Associations Between Police Stress and Alcohol Use: Implications for Practice

Cognitive reappraisal moderates the relationship between PTSD symptoms and alcohol use over time in post-9/11 U.S. military veterans

ABSTRACTBackground: Posttraumatic stress disorder (PTSD) is prevalent among veterans who served post-9/11, and co-occurs with problem alcohol and substance use. Studies using ecological momentary assessment have examined the temporal association between time-varying PTSD symptoms and alcohol use. Results suggest individual differences in these associations. Objectives: We tested hypotheses that alcohol use measured by momentary assessment would be explained by acute increases in PTSD symptoms, and the PTSD–alcohol association would be moderated by trait impulsivity. Methods: A sample of 28 male post-9/11-era veterans who reported past-month PTSD symptoms and risky alcohol use were enrolled. On a quasi-random schedule, participants completed three electronic assessments daily for 28 days measuring past 2-h PTSD symptoms, alcohol, and substance use. At baseline, trait impulsivity was measured by the Barratt Impulsiveness Scale. Past-month PTSD symptoms and alcohol use were measured. Using three-level hierarchical models, number of drinks recorded by momentary assessment was modeled as a function of change in PTSD symptoms since last assessment, controlling for lag-1 alcohol and substance use and other covariates. A cross-level interaction tested moderation of the within-time PTSD–alcohol association by impulsivity. Results: A total of 1,522 assessments were completed. A positive within-time association between PTSD symptom change and number of drinks was demonstrated. The association was significantly moderated by impulsivity. Conclusion: Results provide preliminary support for a unique temporal relationship between acute PTSD symptom change and alcohol use among veterans with trait impulsiveness. If replicated in a clinical sample, results may have implications for a targeted momentary intervention.

IntroductionDue to the increased effectiveness of and access to antiretroviral therapy (ART), people with HIV (PWH) are living longer. As a result, the population of older PWH has increased. Mental and substance use disorders (MSDs) are common and frequently co‐occurring among PWH and are associated with poor HIV care outcomes. Research into the prevalence and co‐occurrence of MSDs among ageing PWH remains limited, particularly in low‐ and middle‐income countries (LMICs).MethodsWe analysed data collected between 2020 and 2022 from the International epidemiology Databases to Evaluate AIDS (IeDEA) Sentinel Research Network cohort of PWH aged 40 years or older on ART at 11 HIV clinics in Brazil, Côte d'Ivoire, India, Kenya, Mexico, Uganda, Rwanda, Togo, Vietnam, Zambia and Zimbabwe. We estimated the prevalence and co‐occurrence of unhealthy alcohol use (AUDIT‐C ≥3 for women, ≥4 for men), unhealthy drug use (ASSIST >3 for cannabis, cocaine, amphetamines, inhalants, sedatives, hallucinogens and/or opioids), and moderate to severe symptoms of depression (PHQ‐9 ≥10), anxiety (GAD‐7 ≥10) and post‐traumatic stress disorder (PTSD) (PCL‐5 ≥33). Psychiatric multimorbidity was defined as having symptoms of two or more disorders assessed. Log binomial models assessed the association between socio‐demographic and HIV care characteristics and symptoms of anxiety, depression, PTSD or unhealthy substance use.ResultsOf 2821 participants, the prevalence of unhealthy alcohol and drug use was 21% and 5%, respectively. The prevalence of moderate to severe symptoms of depression, anxiety and PTSD was 14%, 9% and 6%, respectively. Overall, the prevalence of psychiatric multimorbidity was 11%. Among those with symptoms of at least one mental health or substance use outcome assessed (n = 1036), the prevalence of psychiatric multimorbidity was 31%. In binomial models, the prevalence of symptoms of depression and anxiety was higher, while the prevalence of unhealthy alcohol and drug use was lower among women than men.ConclusionsUnhealthy alcohol use and symptoms of depression were most commonly reported, among this cohort of PWH aged 40 or older across 11 LMICs. Integration of MSD screening and treatment into HIV care should be prioritized. The effectiveness and implementation of transdiagnostic or multi‐focus mental health treatment approaches in HIV care settings should be examined.

