Trauma and dissociation in treatment-seeking alcoholics: towards a resolution of inconsistent findings.
There is consistent empirical evidence for a trauma-dissociation relation in general population samples and in psychiatric patients. However, contradictory findings have been reported on this relation among substance abusers. The present study attempts to resolve these inconsistencies by testing a series of hypotheses related to problems regarding the measurement of childhood abuse, the measurement of psychological dissociation, and the potential existence of substance abuse as a form of chemical dissociation. Alcoholic patients (N = 155) were administered the Dissociative Experiences Scale (DES), the Structured Trauma Interview (STI), the European Addiction Severity Index (EuropASI), and the Posttraumatic Stress Disorder (PTSD) section of the Composite International Diagnostic Interview (CIDI). The DES showed good psychometric properties. Substantial rates of traumatization and PTSD were observed, as well as a significant trauma-PTSD relation. However, the mean DES score was low (11.4) and dissociation was not related to trauma (childhood or lifetime) or to PTSD. Years of lifetime regular medicine use, however, was significantly correlated with the severity of dissociative symptoms and PTSD, particularly in males. Overall, these findings suggest that absence of a trauma-dissociation relation in alcoholics may not be due to measurement problems of childhood abuse and/or dissociation. Rather, a trauma-dissociation link may not exist, particularly in male alcoholics, because these individuals may abuse substances to achieve dissociative-like states. Additional research is needed to further evaluate the utility of the DES in alcoholic samples and to examine the notion of chemical dissociation.
Langeland
Willie
W
Amsterdam Institute for Addiction Research and Academic Medical Center, University of Amsterdam, The Netherlands.
Draijer
Nel
N
van den Brink
Wim
W
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation; D000553:Ambulatory Care; D002648:Child; D002649:Child Abuse / Q000523:psychology; D015897:Comorbidity; D004213:Dissociative Disorders / Q000139:chemically induced* / Q000175:diagnosis; D005260:Female; D006760:Hospitalization; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology*; D016320:Substance Abuse Treatment Centers; D011795:Surveys and Questionnaires