title: Towards a unitary perspective between post-traumatic stress disorder and substance use disorder. Heroin use disorder as case study.
abstract: BACKGROUND
  Genetic, neurobiological, environmental and psychosocial mechanisms have received considerable attention in exploring the mechanisms that underlie comorbid PTSD and SUD. PTSD and SUD are not necessarily linked by a causal relationship, as the self-medication hypothesis had supposed. They might, in fact, both be caused by a third factor that predisposes these subjects to develop the two disorders (so allowing a unitary perspective).
  
  
  METHODS
  Using a conceptualization of the PTSD spectrum, we studied the PTSD-SUD unitary perspective by testing the correlation between severity of heroin addiction, dose of opioid medication and severity of PTSD spectrum in 82 methadone-treated, heroin-dependent patients.
  
  
  RESULTS
  Canonical correlation analysis (Wilks Lambda=0.125F=1.41 p=0.014), univariate and multivariate comparisons between subgroups, identified on the basis of addiction severity, showed a highly positive correlation between the PTSD spectrum and the severity of heroin addiction. In addition, negative correlations were found between PTSD spectrum severity and methadone dose (r=0.225; p=0.042).
  
  
  CONCLUSIONS
  This strength and breadth of the correlations encourage us to move towards a unified vision of the two disorders.
authors.affiliation: Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy, EU.
authors.forename: Liliana
authors.initials: L
authors.lastname: Dell'Osso
authors.affiliation: Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Italy, EU.
authors.forename: Fabio
authors.initials: F
authors.lastname: Rugani
authors.affiliation: Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Italy, EU; Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy, EU.
authors.forename: Angelo Giovanni Icro
authors.initials: AG
authors.lastname: Maremmani
authors.affiliation: Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Italy, EU.
authors.forename: Sara
authors.initials: S
authors.lastname: Bertoni
authors.affiliation: Social and Health Services, Health District 8 (ASL 8) Cagliari, Italy, EU.
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Pani
authors.affiliation: Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Italy, EU; Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy, EU; G. De Lisio Institute of Behavioral Sciences, Pisa, Italy, EU. Electronic address: maremman@med.unipi.it.
authors.forename: Icro
authors.initials: I
authors.lastname: Maremmani
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006556:Heroin Dependence / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D055815:Young Adult