ABSTRACTBackground: Postdisaster increases in substance use have been attributed to use of substances to cope with emotional reactions. However, no study to our knowledge has explored disaster survivors' substance use to cope with posttraumatic stress disorder (PTSD) symptoms. Objective: We investigated the prevalence and correlates of alcohol use and nonmedical prescription drug use (NMPDU) to cope with PTSD symptoms in two population-based samples of adult residents of New York City neighborhoods affected by Hurricane Sandy. Method: Participants completed structured interviews at either 13–16 or 25–28 months postdisaster (combined N = 914). Participants with PTSD symptoms, assessed via the Posttraumatic Stress Checklist for DSM-5, indicated whether they coped with their symptoms through alcohol use or NMPDU, via items adapted from the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regression models explored correlates of substance use coping, including demographic characteristics, lifetime and hurricane-related exposures, and psychiatric symptoms in the combined sample. Results: Over a third of participants in the combined sample (n = 311, 34.0%) reported PTSD symptoms, and of these, 12.8% used alcohol to cope and 9.2% endorsed NMPDU to cope. Older age and being a parent living with a child under 18 years old at the time of the hurricane were associated with a lower likelihood, and more severe depression symptoms with a higher likelihood, of alcohol use coping. Conclusions/Importance: Although preliminary, the results provide evidence for the use of substances to cope with postdisaster PTSD symptoms, and that age, parent status, and depression symptoms are associated with alcohol use coping.

Several hypotheses may explain the association between substance use, posttraumatic stress disorder (PTSD), and depression. However, few studies have utilized a large multisite dataset to understand this complex relationship. Our study assessed the relationship between alcohol and cannabis use trajectories and PTSD and depression symptoms across 3 months in recently trauma-exposed civilians. In total, 1618 (1037 female) participants provided self-report data on past 30-day alcohol and cannabis use and PTSD and depression symptoms during their emergency department (baseline) visit. We reassessed participant's substance use and clinical symptoms 2, 8, and 12 weeks posttrauma. Latent class mixture modeling determined alcohol and cannabis use trajectories in the sample. Changes in PTSD and depression symptoms were assessed across alcohol and cannabis use trajectories via a mixed-model repeated-measures analysis of variance. Three trajectory classes (low, high, increasing use) provided the best model fit for alcohol and cannabis use. The low alcohol use class exhibited lower PTSD symptoms at baseline than the high use class; the low cannabis use class exhibited lower PTSD and depression symptoms at baseline than the high and increasing use classes; these symptoms greatly increased at week 8 and declined at week 12. Participants who already use alcohol and cannabis exhibited greater PTSD and depression symptoms at baseline that increased at week 8 with a decrease in symptoms at week 12. Our findings suggest that alcohol and cannabis use trajectories are associated with the intensity of posttrauma psychopathology. These findings could potentially inform the timing of therapeutic strategies.

Research is limited regarding the role of high-risk behaviors, trauma, and posttraumatic stress disorder (PTSD) symptoms in people with severe mental illnesses (SMI).The current survey of 276 community mental health clients diagnosed with either a schizophrenia spectrum disorder or a major mood disorder examined the mediating role of lifetime high-risk behaviors with regard to lifetime traumatic events and PTSD symptom severity measured by the PTSD Symptom Scale-Interview version. Structural equation modeling revealed that lifetime high-risk behaviors had significant direct effects on PTSD symptom severity, and high-risk behaviors partially mediated the relationship between lifetime trauma and PTSD symptom severity. Lifetime trauma had the greatest total effect on PTSD symptoms, followed by primary Axis I diagnosis and lifetime high-risk behaviors. Implications for practice with people with SMI include more thorough assessments of trauma, PTSD, and high-risk behaviors and use of coping skills approaches to reduce high-risk behaviors. Limitations of the study include the cross-sectional nature of the data. KEY WORDS: high-risk behaviors; major mood disorders; posttraumatic stress disorder; schizophrenia; severe mental illness ********** People with severe mental illnesses (SMIs), including schizophrenia spectrum disorders (SSDs) and major mood disorders (MMDs), experience higher rates of trauma, such as physical and sexual abuse and exposure to violence, than do people in the general public (Mueser et al., 1998; Resnick, Bond, & Mueser, 2003), and they show rates of posttraumatic stress disorder (PTSD) four to five times greater (between 33% and 43%) than do people in the general population (about 8%) (Mueser et al., 1998; O'Hare, Sherrer, & Shen, 2006). People with SMI are also more likely to engage in high-risk behaviors--such as suicide attempts, substance abuse, drug overdoses, unprotected sex, and self-mutilation--and to demonstrate behaviors associated with more severe psychiatric symptoms, have more frequent hospitalizations, be at increased risk of trauma, and have poorer treatment outcomes (Gearon, Kaltman, Brown, & Bellack, 2003; Mueser et al., 1998; O'Hare et al., 2006). Few research investigations have focused on the relationship of high-risk behaviors to trauma and PTSD. Given that the consequences of high-risk behaviors can be retraumatizing, the current study tests whether high-risk behaviors mediate the relationship between lifetime trauma and PTSD symptom severity. AIMS OF THE CURRENT STUDY The relationships among traumatic events, high-risk behaviors, and PTSD remain poorly understood in the SMI population (Butler, Mueser, Sprock, & Braff, 1996; Mueser, Rosenberg, Goodman, & Trumbetta, 2002; O'Hare et al., 2006). Although PTSD symptoms in this population have been shown to be positively related to other measures of emotional distress (O'Hare et al. 2006; Resnick et al., 2003), there is only limited research on the linkages between the frequency of lifetime trauma and PTSD. In addition, the relationship between lifetime trauma and high-risk behaviors is even less understood. Although a recent study of clients, most of whom participated in the current investigation, showed that subjective distress from highrisk behaviors--that is, overdosing on medication, self-mutilation, and suicide attempts--mediated the connection between trauma-related subjective distress and PTSD symptoms (O'Hare et al., 2006), it is not known if high-risk events mediate the relationship between lifetime traumatic events and PTSD symptoms. Discovery of such a link could help improve our understanding of the mediating role of high-risk behaviors with regard to traumatic events and PTSD symptom severity. Gender is a key factor to consider when examining trauma, high-risk events, and PTSD. Women with serious psychiatric disorders appear to be at greater risk for certain stressors, including sexual abuse and interpersonal violence as adults, and men are more likely to witness serious acts of violence (Goodman et al. …

