Underlying Dimensions of Posttraumatic Stress Disorder Symptoms Pre and Post-treatment in Women with Co-occurring Substance Use Disorder

A considerable proportion of women worldwide have experienced various manner of abuse in their lifetime (Devries et al., 2011). Women are more at risk of exposure to physical and sexual violence (Hedtke et al., 2008), and women who have experienced interpersonal violence are at heightened risk of developing several mental health conditions including posttraumatic stress disorder (PTSD), and substance use disorders (SUDs; Acierno et al., 1999; McGruder-Johnson et al., 2000; Messman-Moore & Bhuptani, 2017). Treatment outcomes for individuals with co-occurring PTSD and SUDs tend to be worse than for those diagnosed with PTSD alone (Schäfer & Najavits, 2007), and outcome results for trauma-informed treatments for co-occurring PTSD and SUD are mixed. There is clearly a need for improvement in effectiveness of treatment and applying a dimensional approach to understanding PTSD symptoms could provide valuable insight. The focus of the present study was to explore interrelationships among PTSD symptoms by applying Individual Differences Scaling (INDSCAL) to data from the Women, Co-occurring Disorders, and Violence Study (WCDVS). Primary aims were to identify organizing dimensions for symptoms and evaluate changes in dimension emphasis in relation to treatment outcome for PTSD, alcohol symptoms, and drug-related symptoms. Women who responded positively to treatment such that they no longer met PTSD criteria at six-months placed less emphasis on arousal, re-experiencing trauma content, and threat vigilance. Women who successfully reduced alcohol and drug symptoms placed more emphasis on arousal, re-experiencing trauma content, and threat vigilance. These findings suggest trauma-informed care may reduce PTSD symptoms, however, individuals who experience a reduction in alcohol or drug-related symptoms may continue to have difficulties managing arousal, re-experiencing trauma, and perceiving threats in their environment. These findings underscore the need to treat co-occurring PTSD and substance use symptoms concurrently and highlight the importance of creating new treatment protocols and programs to target both disorders