Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
Division of Clinical Psychology and Psychotherapy, Dept. of Psychology, Philipps-University of Marburg, Marburg, Germany.
Addict Sci Clin Pract. 2022 Sep 4;17(1):46. doi: 10.1186/s13722-022-00329-y.
Post-traumatic stress disorder (PTSD) and substance use disorders (SUDs) often co-occur in adolescent patients. Previous research has shown that these patients differ from SUD patients without PTSD in terms of their substance use patterns. In this study, we aimed to test whether substance use in this population is related to an attempt to self-medicate PTSD-related symptoms.
German adolescent patients (aged 13-18 years) at an outpatient clinic for SUD treatment, n = 111 (43% female), completed a self-designed questionnaire on use motives, a measure of PTSD-related experiences, and underwent a standardized psychiatric interview including structured substance use questions. Participants were subsequently classified as 'no traumatic experiences ('noTEs' but SUD), 'traumatic experiences but no current PTSD diagnosis' ('TEs' with SUD), and 'PTSD' with SUD. After establishing a self-designed motive measurement through exploratory and confirmatory factor analyses, we calculated non-parametric group differences and a mediation analysis in a linear regression framework.
The past-year frequency of MDMA use was highest in the PTSD group and lowest in the noTE group (H (2) = 7.2, p = .027, η = .058), but no differences were found for frequencies of tobacco, alcohol, cannabis, or stimulant use (all H ≤ 4.9, p ≥ .085, η ≤ .033). While controlling for sex, the three groups showed a similar pattern (highest in the PTSD group and lowest in the noTE group) for coping scores (F (103) = 5.77, p = .004, η = .101). Finally, mediation analyses revealed an indirect effect of coping score (b = 0.61, 95% CI [0.29, 1.58], p = .145) on the association between group membership and MDMA use frequency.
In adolescent SUD patients, we found an association of current PTSD and lifetime traumatic experiences with higher MDMA use that could be partially explained by substance use being motivated by an attempt to cope with mental health symptoms. This indicates a coping process involved specifically in MDMA use compared to the use of other psychoactive substances, possibly due to unique psychoactive effects of MDMA.
创伤后应激障碍（PTSD）和物质使用障碍（SUD）在青少年患者中常同时发生。既往研究表明，与无 PTSD 的 SUD 患者相比，这些患者的物质使用模式存在差异。本研究旨在测试该人群的物质使用是否与试图自我治疗 PTSD 相关症状有关。
在一家 SUD 治疗门诊，纳入年龄在 13-18 岁的德国青少年患者（n=111，43%为女性），完成了一份关于使用动机的自我设计问卷、一份与 PTSD 相关经历的测量表，并接受了包括结构化物质使用问题的标准化精神病学访谈。随后，根据创伤经历和 PTSD 诊断，将参与者分为“无创伤经历（无 PTSD 但有 SUD）”、“有创伤经历但无当前 PTSD 诊断（有 PTSD 但有 SUD）”和“有 PTSD 且有 SUD”。通过探索性和验证性因素分析建立自我设计的动机测量后，我们在线性回归框架中计算了非参数组间差异和中介分析。
在 PTSD 组中，过去一年 MDMA 使用的频率最高，在无创伤经历组中最低（H（2）=7.2，p=0.027，η=0.058），但在烟草、酒精、大麻或兴奋剂使用频率方面未发现差异（所有 H≤4.9，p≥0.085，η≤0.033）。在控制性别后，三组的应对评分模式相似（PTSD 组最高，无创伤经历组最低）（F（103）=5.77，p=0.004，η=0.101）。最后，中介分析显示，应对评分（b=0.61，95%CI [0.29，1.58]，p=0.145）对 PTSD 分组和 MDMA 使用频率之间关联的间接效应。
在青少年 SUD 患者中，我们发现当前 PTSD 和终生创伤经历与更高的 MDMA 使用相关，这可以部分解释为物质使用的动机是试图应对心理健康症状。这表明与使用其他精神活性物质相比，与 MDMA 使用相关的特定于物质的应对过程，这可能是由于 MDMA 的独特精神活性作用。
