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PTSD-SUD Comorbidities in the Context of Psychological Injury and Law

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Abstract

Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) are both common psychological problems and they are frequently comorbid. However, there is little longitudinal research that can disentangle their temporal relationship towards determining the mechanisms in their comorbidity. Furthermore, the extant research does not consider possible confounds to diagnosis that are relevant to the area of psychological injury and law, such as exclusion of cases of malingering after appropriate assessment and testing. This paper reviews the literature on the question of comorbidity of PTSD and SUD towards establishing preliminary conclusions that could serve directions for needed research in the area, and with potential application to individual assessment and court purposes. There are four major models in how PTSD and SUD relate—self-medication, high risk, susceptibility, and shared vulnerability. Overall, the self-medication model is supported, but not exclusively. Recent research is examining the different models in these regards with respect to individual differences, including in negative emotionality/constraint, emotional/dysregulation, and patterns in PTSD’s different clusters. Further research is required from a forensic perspective that uses the appropriate populations, rules out malingering in the cases studied, and controls other confounds applicable to the forensic context.

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Author Note

The author has no conflicts of interest related to this paper. He does mostly rehabilitation and some plaintiff work, with isolated insurer cases. This paper was prepared for Conference of the Association for Scientific Advancement in Psychological Injury in Law (ASAPIL) in Toronto, Ontario, on August 7, 2015. The authors wish to thank Charlotte Rimmer for the help in the article search for this paper.

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  1. Department of Psychology, Glendon College, York University, 2275 Bayview Ave., Toronto, ON, M4N 3M6, Canada

    Gerald Young

  2. 106-1333 Sheppard Ave. East, North York, ON, M2J 1V1, Canada

    Jenny Xiaoting Wang

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Young, G., Wang, J.X. PTSD-SUD Comorbidities in the Context of Psychological Injury and Law. Psychol. Inj. and Law 8, 233–251 (2015). https://doi.org/10.1007/s12207-015-9229-z

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