Top

Published in:

01-04-2013

Self-medication among traumatized youth: structural equation modeling of pathways between trauma history, substance misuse, and psychological distress

Authors: Eric L. Garland, Carrie Pettus-Davis, Matthew O. Howard

Published in: Journal of Behavioral Medicine | Issue 2/2013

Abstract

In an effort to self-medicate psychological distress stemming from exposure to traumatic life events, at-risk youth may be likely to seek intoxication via substance use. Concomitantly, self-medication with psychoactive substances is theorized to confer risk of developing future psychiatric and substance use disorders. The present study employed structural equation modeling to examine self-medication among a sample of 723 youth in residential treatment for antisocial behavior via recursive and non-recursive relationships between trauma history, substance misuse, and psychological distress. Results supported study hypotheses that: (a) the effects of trauma history on psychological distress are partially mediated by substance misuse, and (b) exposure to traumatic life events drives a feedback loop between substance misuse and psychological distress. Findings from this large-scale survey of adolescents exhibiting behavioral dysfunction suggest that identification of self-medication processes among traumatized youth may be crucial for developing targeted prevention and treatment initiatives.

Abram, K. M., Teplin, L. A., Charles, D. R., Longworth, S. L., McClelland, G. M., & Dulcan, M. K. (2004). Posttraumatic stress disorder and trauma in youth in juvenile detention. Archives of General Psychiatry, 61, 403.PubMedCrossRef

Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., et al. (2006). The enduring effects of abuse and related adverse experiences in childhood—A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256, 174–186.PubMedCrossRef

Baker, T. B., Piper, M. E., McCarthy, D. E., Majeskie, M. R., & Fiore, M. C. (2004). Addiction motivation reformulated: An affective processing model of negative reinforcement. Psychological Review, 111, 33–51.PubMedCrossRef

Bremne, J. D., & Vermetten, E. (2001). Stress and development: Behavioral and biological consequences. Developmental Psychopathology, 13, 473–489.CrossRef

Breslau, N., Davis, G. C., Andreski, P., & Peterson, E. (1991). Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry, 48, 216–222.CrossRef

Brewin, C. R., Gregory, J. D., Lipton, M., & Burgess, N. (2010). Intrusive images in psychological disorders: Characteristics, neural mechanisms, and treatment implications. Psychological Review, 117, 210–232.PubMedCrossRef

Bryant, R. A., Friedman, M. J., Spiegel, D., Ursano, R., & Strain, J. (2011). A review of acute stress disorder in DSM-5. Depression and Anxiety, 28, 802–817.PubMedCrossRef

Brook, J. S., Cohen, P., & Brook, D. W. (1998). Longitudinal study of co-occurring psychiatric disorders and substance use. Journal of American Academy of Child and Adolescent Psychiatry, 37, 322–330.CrossRef

Brook, J. S., Katten, N. S., Zhang, C., & Brook, D. W. (2009). Psychosocial antecedents and adverse health consequences resulting from tobacco use, alcohol, and other drug-related problems. American Journal of Public Health, 99, 563.PubMedCrossRef

Brosschot, J. F., Gerin, W., & Thayer, J. F. (2006). The perseverative cognition hypothesis: A review of worry, prolonged stress-related physiological activation, and health. Journal of Psychosomatic Research, 60, 113–124.PubMedCrossRef

Buka, S. L., Stichick, T. L., Birdthistle, I., & Earls, F. J. (2001). Youth exposure to violence: Prevalence, risks, and consequences. American Journal of Orthopsychiatry, 71, 298–310.PubMedCrossRef

Byrne, B. M. (2012). Structural equation modeling with Mplus. New York: Routledge.

Curran, P. J., West, S. G., & Finch, J. F. (1996). The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychological Methods, 1, 16–29.CrossRef

Derogatis, L. R., & Melisaratos, N. (1983). The brief symptom inventory: An introductory report. Psychological Medicine, 13, 595–605.PubMedCrossRef

Ehlers, A., Hackmann, A., Steil, R., Clohessy, S., Wenninger, K., & Winter, H. (2002). The nature of intrusive memories after trauma: The warning signal hypothesis. Behavior Research and Therapy, 40, 995–1002.CrossRef

Elliott, D. S., Huizinga, D., & Menard, S. (1989). Multiple problem youth: Delinquency, substance use, and mental health problems. New York: Springer.CrossRef

