The use of alcohol and drugs to self-medicate symptoms of posttraumatic stress disorder.
BACKGROUND
Self-medication has been proposed as an explanation for the high rates of comorbidity between posttraumatic stress disorder (PTSD) and substance use disorders; however, knowledge of self-medication in PTSD is scarce. We describe the prevalence and correlates of self-medication in PTSD in the general population.


METHODS
Data came from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2 (N=34,653; response rate: 70.2%), a nationally representative survey of mental illness in community-dwelling adults. Self-medication was assessed separately for alcohol and drugs. Prevalence rates were determined for self-medication among individuals with DSM-IV PTSD. Regression analyses determined associations between self-medication and a variety of correlates, including sociodemographic factors, comorbid mental disorders, suicide attempts, and quality of life.


RESULTS
Approximately 20% of individuals with PTSD used substances in an attempt to relieve their symptoms. Men were significantly more likely than women to engage in self-medication behavior. In adjusted models, using illicit drugs or misusing prescription medications to control PTSD symptoms was associated with a substantially higher likelihood of dysthymia and borderline personality disorder. After controlling for mental disorder comorbidity, self-medication was independently associated with higher odds of suicide attempts (adjusted odds ratio=2.46; 95% confidence interval 1.53-3.97) and lower mental health-related quality of life.


CONCLUSIONS
Self-medication is a common behavior among people with PTSD in the community, yet has potentially hazardous consequences. Health care practitioners should assess reasons for substance use among people with PTSD to identify a subgroup with higher psychiatric morbidity.
Leeies
Murdoch
M
Department of Psychiatry, University of Manitoba, Winnipeg, Canada.
Pagura
Jina
J
Sareen
Jitender
J
Bolton
James M
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology*; D001883:Borderline Personality Disorder / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D019263:Dysthymic Disorder / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011788:Quality of Life / Q000523:psychology; D012651:Self Medication / Q000523:psychology* / Q000706:statistics & numerical data*; D013223:Statistics as Topic; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology*; D055815:Young Adult