Posttraumatic stress disorder and alcohol dependence: Individual and combined associations with social network problems☆
Introduction
Posttraumatic stress disorder (PTSD) and alcohol dependence (AD) are chronic, often disabling conditions (Hasin et al., 2007, Kessler, 2000, Kessler et al., 1995, Samokhvalov et al., 2010). Moreover, PTSD and AD are commonly comorbid (Back et al., 2005, Brown et al., 1995, Kessler et al., 1997, Pietrzak et al., 2011, Stewart, 1996). Research suggests that compared to the presence of unimorbid PTSD or AD, comorbid PTSD/AD is associated with greater problem severity across multiple indices. For example, the co-occurrence of these two disorders is associated with a more severe clinical presentation (Mills et al., 2006, Ouimette et al., 2006), including increased co-occurrence of additional anxiety disorders and depression (Bonin et al., 2000, Drapkin et al., 2012, Rash et al., 2008, Read et al., 2004), a longer history of problematic substance use, a greater likelihood of suicide attempts (Bonin et al., 2000), and worse treatment outcomes (e.g., Brown and Wolfe, 1994, Najavits et al., 1999, Ouimette et al., 1998, Ouimette et al., 1999). As such, it is important to identify factors that differ between people with comorbid PTSD/AD and those suffering from only one of these problems in order to advance our currently limited understanding of what may account for the particularly severe problems introduced by this comorbidity.
People with PTSD experience elevated problems with social networks. There is a strong negative association between social support and symptoms of posttraumatic stress subsequent to traumatic event exposure (Brewin et al., 2000, Danner and Radnitz, 2000, Eriksson et al., 2001, Kaniasty and Norris, 2008, Tucker et al., 2000). Research has consistently demonstrated a bi-directional association between PTSD severity and social support (Kaniasty and Norris, 2008, Turner, 1981). For example, one study found that pre-trauma social support predicted PTSD symptoms 6–12-months following traumatic event exposure, while both pathways from social support to PTSD, as well as PTSD to social support were significant 12–18 months following the traumatic event (Kaniasty & Norris, 2008). Symptoms of PTSD, such as loss of interest in activities, feelings of estrangement of others, and increased anger are possible mechanisms underlying decreases in social support following a traumatic event (Kaniasty & Norris, 2008). People with PTSD also endorse elevated levels of social conflict (Galovski and Lyons, 2004, Monson et al., 2009, Monson et al., 2012). Indeed, PTSD has been associated with relatively elevated levels of both physical and psychological aggression in significant interpersonal relationships (Taft, Watkins, Stafford, Street, & Monson, 2011). For example, in a sample of treatment seeking male veterans with a partner, approximately 33% endorsed perpetrating physical aggression, and 91% endorsed perpetrating psychological aggression toward their partner (Taft, Weatherill et al., 2009). Similarly, PTSD symptoms were positively correlated with both physical and psychological victimization and perpetration in a civilian sample of flood survivors (Taft, Monson et al., 2009).
Deficits in social support have also been linked to alcohol use. Research suggests people with supportive friends and families report more success in reducing alcohol use (Beattie and Longabaugh, 1997, Gordon and Zrull, 1991, Tucker et al., 1995). Social support for alcohol-related treatment and abstinence, more specifically, is positively associated with percentage of days abstinent following treatment, and negatively correlated with the proportion of days of heavy drinking following treatment (Beattie & Longabaugh, 1999). Research on alcohol use disorders and relationship functioning has suggested an association between alcohol use and relationship difficulties, including lower marital satisfaction (Marshal, 2003) and elevated marital aggression (Leonard and Blane, 1992, Murphy and O’Farrell, 1994). Similarly, effects of drinking in men with an alcohol use disorder have been linked to elevated social conflict (Kachadourian et al., 2012, O’Farrell and Murphy, 1995). In fact, social conflict has been associated with the maintenance of alcohol use via its correlation with relapse during alcohol use quit attempts (Marlatt & Gordon, 1980). Despite a corpus of data suggesting problems with social networks are linked to both PTSD and AD, relatively little research has examined social network problems among people with comorbid PTSD/AD.
