Abstract
Aims: Epidemiological studies indicate Posttraumatic Stress Disorder (PTSD) frequently co-occurs with substance use and abuse, particularly among women. This study examined the PTSDsubstance use relation in a sample of men and women smokers with serious mental illness. Methods: 733 adult smokers (51% male) aged 18–73, were recruited from 5 acute inpatient psychiatry units. The e-MINI measured PTSD. Past 30-day substance use and readiness to change were assessed for heavy alcohol use (ALC), stimulants (STIM), sedatives (SED), hallucinogens (HAL), opiates (OP), and marijuana (MJ). The SF-12 assessed physical and mental health functioning. Logistic regression analyses tested for women and men separately the relation of PTSD with substance use and readiness to change. Results: 44% of women and 36% of men had PTSD. Past 30 day use of ALC, STIM, SED, OP and MJ was high (women range: 21.5–39.6%, men range: 24.9–47.1%). HAL use was lower (women: 3.9%, men: 5.9%). On average, women used 1.6 (sd =1.2) and men used 1.7 (sd =1.2) substances, during the past 30 days. Adjusting for covariates, use of OP (OR=2.1, p= .01), SED (OR=1.8, p= .02), and MJ (OR=1.9, p= .01) predicted PTSD in women. Use of STIM (OR=1.8, p= .04) and MJ (OR=1.7, p= .04) predicted PTSD in men. Number of substances used predicted PTSD in women (OR=1.5, p< .01), but not men. PTSD was unrelated to motivation to quit ALC/drugs. PTSD and # of substances used were associated with poorermental health functioning, anda significant interaction indicated mental health functioning was the worst among those with both PTSD and greater substance use (b=2.1, p= .03). Conclusions: Among smokers with serious mental illness, recent heavy alcohol, illicit drug use, and PTSD were common, found to co-occur, and predictive of worse mental health functioning. Integrative treatments for PTSD and substance abuse, with attention to sex-specific drugs of abuse, appear warranted. Financial support: Funding: K23MH083684, K05DA01869, P50DA09253, TRDRP#23BT-0018, T32HL007034.
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