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EVIDENCE IN ACTION
A quarterly research brief from the
Center on Trauma and Children
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Trauma and Substance Use Disorder in Youth
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Cole, J., Sprang, G., & Silman, M. (2018). Interpersonal Trauma Exposure, Trauma Symptoms, and Severity of Substance Use Disorder among Youth Entering Outpatient Substance Abuse Treatment, Journal of Child and Adolescent Trauma,
https://doi.org/10.1007/s40653-018-0239-3
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The prevalence of
interpersonal victimization among clinical populations has been reported to be as high as
60% for an adolescent outpatient sample, and
87% in a residential treatment sample (Shane et al., 2006). With regard to one
major type of interpersonal trauma exposure, child maltreatment, a review of 35 studies of community and school samples found significant associations between childhood maltreatment and alcohol and drug misuse (Tonmyr et al., 2010
), consistent with findings from large scale studies in community, clinical and child welfare populations (Goldstein et al., 2011; Kobulsky et al., 2016; Yoon et al., 2017;
Moran et al., 2004
; Pilowsky and Wu, 2006
). A substantial body of literature has found associations between interpersonal victimization, trauma symptoms, and substance use disorders (SUD) among adolescents. Substance use may serve as a coping strategy to buffer the emotional and neurobiological dysregulation associated with traumatic stress (Andersen & Teicher, 2009; Briere et al., 2010; Cohen et al., 2003; De Bellis, 2002), specifically managing feelings of
shame (Goldstein et al., 2011).
In this study, secondary data analysis was conducted on structured interview data collected by treatment providers as 172 adolescents (ages 12
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19) entered outpatient substance abuse treatment. Results indicate high prevalence rates of interpersonal trauma exposure: 71.5% self-reported trauma exposure, specifically direct physical abuse or assault, sexual abuse or assault, and/or witnessing intimate partner violence toward a parent. Severity of SUD, as measured by the number of DSM-5 criteria endorsed, was not only associated with the number of types of criterion A events for Posttraumatic Stress Disorder, but also more self-reported internalizing problems. Additionally, there was no significant relationship between the severity of SUD and the severity of trauma symptoms at treatment intake, gender, or attention problems.
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- Ongoing assessment of possible trauma symptoms is recommended throughout substance abuse treatment with youth who have reported trauma exposure, as well as continued screening of trauma exposure as symptoms may emerge during treatment.
- Youth with comorbid substance use and trauma exposure require treatment approaches that can simultaneously counteract the neuro-adaptation to drug effects, modulate sensitization to rewards and punishment, and attenuate negative mood states.
- The Integrated Dual Disorder Treatment (IDDT) model is an evidence-based framework that could be used to combine adolescent substance abuse treatment with empirically established trauma treatments, which may reduce trauma symptoms, improve functioning, and promote recovery or remission from addiction (Drake et al., 2006).
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Acknowledgments
This research was supported in part by the Kentucky Department of Behavioral Health, Developmental and Intellectual Disabilities, Division of Behavioral Health under a contract with the University of Kentucky
Center on Drug and Alcohol Research.
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