Preliminary evidence suggests that people with PTSD/AD may experience particularly severe problems with social networks. People with comorbid PTSD/AD are less likely to be married (Drapkin et al., 2012) and more likely to report interpersonal problems (Najavits et al., 1998). Given these data, the current study tested if the combination of PTSD and AD is related to particularly elevated social network problems, even relative to each of these conditions alone. First, we predicted that people with either lifetime PTSD, AD, or comorbid PTSD/AD would report lower levels of perceived social closeness to others, decreased ability to rely on or open up to relatives, greater social conflict, and more apprehension about utilizing social support when compared to those without a lifetime history of Axis I psychopathology. Second, it was predicted that individuals with lifetime comorbid PTSD/AD would report lower perceived social support in the form of lower perceived closeness in general, as well as reduced perceived ability to rely on or open up to relatives, greater perceived social conflict, and more apprehension about social support when compared to people who meet lifetime criteria for only one of these disorders.
After first examining the predicted associations between PTSD and AD with these social network factors, these associations were examined after statistically covarying for variance accounted for by other comorbid conditions. Given both PTSD and AD are commonly comorbid with multiple types of psychopathology that also may impact social networks (e.g., major depressive disorder, panic disorder; Back et al., 2005, Bonin et al., 2000, Drapkin et al., 2012, Jacobsen et al., 2001, Rash et al., 2008, Stewart, 1996), it is important to try and gauge the degree to which comorbid PTSD/AD is uniquely related to social network problems above and beyond other comorbid conditions. While analysis of covariance does not equate groups given important group differences (Miller & Chapman, 2001), it can be used to tentatively gauge the uniqueness of an association given inferences are situated within the limitations of the approach (Zinbarg, Suzuki, Uliaszek, & Lewis, 2010).
Section snippets
Participants
The current study examined data from the National Comorbidity Survey-Replication (NCS-R; Kessler & Merikangas, 2004). This nationwide epidemiological study included a nationally-representative sample of English-speaking adults (≥17 years old) from 48 states in the United States. To identify potential participants, a stratified, multistage probability sample was utilized. Participation in Part I was adjusted for the differential probability of selection between the sample and the United States
Examination of social network items
First, the 14 items from the social network measure were simultaneously submitted to a PCA. The first four eigenvalues from the PCA were 3.18 (Closeness), 2.31 (Conflict), 1.29 (Family Support), and 1.10 (Apprehension), which accounted for 56.29% of total variance. Parallel analysis supported a 4-factor solution, as eigenvalues of the four PCA extracted factors were all larger than the upper limit of the 95% confidence interval [CI] for their parallel Monte Carlo generated eigenvalues (M = 1.13,
Discussion
Problems with social networks have been linked to both PTSD and alcohol use disorders (Brewin et al., 2000, Kaniasty and Norris, 2008, Taft et al., 2009a, Taft et al., 2009b, Taft et al., 2011). Unfortunately, there is little data describing social networks among people with comorbid PTSD/AD. Results were partially consistent with the general hypothesis that those with comorbid PTSD/AD would report greater problems with their social network than those with only one diagnosis, all of whom would
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2022, Addictive Behaviors ReportsCitation Excerpt :However, studies have not yet examined whether social support modulates SUD treatment outcomes or if SUD symptoms moderate changes in social support during treatment. Individuals with co-occurring SUD and PTSD tend to report lower family support and greater apprehension about being close with others (Dutton, Adams, Bujarski, Badour, & Feldner, 2014). Some research has started to examine the links underlying the association between co-occurring SUD and PTSD and social support.
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2022, Journal of Affective DisordersCitation Excerpt :This will be key in developing and testing prevention and intervention strategies. Further, while our measures of social support in the NCS-R dataset have been used in previous research (Dutton et al., 2014; Rodebaugh, 2009), their validity has not been rigorously established. Future studies may wish to use validated measures of perceived social support and closeness, such as the Multidimensional Scale of Perceived Social Support (Zimet et al., 1988), as well as more granular assessment of social contact in order to replicate these findings.
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2019, Drug and Alcohol DependenceCitation Excerpt :However, contrary to our hypothesis, Veterans with PTSD/AUD did not score lower on these measures than those with PTSD alone. Although previous studies have found that PTSD/AUD is associated with lower scores on measures of certain protective factors (e.g., perceived social support) in comparison to those with PTSD or AUD alone (Drapkin et al., 2011; Dutton et al., 2014), those studies primarily utilized treatment-seeking or civilian samples to examine a small number of protective factors. Our findings converge with studies using Veteran samples, however, which have observed that Veterans with PTSD and comorbid disorders (substance and non-substance use disorders) do not differ from those with PTSD alone on measures of social support and attachment style (Brancu et al., 2014; Owens et al., 2014).
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The views expressed in this manuscript are those of the authors and do not necessarily represent those of the Department of Veterans Affairs or the US government.