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Trauma, Gender, and Mental Health Symptoms in Individuals with Substance Use Disorders.

Journal of Interpersonal Violence 2014;30(1):3-24. [doi: 10.1177/0886260514532523]

Lori Keyser-Marcus, PhD (Virginia Commonwealth University, MA Node), Anika Alvanzo, MD, MS (Johns Hopkins University School of Medicine, MA Node), Traci R. Rieckmann, PhD (Oregon Health & Science University, WS Node), Leroy Thacker, PhD (Virginia Commonwealth University, MA Node), Allison Sepulveda (Virginia Commonwealth University, MA Node), Alyssa A. Forcehimes, PhD (University of New Mexico, SW Node), Leila Z. Islam, PhD (Virginia Commonwealth University, MA Node), Monica Leisey, PhD, MSW (Salem State University), Maxine L. Stitzer, PhD (Johns Hopkins University School of Medicine, MA Node), Dace S. Svikis, PhD (Virginia Commonwealth University, MA Node).

Individuals with substance use disorders are often plagued by psychiatric comorbidities and histories of physical and/or sexual trauma. Males and females, although different in their rates of expressed trauma and psychiatric symptomatology, experience comparable adverse consequences, including poorer substance abuse treatment outcomes, diminished psychosocial functioning, and severe employment problems. This study's goal was to examine the relationships between trauma history, lifetime endorsement of psychiatric symptoms, and gender in a sample of individuals participating in outpatient substance abuse treatment.

Study participants (N=625) from six psychosocial counseling and five methadone maintenance programs were recruited as part of a larger study of an employment intervention conducted through the National Drug Abuse Treatment Clinical Trials Network (CTN-0020, "Job Seekers Training for Patients with Drug Dependence"). Measures included lifetime trauma experience (yes/no), type of trauma experienced (sexual, physical, both), lifetime depression/anxiety, and lifetime suicidal thoughts/attempts (as measured by the Addiction Severity Index-Lite (ASI-Lite)). Lifetime endorsement of psychiatric symptoms was compared between individuals with and without trauma history. The role of gender was also examined. Results indicated that the experience of trauma was associated with an increase in lifetime report of psychiatric symptoms. Experience of physical and combined physical and sexual trauma consistently predicted positive report of psychiatric symptoms in both males and females, even when controlling for demographic and treatment-related variables. Employment outcomes, however, were not predicted by self-reported history of lifetime trauma.

Conclusions: Consistent with previous research, a substantial proportion of the study sample -- nearly 50% -- reported a lifetime history of physical and/or sexual victimization. Not surprisingly, the hypothesis regarding gender differences in rates of abuse was also confirmed in this study, a finding consistent with prior research demonstrating that women with SUDs typically experience dramatically higher rates (2 times or greater) of lifetime physical and sexual trauma than men. That said, although rates of trauma in the current sample were higher for women, the severity of mental health symptoms was comparable in males and females, suggesting that the aftermath of trauma equally affects both sexes. These findings highlight the need for improved gender-specific trauma screening and intervention strategies, as well as future research on techniques to better identify and treat the overlooked population of men with trauma histories. (Article (Peer-Reviewed), PDF, English, 2014)

Keywords: Co-occurring disorders | CTN platform/ancillary study | Gender-specific interventions | Post-traumatic stress disorder (PTSD) | Sexual abuse | Trauma | Vocational rehabilitation | Women | Journal of Interpersonal Violence (journal)

Document No: 1065, PMID: 24811286, PMCID: PMC4766974.

Submitted by the CTN Dissemination Librarians, 5/15/2014.

Alvanzo, Anika search
Forcehimes, Alyssa A. search mail
Islam, Leila Z. search
Keyser-Marcus, Lori search mail
Leisey, Monica search
Rieckmann, Traci R. search mail
Sepulveda, Allison search
Stitzer, Maxine L. search mail
Svikis, Dace S. search mail
Thacker, Leroy search
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