Predictors of remission from PTSD symptoms after sexual and non-sexual trauma in the community: A mediated survival-analytic approach

The Critical Incident History Questionnaire (CIHQ) measures, through multiple measurement methods, the severity and frequency of traumatic events experienced by law enforcement officers. We, however, found no studies utilizing the CIHQ to examine posttraumatic growth (PTG) as measured by the Posttraumatic Growth Inventory. The purpose of this brief report was to assess the strength and direction of the relationships between PTG with trauma frequency, trauma severity, and health variables, including subjective traumatic stress, relationship stress, nontraumatic work stress, posttraumatic stress disorder (PTSD) symptoms, depression, and alcohol use among law enforcement officers (N = 193) from small and midsize agencies. In addition, we sought to explore differences between cognitive and behavioral PTG. Based on results from bivariate and multivariate analyses, we found that an idiosyncratic view of trauma severity shaped by personal experience demonstrated the strongest relationship with PTG among the frequency and severity variables and that increased PTG was not associated with reduced psychological distress. Alcohol use, a variable that is assessed primarily through behaviors compared with cognitions, was not significantly associated with PTG. Overall, the findings of this study demonstrate the importance for future research to consider both the frequency and severity of trauma exposure in the development of PTG and its impact on health outcomes.

Alcohol-related problems (e.g., physical, interpersonal, intrapersonal, impulse control, social responsibility) can have an impact on posttraumatic stress disorder (PTSD) symptoms during treatment. Evidence-based online self-help tools exist to target alcohol use and related problems and co-occurring PTSD symptoms. It is unknown to what degree individuals with varying alcohol-related problems respond differently to web-based interventions for hazardous alcohol use and PTSD. The current study evaluated specific alcohol-related problems as potential moderators of PTSD symptom changes during the VetChange online intervention while controlling for average daily alcohol use, gender, race, and age. We conducted a secondary analysis of a randomized controlled trial that included 600 post-9/11 veterans (518 men and 82 women). Mixed-effects regression models of alcohol-related problems on PTSD severity scores over time were performed separately in an initial intervention group (IIG; n = 404) and a delayed intervention group (DIG; n = 196) that was used as a comparison condition. Interpersonal problems emerged as a moderator of PTSD symptom changes in IIG such that veterans endorsing greater interpersonal problems demonstrated larger reductions in PTSD symptoms throughout VetChange. There were no significant moderation effects in DIG. Non-White veterans reported significantly higher PTSD symptoms during VetChange. Post hoc analyses indicated that veterans with higher interpersonal problems were more likely to engage in online intervention content focused on identifying high-risk drinking situations and coping with symptoms. Findings imply that veterans reporting alcohol-related interpersonal problems may benefit the most from, and be more motivated to use, online interventions for hazardous alcohol use and PTSD symptoms.