Field, M., & Powell, H. (2007). Stress increases attentional bias for alcohol cues in social drinkers who drink to cope. Alcohol and Alcoholism, 42, 560–566.PubMedCrossRef

Floden, D., Alexander, M. P., Kubu, C. S., Katz, D., & Stuss, D. T. (2008). Impulsivity and risk-taking behavior in focal frontal lobe lesions. Neuropsychologia, 46, 213–223.PubMedCrossRef

Garland, E. L., & Howard, M. O. (2011). Adverse consequences of acute inhalant intoxication. Experimental and Clinical Psychopharmacology, 19, 134.PubMedCrossRef

Garland, E. L., & Roberts-Lewis, A. (2011). Differential roles of dispositional mindfulness and thought suppression in post-traumatic stress symptoms and craving. Addictive Behaviors. doi:10.1016/j.bbr.2011.03.031.

Garland, E. L., Gaylord, S. A., Boettiger, C. A., & Howard, M. O. (2010). Mindfulness training modifies cognitive, affective, and physiological mechanisms implicated in alcohol dependence: Results from a randomized controlled pilot trial. Journal of Psychoactive Drugs, 42, 177–192.PubMedCrossRef

Garland, E. L., Boettiger, C. A., & Howard, M. O. (2011). Targeting cognitive-affective risk mechanisms in stress-precipitated alcohol dependence: An integrated, biopsychosocial model of allostasis, automaticity, and addiction. Medical Hypotheses, 76, 745–754.PubMedCrossRef

Grisso, T., & Barnum, R. (2000). Massachusetts youth screening instrument-second version: User’s manual and technical reports. Boston, MA: University of Massachusetts Medical School.

Hodgins, S., Larm, P., Molero-Samuleson, Y., Tengström, A., & Larsson, A. (2009). Multiple adverse outcomes over 30 years following adolescent substance misuse treatment. Acta Psychiatrica Scandinavica, 119, 484–493.PubMedCrossRef

Hofstra, M. B., Van Der Ende, J., & Verhulst, F. C. (2002). Child and adolescent problems predict DSM-IV disorders in adulthood: A 14-year follow-up of a Dutch epidemiological sample. Journal of American Academy of Child and Adolescent Psychiatry, 41, 182–189.CrossRef

Holmes, E. A., Grey, N., & Young K. A. (2005). Intrusive images and “hotspots” of trauma memories in posttraumatic stress disorder: An exploratory investigation of emotions and cognitive themes. Journal of Behavioral Therapy and Experimental Psychiatry, 36, 3–17.CrossRef

Hu, L., Bentler, P. M., & Kano, Y. (1992). Can test statistics in covariance structure analysis be trusted? Psychological Bulletin, 112, 351–362.PubMedCrossRef

Jacobsen, L. K., Southwick, S. M., & Kosten, T. R. (2001). Substance use disorders in patients with posttraumatic stress disorder: A review of the literature. American Journal of Psychiatry, 158, 1184–1190.PubMedCrossRef

Kaye, J. M., & Lightman, S. L. (2005). Psychological stress and endocrine axes. In K. Vedhara & M. Irwin (eds.), Human Psychoneuroimmunology. New York: Oxford University Press.

Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048–1060.PubMedCrossRef

Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4, 231–244.PubMedCrossRef

Kilpatrick, D. G., Acierno, R., Saunders, B., Resnick, H. S., Best, C. L., & Schnurr, P. P. (2000). Risk factors for adolescent substance abuse and dependence: Data from a national sample. Journal of Consulting and Clinical Psychology, 68, 692–700.CrossRef

Kilpatrick, D. G., Ruggiero, K. J., Acierno, R., Saunders, B. E., Resnick, H. S., & Best, C. L. (2003). Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: Results from the national survey of adolescents. Journal of Consulting and Clinical Psychology, 71, 692.PubMedCrossRef

Kline, R. B. (1998). Principles and practice of structural equation modeling. NY, USA: Guilford Press.

