title: Trauma exposure, posttraumatic stress disorder and risk for alcohol, nicotine, and marijuana dependence in Israel.
abstract: BACKGROUND
  Substance dependence is more common among trauma-exposed individuals; however, most studies suggest that Posttraumatic Stress Disorder (PTSD) accounts for the link between trauma exposure (TE) and substance dependence.
  
  
  OBJECTIVE
  This study examined associations between TE and substance dependence (alcohol, nicotine, and marijuana), and whether PTSD accounted for this association.
  
  
  METHODS
  1317 Jewish Israeli household residents completed in-person structured interviews assessing TE, PTSD, and substance (alcohol, nicotine, marijuana) dependence between 2007 and 2009. Regression analyses examined associations among TE, PTSD, and substance dependence.
  
  
  RESULTS
  In the full sample, mean number of traumatic events was 2.7 (sd=2.2), with 83.7% experiencing at least one event. In the full sample, mean number of PTSD symptoms was 2.5 (sd=3.4), with 13.5% meeting PTSD diagnostic criteria. Prevalence of alcohol dependence was 13.4%; nicotine dependence 52.8%; and marijuana dependence 12.1%. Number of traumatic events was associated with increased odds of alcohol (OR=1.3; 95% CI=1.2-1.4) and nicotine (OR=1.2; 95% CI=1.1-1.3) dependence. Similarly, any traumatic event exposure was associated with increased odds of alcohol (OR=3.1; 95% CI=1.6-6.0) and nicotine (OR=1.9; 95% CI=1.2-2.9) dependence. PTSD symptoms were associated with increased odds of alcohol (OR=1.2; 95% CI=1.1-1.3), nicotine (OR=1.1; 95% CI=1.1-1.2), and marijuana (OR=1.1; 95% CI=1.04-1.2) dependence; similarly, a PTSD diagnosis was associated with increased odds of alcohol (OR=3.4; 95% CI=2.1-5.5), nicotine (OR=2.2; 95% CI=1.4-3.4), and marijuana (OR=2.6; 95% CI=1.2-5.9) dependence. PTSD symptoms accounted for a sizeable proportion of the TE effect on alcohol (46%) and nicotine dependence (31%).
  
  
  CONCLUSIONS
  Individuals with more traumatic events had heightened risk for alcohol and nicotine dependence, and PTSD symptoms partially accounted for this risk. However, marijuana dependence was only significantly related to PTSD symptoms. Clinicians and researchers should separately assess different types of dependence among trauma-exposed individuals both with and without PTSD symptoms.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Walsh
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Elliott
authors.affiliation: Department of Psychiatry, Columbia University Medical Center, New York, New York 10032, USA; New York State Psychiatric Institute, New York, New York 10032, USA.
authors.forename: Dvora
authors.initials: D
authors.lastname: Shmulewitz
authors.affiliation: Department of Psychiatry, Columbia University Medical Center, New York, New York 10032, USA; New York State Psychiatric Institute, New York, New York 10032, USA.
authors.forename: Efrat
authors.initials: E
authors.lastname: Aharonovich
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 69978.
authors.forename: Rael
authors.initials: R
authors.lastname: Strous
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 69978; Felsenstein Medical Research Center, Petach Tikva, Israel, 49100.
authors.forename: Amos
authors.initials: A
authors.lastname: Frisch
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 69978; Felsenstein Medical Research Center, Petach Tikva, Israel, 49100; Research Unit, Geha Mental Health Center, Petach Tikva, Israel, 49100.
authors.forename: Abraham
authors.initials: A
authors.lastname: Weizman
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 69978.
authors.forename: Baruch
authors.initials: B
authors.lastname: Spivak
authors.affiliation: Laboratory of Epidemiology and Biometry, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland, USA.
authors.forename: Bridget F
authors.initials: BF
authors.lastname: Grant
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA; Department of Psychiatry, Columbia University Medical Center, New York, New York 10032, USA; New York State Psychiatric Institute, New York, New York 10032, USA. Electronic address: dsh2@columbia.edu.
authors.forename: Deborah
authors.initials: D
authors.lastname: Hasin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008016:Life Change Events; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D015995:Prevalence; D012306:Risk; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000453:epidemiology*; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult