Posttraumatic Stress Disorder and the Incidence of Nicotine, Alcohol, and Other Drug Disorders in Persons Who Have Experienced Trauma

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Abstract
ASSOCIATIONS BETWEEN posttraumatic stress disorder (PTSD) and substance use disorders have been reported in studies1-11 of Vietnam veterans and civilian samples. Little is known about the causal pathways that might explain these associations. Alternative explanations have been proposed.7 First, substance use disorders increase the likelihood of PTSD either by their association with lifestyles that involve an elevated risk of exposure to traumatic events that induce PTSD or by increasing persons' susceptibility to the PTSD-inducing effects of trauma. Second, PTSD is a causal risk factor for substance use disorders, when substances are used to relieve distressing symptoms of PTSD. Third, the association of substance use disorders with PTSD might be noncausal, reflecting shared genetic or environmental factors. Genetic factors common to PTSD, alcohol consumption or disorder, and other drug disorders have been reported.12,13 A suspected shared environmental risk factor in the PTSD–substance use disorders comorbidity is the exposure to trauma.1,14 It has been suggested that traumatic events that lead to PTSD also induce diatheses for other disorders.15 According to this hypothesis, some persons who experience trauma develop PTSD, whereas others develop other disorders, depending on the persons' vulnerabilities; comorbidity of PTSD with other disorders would, thus, reflect the co-occurrence of distinct diatheses.15,16