Koob, G. F. (2003). Alcoholism: Allostasis and beyond. Alcoholism, Clinical and Experimental Research, 27, 232–243.PubMedCrossRef

Koob, G. F., & Le Moal, M. (2001). Drug addiction, dysregulation of reward, and allostasis. Neuropsychopharmacology, 24, 97–129.PubMedCrossRef

Koob, G. F., & Le Moal, M. (2008). Addiction and the brain antireward system. Annual Review of Psychology, 59, 29–53.PubMedCrossRef

Leeies, M., Pagura, J., Sareen, J., & Bolton, J. M. (2010). The use of alcohol and drugs to self-medicate symptoms of posttraumatic stress disorder. Depression and Anxiety, 27, 731–736.PubMed

Liston, C., McEwen, B. S., & Casey, B. J. (2009). Psychosocial stress reversibly disrupts prefrontal processing and attentional control. Proceedings of the National Academy of Science USA, 106, 912–917.CrossRef

Little, R. J. A., & Rubin, D. A. (2002). Statistical analysis with missing data (2nd ed.). New York: Wiley.

McEwen, B. S. (1998). Stress, adaptation, and disease: Allostasis and allostatic load. Annals of New York Academy of Sciences, 840, 33–44.CrossRef

McEwen, B. S. (2003). Mood disorders and allostatic load. Biological Psychiatry, 54, 200–207.PubMedCrossRef

McEwen, B. S. (2007). Physiology and neurobiology of stress and adaptation: Central role of the brain. Physiological Review, 87, 873–904.CrossRef

McEwen, B. S., & Wingfield, J. C. (2003). The concept of allostasis in biology and biomedicine. Hormones and Behavior, 43, 2–15.PubMedCrossRef

Muthén, B., & Muthén, L. (2010). Mplus user’s guide (6th ed.). Los Angeles, CA: Muthén and Muthén.

Robinson, J., Sareen, J., Cox, B. J., & Bolton, J. M. (2011). Role of self-medication in the development of comorbid anxiety and substance use disorders: A longitudinal investigation. Archives of General Psychiatry, 68, 800.PubMedCrossRef

Sinha, R. (2007). The role of stress in addiction relapse. Current Psychiatry Reports, 9, 388–395.PubMedCrossRef

Slawik, H., Salmond, C. H., Taylor-Tavares, J. V., Williams, G. B., Sahakian, B. J., & Tasker, R. C. (2009). Frontal cerebral vulnerability and executive deficits from raised intracranial pressure in child traumatic brain injury. Journal of Neurotrauma, 26, 1891–1903.PubMedCrossRef

Stice, E., Myers, M. G., & Brown, S. A. (1998). A longitudinal grouping analysis of adolescent substance use escalation and de-escalation. Psychology of Addictive Behaviors, 12, 14–27.CrossRef

Wothke, W. (1998). Longitudinal and multi-group modeling with missing data. In T. D. Little, K. U. Schnabel, & J. Baumert (Eds.), Modeling longitudinal and multiple group data: Practical issues, applied approaches and specific examples. Mahwah, NJ: Lawrence Erlbaum Associates.

Zimmermann, U. S., Blomeyer, D., Laucht, M., & Mann, K. F. (2007). How gene-stress-behavior interactions can promote adolescent alcohol use: The roles of predrinking allostatic load and childhood behavior disorders. Pharmacology, Biochemistry and Behavior, 86, 246–262.CrossRef

Title: Self-medication among traumatized youth: structural equation modeling of pathways between trauma history, substance misuse, and psychological distress
Authors: Eric L. Garland
Carrie Pettus-Davis
Matthew O. Howard
Publication date: 01-04-2013
Publisher: Springer US
Published in: Journal of Behavioral Medicine / Issue 2/2013
Print ISSN: 0160-7715
Electronic ISSN: 1573-3521
DOI: https://doi.org/10.1007/s10865-012-9413-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Self-medication among traumatized youth: structural equation modeling of pathways between trauma history, substance misuse, and psychological distress

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2013

Adults with cardiovascular disease who help others: a prospective study of health outcomes

Purpose in life and reduced risk of myocardial infarction among older U.S. adults with coronary heart disease: a two-year follow-up

Depressive symptoms and serum lipid levels in young adult women

Impaired cerebral and systemic hemodynamics under cognitive load in young hypotensives: a transcranial Doppler study

Randomized controlled trial on the long-term efficacy of a multifaceted, interdisciplinary lifestyle intervention in reducing cardiovascular risk and improving lifestyle in patients at risk of cardiovascular disease

Conscientiousness and stress exposure and reactivity: a prospective study of adolescent females