Law enforcement officers tend to be exposed to a high frequency of potentially traumatic incidents. A dichotomous distinction among these events involves the witnessing of threat or harm to others and the experiencing of threat or harm directly to oneself. Past research suggests that different types of trauma exposure produce varying levels of negative posttraumatic responses including posttraumatic stress disorder (PTSD) symptoms and positive outcomes such as posttraumatic growth (PTG). With the goal of better assisting officers experiencing posttraumatic stress, enhanced knowledge regarding this psychological response to the development of PTG is necessary. The purpose of this study was to test a proposed model involving a pathway from type of trauma exposure to PTG that is mediated by PTSD symptoms among law enforcement officers (N = 193). Differences among cognitive PTG and behavioral PTG as our dependent variables, with age, marital status, and relationship stress as control variables, were assessed. Findings indicate that events involving threat to self are more closely related to PTG, via an indirect pathway through PTSD symptoms. Additionally, personal relationship stress was directly associated with PTSD symptoms and behavioral PTG, but not cognitive PTG. Overall, the results of this study provide initial evidence that trauma exposure type (i.e., direct vs. indirect) plays a significant role in the level of PTG. Lastly, the results allow for the possibility of positive changes in behaviors facilitated by cognitive avoidance, in contrast to the common notion that deliberate cognitive engagement is required for growth to occur. (PsycINFO Database Record

Aim: This study was carried out to determine the prevalence of drug and alcohol use among medical students in a private University based in Abuja, Nigeria.
 Study Design: A descriptive cross-sectional survey.
 Place and Duration of Study: College of Health Sciences (CHS), Nile University of Nigeria, Abuja, between June 2018 and September 2018.
 Methodology: Using a semi-structured, self-administered questionnaire, information was obtained from 49 second year medical students (11 males, 38 females; age range 17-25 years), who were surveyed for the prevalence and reason of drug and alcohol use. Data retrieved was sorted, collated and subjected to statistical analysis using SPSS version 23.0 statistical package.
 Results: The mean age of students was 18.9 years and a higher proportion of respondents were female students (n=38; 77.6%). Out of the 49 students examined in this study, only 2 students currently use drugs while 8 students consume alcohol, given a prevalence of 4% and 16.3% respectively. Reasons given by one male alcohol user include: to build self-confidence (12.5%), while one female drug user uses it to escape from worries or troubles (50%). The prevalence of alcohol use was highest among male students (n=5; 62.5%), while that of drug use was highest among female students (n=2; 100%). Results also showed that the majorities of students were occasional users; and so there was no evidence of physical dependence.
 Conclusion: Findings established low prevalence of drug and alcohol use among study groups. However evaluation of full-scale university-level intervention is highly necessary.

Background: Filipino migrant workers in Macao are vulnerable to posttraumatic stress disorder (PTSD) symptoms and addictive behaviours due to trauma histories, postmigration stressors, and access to alcohol and gambling venues. While PTSD addiction comorbidity is well-established in the existing literature, such research among migrant workers is lacking. Objective: The current study investigated differential relations between PTSD symptoms and addictive behaviours in a polytrauma exposed sample of Filipino domestic workers in Macao (SAR), China. Methods: Data were collected from 1375 Filipino migrant workers; data from a subsample of 1200 participants who reported an index traumatic event and PTSD symptoms were used in the analyses. Participants responded to the PTSD Checklist for DSM-5, gambling disorder symptoms checklist from DSM-5, and The Alcohol Use Disorders Identification Test. We estimated a regularized partial correlation network structure of PTSD symptoms and addictive behaviours employing graphical LASSO and extended Bayesian information criterion. Results: PTSD symptoms of arousal and negative emotions had bridge connections with gambling disorder symptoms; while PTSD symptoms of arousal, restricted affect, negative emotions, and emotional reactivity had bridge connections with alcohol misuse. Conclusions: PTSD's arousal and negative emotion symptoms were common in the networks of PTSD and addictive behaviours, while PTSD's restricted affect and emotional reactivity symptoms were unique to the network of PTSD and alcohol misuse. Treatment of the comorbidity of PTSD and addictive behaviours may yield optimal effects when tailored to these symptoms.

