Substance use disorders (SUDs) continue to be associated with significant mental health problems (Brady & Randall, 1999; Finney, Moos, &Timko, 1999; Schukit, 2006). SUDs are commonly associated with other psychological disorders, thus complicating treatment for these populations and influencing treatment outcomes (Najt, Fusar-Poli, & Brambilla, 2011; Compton, Cottler, Abdallah, & Spitznagel, 2003). Women with substance use disorders (SUDs) have co-occurring disorders (Mangrum, Spence, & Steinley-Bumgarner, 2006), more impaired psychological and occupational functioning and often have difficulty adhering to treatment regimens (Mangrum, Spence, & Steinley-Bumgarner, 2006). Exposure to trauma is often related to the onset of several psychological disorders and has been shown to significantly predict substance use (Dansky, Brady, Saladin, Killeen, Becker, & Roitzsch, 1996). Peritraumatic dissociation (PD) is a specific symptom cluster associated with trauma exposure. It is defined as emotional numbing, detachment, and memory impairments shortly after a traumatic experience (van der Velden & Wittmann, 2008). PD has been found to significantly predict PTSD among college students (Bernat, Ronfeldt, Calhoun, & Arias, 1998) and women with histories of trauma (Olde, van der Hart, Kleber, van Son, Wijen, & Pop, 2005). However, neither of these studies examined the influence of PD symptoms among women with histories of SUDs who have been shown to be at higher risk for long term psychological dysfunction and poorer treatment outcomes (Levin, Ilgen, & Moos, 2007). It is unclear how PD influences psychological symptoms, making it difficult to determine what (if any) influence PD symptoms have on treatment outcomes or psychological functioning.
Procedures: In the original study (Hien et al., 2005), interested women were asked to consent on IRB approved written consent forms. Next, the participants were screened to ensure they met the inclusion criteria for substance abuse or dependence and PTSD or subthreshold PTSD. Once the baseline assessment was completed, each site randomly assigned participants into the trauma or WHE group. Data on treatment service utilization, abstinence, PTSD symptom severity, global psychiatric symptoms, and substance use severity were collected across four time intervals.
Results and Discussion
The findings did not support hypothesis one. Specifically. PD did not predict days of substance abuse or treatment utilization at 6 months. The results did support hypothesis two baseline as PD symptom severity was significantly associated with greater psychiatric symptom severity and more PTSD symptoms at all four time intervals. The findings did not support the hypothesis that PD symptoms were associated with greater substance use severity. The results also revealed that relationship between PD and PTSD is weaker among African Americans than Whites.
This study clearly demonstrates the relation of PD to psychiatric symptoms among substance using women with trauma histories. The findings suggest that addressing trauma generally and PD specifically may be essential to psychological functioning among women with histories of trauma and SUDs. These findings have been consistent in the literature and suggest that PD symptoms are associated with greater psychological impairments (Sibranji, et.al, 2012; Breh & Seidler, 2007).