Emotional Processing in Individuals with Substance Use Disorder and Posttraumatic Stress Disorder

Kimberly A. Ehntholt,Shamil Wanigaratne,Laura K. Kemmis

doi:10.1007/s11469-016-9727-6

Abstract

Previous research has shown that individuals with substance use disorder (SUD) and posttraumatic stress disorder (PTSD) have emotional processing difficulties. However, no studies have specifically investigated the role of emotional processing in those with co-morbid SUD-PTSD. This study investigated whether there are more emotional processing abnormalities among patients with SUD-PTSD, than those with either a single diagnosis of PTSD or SUD. Emotional processing was assessed in three groups [1) SUD (without PTSD); 2) PTSD (without SUD); and 3) co-morbid SUD-PTSD] using the Emotional Processing Scale (EPS-25) and the International Affective Picture System (IAPS). Each of the three groups reported evidence of emotional processing dysfunction relative to the normal population. Within the SUD-PTSD group there was significant evidence that the additional impact of trauma increased emotional processing dysfunction but less evidence to suggest that substance use increased emotional processing dysfunction further. These findings call into question current United Kingdom guidelines for the treatment of co-morbid SUD-PTSD, which recommend that the drug or alcohol problem should be treated first.

Highlights

Previous research has shown that individuals with substance use disorder (SUD) and posttraumatic stress disorder (PTSD) have emotional processing difficulties
One barrier is that prolonged exposure (PE) treatment was traditionally considered inappropriate for use among patients with SUD due to safety concerns and risks of exacerbating symptoms (Foa and Rothbaum 1998)
This study examines whether individuals with SUD-Posttraumatic stress disorder (PTSD) have more emotional processing abnormalities compared to individuals with PTSD alone and individuals with SUD alone

Summary

Participants

A total of 90 individuals, aged between 18 and 70 years, were recruited through a PTSD outpatient treatment service and inpatient and community addiction services. Three screening measures were employed including the Traumatic Stress Questionnaire (TSQ; Brewin et al 2002) as well as the Alcohol Use Disorders Identification Test (AUDIT, Piccinelli et al 1997) or the Severity of Dependence Scale (SDS, Gossop et al 1995), depending on their substance of choice. The mean valence and arousal ratings for each picture have been published (Lang et al 2008) and are highly internally consistent (0.94 and 0.93) and have excellent test-retest validity (0.99 and 0.97), (Lang et al 2008) These ‘normed responses’ have yielded good agreement with control subjects in others studies (e.g. SpahicMihajlovic et al 2005) and were deemed appropriate for use with the present population. ‘Set A’ always preceded ‘Set B’ in order to ensure consistency with previous studies that have employed ‘Set A’ published by Lang et al (2008)

Procedure

Results

Discussion