Post-traumatic Stress Disorder and Substance Use Disorders
There is a high incidence of exposure to traumatic experiences in the U.S. general population. The majority of the population at some time in their lives experience a distressing and traumatic event. Two common psychiatric conditions that occur post-trauma include post-traumatic stress disorder and substance use, abuse, or dependence. This chapter summarizes current literature on the shared epidemiology, course, genetic, and neurobiological basis of post-traumatic stress disorder (PTSD) and substance use disorders (SUDs), as well as provides guidance on current treatment approaches. A uniformly strong association between PTSD and SUDs has been reported. This association has a number of clinically important implications regarding the course, severity, additional comorbidity, daily functioning, and treatment outcomes for both PTSD and SUDs. Various theories regarding the nature of the causal relationship are reviewed in the chapter, including hypotheses that SUDs predispose to PTSD, SUDs are used to self-medicate PTSD, and that the co-occurrence is due to a shared genetic vulnerability. Relevant neurobiological literature on stress and substance use in both human and laboratory animal research is reviewed, focusing on the role of norepinephrine, corticotropin-releasing factor (CRF), and dopamine.
