Trauma Exposure, PTSD, and Alcohol Use Among Emerging Adults - PowerPoint Presentation

Slide1

Trauma Exposure, PTSD, and Alcohol Use Among Emerging Adults

Ananda Amstadter, PhDVirginia Institute for Psychiatric and Behavioral GeneticsSlide2
Slide3

Trauma Type

Females

Males

Total

Sexual Victimization

(pre VCU)

29.3%*

10.9%

22.2%

Physical Assault (pre VCU)21.0%28.9%*24.1%Sexual Victimization (since VCU)23.0%*11.6%18.7%Physical Assault (since VCU)9.3%12.4%*10.5%Sexual Victimization (revictimization)40.6%33.5%39.2%Physical Assault(revictimization)16.0%20.0%17.4%

(Overstreet, Hawn, Conley,

Kendler

, Dick*, Amstadter*, under review; *co-last)

(Conley, Overstreet, Hawn,

Kendler

, Dick*, Amstadter*, under review; *co-last) Slide4

Posttraumatic Stress

Disorder (PTSD) and Alcohol Use Disorder (AUD)

PTSD

Criterion A: Stressor

Intrusions

Avoidance

Negative Alterations in Cognitions and Mood

Alterations in Arousal and ReactivityDuration

>1 month

Function

ImpairmentDistress AUDDrank more than intendedWanted to cut downSpent a lot of time drinkingCravingInterference with lifeDrank despite problemsGiven up on desired activitiesDrinking increased harmContinued to drink even if it made one feel depressed/anxiousToleranceWithdrawalDSM-VSlide5

Trauma Exposure is Associated with Psychiatric Disorders

OR=3.21

OR=2.90

OR=2.80

OR=2.82

National Survey of Adolescents Slide6

PTSD

OR (95% CI)

Alcohol Abuse

OR (95% CI)

Gender

2.31

(1.67-3.19)

1.14 (.84-1.54)

Race/Ethnicity

1.08

(.78-1.49)1.31 (.95-1.82)Income1.03 (.97-1.10)1.07 (1.01-1.15)Sexual Assault2.86 (1.97-4.15)1.77 (1.17-2.66)Physical Assault3.61 (2.60-5.00)3.09 (2.24-4.25)Witnessed Violence3.27 (2.30-4.65)3.18 (2.26-4.47)Other trauma1.42 (1.04-1.94)1.45 (1.07-1.97)National Survey of Adolescents Slide7

PTSD and Alcohol Use Disorder Comorbidity

Nearly half of those seeking treatment for an AUD meet current criteria for PTSD (Brown et al., 1999), an estimate more than five times greater than the

lifetime

prevalence

52% of adult males and 30% of adult females with PTSD also have an AUD (Kessler et al., 1995)

PTSD was associated with a nearly 4 fold increased risk for AUD in young adults (Amstadter et al., 2014)Also shown in youth: 30% of adolescent males and 24% of adolescent females with PTSD also have a substance use disorder (Kilpatrick et al., 2003)Slide8

Models of Comorbidity

Self-medication hypothesisDrinking to copePTSD should precede AUDAUD may increase risk for PTSD

AUD will increase likelihood of trauma

Withdrawal is associated with

anxiogenic

withdrawal symptoms that increase PTSD symptoms after trauma exposure

Third variable hypothesisShared genetic riskTrauma exposure itself may increase riskSlide9

Test of the 3 Models in Adolescents

NSA-R; youth ages 12-17, n=3,614 assessed three times approximately one year apartCumulative trauma, PTSD, Alcohol use quantity and frequency to determine binge drinkingParallel process latent growth curve models demonstrated:

Cumulative trauma over time predicted increased PTSD and binge drinking

PTSD and binge drinking were NOT prospectively related when controlling for trauma exposure

Regardless of direction of causation, only significant when not controlling for trauma exposure

Specific to interpersonal trauma

Does not support self-medication or AUD-> PTSD modelsThird variable explanation: cumulative trauma exposure may have effects on neurobiological mechanisms that mediate vulnerability for both phenotypes

Shared genetic vulnerability?

(

Cisler

, Begle, Resnick, Danielson, Saunders, Kilpatrick, & Amstadter, 2012)Slide10

Trauma, PTSD, and Alcohol Use among VCU: S4S

Spit for Science - 1,197 students were included in analyses (68.0% female

). Students were assessed at the beginning of college, then each spring semester for two years

Quantity

and frequency of alcohol use,

traumatic events, and probable PTSD status

Linear growth curve models

demonstrated:Pre-college interpersonal PTE was associated with greater initial alcohol use for female but not male students

.

College

-onset interpersonal PTE predicted greater alcohol use at concurrent and future assessments for female but not male students, above and beyond the effects of pre-college interpersonal PTE. Pre-college probable PTSD did not predict initial level of alcohol use or alcohol trajectories.There may be a stronger and longer-lasting impact of interpersonal PTE for college women compared to men on alcohol phenotypesThe results highlight the need for secondary prevention to reduce the likelihood of negative outcomes such as problem drinking among college women impacted by interpersonal PTE.(Berenz*, Cho*, Overstreet, Kendler, Amstadter*, & Dick*, 2015; co-first/last) Slide11

Disaster Exposed Adolescents

704 youth, 12-17 were assessed for severity of trauma, PTSD, and binge drinking after a tornado, and a genetic risk sum score was computed for alcohol-phenotypesPTSD

symptoms mediated the effect of severity of exposure on drinking

Consistent with literature on self-medication

Higher

genetic risk was associated with binge drinking

Genetic risk moderated the effect of PTSD symptom on drinking (effect was strongest for those at or above the mean of genetic risk)Self-medication may be stronger for those with a greater propensity for alcohol misuse

Past Month Binge Drinking

Severity of Tornado-related Exposure

Adolescent PTSD symptoms

 Baseline Four-Month Follow-Up Twelve-Month Follow-Up 

Adolescent Genetic Risk

(

Bountress

,

Tomko

, Danielson, Williamson,

Vladimirov

, Gelernter, Ruggiero, & Amstadter, under review) Slide12

Conclusions and Implications

Across all three longitudinal studies the cumulative effect of trauma was related to both PTSD and alcohol outcomes, suggesting that secondary prevention among trauma exposed individuals is keyThis was demonstrated to be IPV specific in the first two studies, but found in a non-IPV sample when trauma severity was measured

Trauma exposure, especially during sensitive developmental windows, may have effects on

neurobiologic

systems related to both PTSD and AUD

Additional mechanistic studies are needed

Genetic risk may moderate the effect of PTSD symptoms on alcohol outcomesSelf-medication may be more pronounced for those at genetic risk alcohol outcomes, suggesting the need for multimodal studiesSlide13

Collaborators

Bounce

Back Now

Ken Ruggiero

Kaitlin

Bountress

Carla Danielson

Joel GelernterVlady

Vladimirov

Vernell

WilliamsonAnd othersSpit for ScienceDanielle DickKen KendlerErin BerenzBin ChoCassie OverstreetSage HawnAbigail ConleyAnd many more!National Survey of AdolescentsJosh CislerDean KilpatrickKen RuggieroHeidi ResnickCarla DanielsonAngie Moreland

I am

supported by grants R01AA020179, K02 AA023239

, BBRF

20066, R21 MH103686, R01MH101518, and P60MD002256.