Elsevier

Psychiatry Research

Volume 228, Issue 3, 30 August 2015, Pages 251-256
Psychiatry Research

Childhood adversities as specific contributors to the co-occurrence of posttraumatic stress and alcohol use disorders

https://doi.org/10.1016/j.psychres.2015.06.034Get rights and content

Highlights

  • Higher occurrences of childhood adversities were found in subjects with comorbid PTSD-AUD than in subjects with PTSD alone.

  • In particular, childhood sexual trauma was highly associated with PTSD-AUD comorbidity in adulthood.

  • Comorbid PTSD-AUD was linked to higher illness severity in terms of more psychiatric comorbidity and PTSD avoidance symptoms.

Abstract

There is much evidence that alcohol use disorders (AUD) often co-occur with posttraumatic stress disorders (PTSD), and that the comorbid condition is associated with a more severe clinical profile than that of PTSD without AUD. However, little is known about the role of childhood adversities as specific risk factors for the development of AUD in individuals presenting with PTSD. The aim of the study was to explore whether specific stressors from the spectrum of trauma and childhood adversities contribute to the development of AUD among subjects with PTSD. From a large community sample, of N=140 individuals with PTSD, N=24 (17.14%) received an additional diagnosis of AUD with an onset after the onset of PTSD. Those with comorbid PTSD/AUD and those with PTSD only were compared regarding type and features of their trauma, childhood adversities and psychiatric comorbidity. Compared to PTSD alone, PTSD/AUD was associated with higher levels of stress in terms of childhood adversities; in particular, sexual abuse below the age of 16, but also with having been brought up in a foster home. PTSD/AUD was also associated with an earlier age of adverse events. Treatment of AUD should include standardized assessments of trauma, especially of trauma experienced during childhood.

Introduction

The DSM-IV defines posttraumatic stress disorder (PTSD) as a psychological reaction following exposure to a traumatic event characterized by symptoms of re-experiencing, avoidance and increased arousal for at least one month (American Psychiatric Association, 1994). PTSD is frequently associated with a considerable amount of comorbid conditions and suicidality (Galatzer-Levy et al., 2013, Müller et al., 2014). Previous research suggests that the course and clinical profile of PTSD might be especially complicated by comorbid alcohol use disorders (AUD) (Carter et al., 2011, Saladin et al., 1995). Indeed, the co-occurrence of PTSD and AUD is well documented by a number of studies (for a review Debell et al., 2014; Stewart et al., 1998). The prevalence of AUD in individuals with PTSD was estimated from 10% in a community sample up to 61% in Vietnam veterans (Debell et al., 2014). In the general population PTSD, defined according to the DSM-IV, was the anxiety disorder that was most strongly associated with AUD (Leray et al., 2011, Norman et al., 2012). Although the epidemiological prevalence of PTSD/AUD is rather low compared to other co-occurring common mental disorders, this condition has been associated with some of the poorest treatment outcomes, a higher number of comorbid psychiatric conditions, functional impairment as well as lower quality of life (Blanco et al., 2013, Sartor et al., 2010).

The awareness of the negative consequences of co-occurring PTSD and AUD has led to a sizeable amount of research on its etiology in order to develop appropriate prevention and treatment strategies (Pennington et al., 2014, Schaumberg et al., 2015). Thereby, some research has focused on the role of adverse environmental factors in the etiology and functional association of these conditions (Maniglio, 2012, Norman et al., 2012, Stewart et al., 1998). Epidemiological data suggest that approximately three quarters of individuals with AUD have experienced at least one traumatic event during their lives (Mills et al., 2006).