An increasing number of states have approved posttraumatic stress disorder (PTSD) as a qualifying condition for medical marijuana, although little evidence exists evaluating the effect of marijuana use in PTSD. We examined the association between marijuana use and PTSD symptom severity in a longitudinal, observational study. From 1992 to 2011, veterans with DSM-III/-IV PTSD (N = 2,276) were admitted to specialized Veterans Affairs treatment programs, with assessments conducted at intake and 4 months after discharge. Subjects were classified into 4 groups according to marijuana use: those with no use at admission or after discharge ("never-users"), those who used at admission but not after discharge ("stoppers"), those who used at admission and after discharge ("continuing users"), and those using after discharge but not at admission ("starters"). Analyses of variance compared baseline characteristics and identified relevant covariates. Analyses of covariance then compared groups on follow-up measures of PTSD symptoms, drug and alcohol use, violent behavior, and employment. After we adjusted for relevant baseline covariates, marijuana use was significantly associated with worse outcomes in PTSD symptom severity (P < .01), violent behavior (P < .01), and measures of alcohol and drug use (P < .01) when compared with stoppers and never-users. At follow-up, stoppers and never-users had the lowest levels of PTSD symptoms (P < .0001), and starters had the highest levels of violent behavior (P < .0001). After adjusting for covariates and using never-users as a reference, starting marijuana use had an effect size on PTSD symptoms of +0.34 (Cohen d = change/SD), and stopping marijuana use had an effect size of -0.18. In this observational study, initiating marijuana use after treatment was associated with worse PTSD symptoms, more violent behavior, and alcohol use. Marijuana may actually worsen PTSD symptoms or nullify the benefits of specialized, intensive treatment. Cessation or prevention of use may be an important goal of treatment.

This study aimed to examine the same-sex matching effect of posttraumatic stress disorder (PTSD) symptoms from parents to children and the mediating role of children' sense of security and catastrophization. Longitudinal data from 447 parent-child dyads were acquired using self-report scales. Parents (77.0% mothers; Mage = 40.15 years old) reported their PTSD symptoms 3 months after Super Typhoon Lekima, and children (55.9% girls; Mage = 13.40 years old) reported their PTSD symptoms, sense of security, and catastrophization 3 months and 15 months after the typhoon. Results showed that intrusion in mothers predicated intrusion, avoidance, and hyperarousal symptoms in daughters, while avoidance and hyperarousal in mothers predicted the same symptoms in daughters. This was not observed in any other parent-child dyads. Moreover, mothers' intrusion positively predicted daughters' PTSD symptoms via daughters' sense of security and then catastrophization, while mothers' hyperarousal showed the opposite prediction. These findings suggest that a same-sex matching effect occurs from mothers to daughters in terms of intrusion, avoidance, and hyperarousal symptoms of PTSD. Thus, clinical interventions that target daughters' PTSD symptoms should also consider mothers' intrusion and avoidance symptoms. Moreover, it may be possible to develop interventions to improve daughters' sense of security.

&lt;div class="page" title="Page 5"&gt;&lt;div class="section"&gt;&lt;div class="layoutArea"&gt;&lt;div class="column"&gt;&lt;p&gt;&lt;strong&gt;Objective.&lt;/strong&gt; To estimate if there is a non-linear association between varying levels of alcohol use and poor mental health (depressive and post-traumatic stress disorder (PTSD) symptoms) in university students from low-, middle- and high-income countries. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods.&lt;/strong&gt; Using anonymous questionnaires, data were collected from 19 238 undergraduate university students (mean age 20.8; standard deviation (SD) 2.8) from 27 universities in 26 countries across Asia, Africa and the Americas. Alcohol use was assessed in terms of number of drinks in the past 2 weeks and number of drinks per episode, and measures of depression and PTSD symptoms were administered. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results.&lt;/strong&gt; The proportion of students with elevated depression scores was 12.3%, 16.9%, and 11.5% for non-drinkers, moderate drinkers, and heavy drinkers, respectively, while the proportion of students with high PTSD symptoms was 20.6%, 20.4% and 23.1% for non-drinkers, moderate drinkers, and heavy drinkers, respectively. Logistic regression found that non-drinkers and heavy drinkers had a lower odds than moderate drinkers to have severe depression, after adjusting for sociodemographic variables, social support and subjective health status. Further, heavy, more frequent drinkers and more frequent binge drinkers had a higher odds to have elevated PTSD symptoms than moderate and non-drinkers, after adjusting for sociodemographic variables, social support and subjective health status. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion.&lt;/strong&gt; The results suggest a reverse U-shaped association between recent alcohol use volume and frequency and depressive symptoms (unlike that previously identified), and a J-shaped association between binge drinking frequency and depressive symptoms and alcohol use and PTSD symptoms.&lt;/p&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;