三个假设进行检验：（1）一般而言，物质滥用者比非成瘾群体更多地采用回避应对方式；（2）符合《精神疾病诊断与统计手册第三版》（DSM-III）中物质使用障碍和创伤后应激障碍（PTSD）标准的越南战争退伍军人，比仅符合物质使用障碍标准但不符合PTSD标准的越南战争退伍军人，表现出显著更多的回避应对方式——尤其是在应对焦虑的内心状态时；（3）对于那些同时符合物质使用障碍和PTSD标准的人，黑人越南战争退伍军人（作为少数群体成员，他们可能遭遇了更多压力）比白人越南战争退伍军人表现出更多的回避应对方式。这三个假设通过佩克（1981年）新开发的个体应对方式量表进行检验，该量表测量了五个行为情境下应对过程的四个阶段。所有三个假设均得到证实。研究结果被讨论为证实了《精神疾病诊断与统计手册第三版修订本》（1987年）标准中的最新变化，强调广义的回避策略部分作为诊断PTSD的标准（除了特定回避创伤记忆的行为）。文中还讨论了一些越南战争退伍军人物质滥用的创伤成因维度的理论意义，以及对治疗方案的影响。