There is evidence that certain trauma types, specifically childhood traumatic experiences, are outstanding determinants in the development of AUD in individuals with PTSD (Khoury et al., 2010). From those, sexual abuse appeared to be the most specific risk factor for a PTSD/AUD comorbidity in clinical as well as epidemiological samples (Langeland et al., 2004, Sartor et al., 2010). A recent epidemiological study also found that other adverse environmental factors during childhood, which refer to familial dysfunction such as parental mental health problems or familial instability, were more likely in individuals with PTSD and AUD than in those with PTSD alone (Blanco et al., 2013). Even although these findings are based on bi-variate associations, they raise an interesting point since no other data on this topic are currently available. Previous research has shown that adversities in childhood, such as unstable family structures, parental mental health and overall unhappy childhood increase the risk for both PTSD (Peleikis et al., 2004) and AUD (Kauhanen et al., 2011, Kestila et al., 2008), independently from adversities experienced during adulthood. However, it is not well known whether childhood adversities constitute a unique risk in comorbid cases (PTSD/AUD) after accounting for background variables such as sociodemographic and clinical factors. Accordingly, a number of individual level determinants that were found to be associated with an increased risk of having both PTSD and AUD have been taken into account. These factors comprise male gender, older age, lower educational attainment and lower socio-economic status, or having more psychiatric comorbidities including other substance use disorders and suicide attempts (Blanco et al., 2013, Leeies et al., 2010, Sonne et al., 2003).

While most research on the comorbidity of PTSD/AUD focused on clinical samples the current study provides the opportunity to examine environmental factors associated with this condition in a community sample. Notably, relatively few epidemiological data on trauma and PTSD are available for Switzerland (Hepp et al., 2006, Perrin et al., 2014). Compared to most other Western countries, Switzerland is a relatively secure environment with rather low rates of trauma exposure (Hepp et al., 2006, Perrin et al., 2014). On the other hand there were quite high rates of PTSD in the current sample compared to other populations with similar or even higher rates of exposure (Kawakami et al., 2014, Müller et al., 2014, Olaya et al., 2014), which makes this sample somewhat unique in the general population.

The current study aims to examine how trauma characteristics (type and age of trauma), and other environmental adversities that occurred during childhood (dysfunctional familial environment) are related to comorbid AUD in our community sample of individuals with PTSD. First, we hypothesized that sexual abuse would be more likely in the comorbid condition group than in the group with PTSD alone while we expected no such associations for other trauma types. Second, we expected trauma exposure below the age of 16, in particular sexual abuse, to be more strongly related to the comorbid condition than to PTSD alone. We also expected the comorbid group to report a younger recalled age of exposure to sexual trauma in particular than the group with PTSD alone. Finally, we sought to replicate earlier preliminary findings of high associations between childhood environmental adversities and comorbid PTSD/AUD. Thus, we hypothesized that the comorbid group were more likely to have experienced an adverse childhood environment than the group with PTSD alone.

Section snippets

Sample and procedure

All data were collected within the PsyCoLaus study, a subsample from the larger CoLaus study, a randomly selected population-based cohort study in Lausanne, i.e. in the French-speaking part of Switzerland. From 2003 to 2006, a community sample of N=6734 subjects aged between 35 and 75 years was recruited for the first wave of CoLaus, an epidemiological study designed to assess the prevalence of cardiovascular risk factors and diseases. From a total of 5,535 individuals that finally participated

Results

Table 1 shows the distribution of socio-demographic and clinical variables for the total sample and the subsamples of subjects with PTSD/AUD (17.14%) and PTSD alone (82.86%), respectively. The comorbid group did not differ from those with PTSD alone regarding any socio-demographic characteristics. However, compared to PTSD alone, comorbid PTSD/AUD was associated with higher rates of antisocial personality disorder, other substance-related disorders, lifetime suicide attempts as well as with a

Discussion

The present study aimed to examine environmental factors that potentially contribute to the development of comorbid AUD in subjects with pre-existing PTSD. For this analysis, individuals with a lifetime diagnosis of PTSD were chosen from a large representative sample from the Swiss community. Lifetime and childhood traumatic events as well as markers of adverse or dysfunctional childhood environments were examined for their association with the development of AUD.

As expected, our results

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    The authors declare that they have no competing interests.

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