74.2 EXPLORING BIOLOGIC INTERSECTIONS OF TRAUMA AND SUBSTANCE USE DISORDERS

Abstract

The objectives of this presentation are to: 1) review overlapping functional domains and symptoms in PTSD and substance use disorders (SUDs); 2) learn about shared neurobiologic factors; and 3) explore how co-occurring disorders and findings may result in symptom exacerbation. A review of the literature was conducted in PubMed. Supplemented with case vignettes, we will present common functional domains in PTSD and SUD. Neurobiologic factors, including neuroimmune, neuroanatomy, and connectivity, will be discussed. Case vignettes will be used to facilitate group discussion of overlapping symptoms between trauma and states of substance intoxication or withdrawal and to explore how co-occurring disorders may result in symptom exacerbation. Neurodevelopment continues through adolescence, which is a vulnerable period for exposure to trauma and substance use. Youth with a history of childhood maltreatment are at increased risk of developing co-occurring PTSD and SUD. In addition, adolescence is a time of increasing autonomy and risk-taking behaviors. Increasing prevalence of substance use and risk taking may subsequently result in more traumatic exposures. Substance use may also exacerbate trauma symptoms, and trauma symptoms may reinforce substance use habits. Likewise, there is overlap in symptoms between specific states of intoxication or withdrawal and PTSD, including mood, autonomic hyperactivity, alterations in arousal and reactivity, hypervigilance, and sleep disturbance. Through clinical vignettes, we will synthesize overlapping symptoms, theories of co-occurring disorders, and suspected neurobiologic changes. Neurobiologic changes that will be reviewed include catecholamine expression, the hypothalamic-pituitary-adrenal (HPA) axis, neuroimmunology, and neuroanatomy and connectivity. Research has also identified impulsivity and resilience as common domains of interest, as well as the possibility of sensitization/cross-sensitization. PTSD and SUD commonly co-occur. It is important to develop an understanding of overlapping symptoms, mechanisms of reinforcement, and neurobiologic changes that may complicate treatment and lead to poorer outcomes.