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Am J Psychiatry 1992; 149:664-670
Copyright © 1992 by American Psychiatric Association
Posttraumatic stress disorder among substance users from the general population
LB Cottler, WM Compton 3d, D Mager, EL Spitznagel and A Janca
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110.
OBJECTIVE: The purpose of the study was to evaluate the prevalence of
posttraumatic stress disorder (PTSD) among substance users in the general
population. METHOD: The St. Louis Epidemiologic Catchment Area study, a
survey of psychiatric illness in the general population, collected data on
PTSD and substance use with the Diagnostic Interview Schedule. Among the
2,663 respondents, 430 reported a traumatic event that could qualify for
PTSD; however, the rate of PTSD was low, 1.35% overall. To evaluate the
relationship between PTSD and substance use, respondents were
hierarchically classified into one of four substance use categories ranging
from polydrug use to alcohol use only. Substance users from each category
as well as substance users in general were compared with persons who did
not meet the substance use threshold (comparison subjects). RESULTS:
Findings indicate that cocaine/opiate users are over three times as likely
as comparison subjects to report a traumatic event, report more symptoms
and events, and are more likely to meet diagnostic criteria for PTSD.
Physical attack, but not combat- related events, was the most prevalent
event reported among cocaine/opiate users. Onset of substance use preceded
onset of posttraumatic symptoms, suggesting that substance use predisposes
the individual to exposure to traumatic events. When other variables--
including antisocial behavior--were controlled, female gender and use of
cocaine/opiates predicted PTSD. CONCLUSIONS: These analyses of the
co-occurrence of substance abuse and PTSD warrant further study and suggest
that PTSD is much more common among substance abusers than was previously
known.
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