title: Past year non-medical opioid use and abuse and PTSD diagnosis: Interactions with sex and associations with symptom clusters.
abstract: BACKGROUND
  Few studies have examined the associations between posttraumatic stress disorder (PTSD) and non-medical opioid use (NMOU), particularly in general U.S.
  
  
  METHODS
  We analyzed data from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of non-institutionalized adults, to examine (1) the relationship between PTSD diagnosis with NMOU, Opioid Use Disorder diagnosis, and average monthly frequency of NMOU; and (2) the relationship between PTSD symptom clusters with NMOU, Opioid Use Disorder diagnosis, and average monthly frequency of NMOU. We also explored sex differences among these associations.
  
  
  RESULTS
  In the adjusted model, a past year PTSD diagnosis was associated with higher odds of past year NMOU for women and men, but the association was stronger for women. In addition, PTSD was associated with higher odds of an Opioid Use Disorder diagnosis for women, but not for men. With regard to the relationship between specific symptom clusters among those with a past year PTSD diagnosis, important sex differences emerged. For women, the avoidance symptom cluster was associated with higher odds of NMOU, an Opioid Use Disorder diagnosis, and higher rate of average monthly frequency of NMOU, while for men the arousal/reactivity cluster was associated with higher odds of NMOU, an Opioid Use Disorder diagnosis, and a higher rate of average monthly frequency of NMOU. In addition, for men, the avoidance symptom cluster was associated with higher odds of an Opioid Use Disorder diagnosis, but a lower rate of average monthly frequency of NMOU.
  
  
  CONCLUSIONS
  Results add to the literature showing an association between PTSD and NMOU and suggest that PTSD is more strongly associated with substance use for women than men. Further, results based on individual symptom clusters suggest that men and women with PTSD may be motivated to use substances for different reasons.
authors.affiliation: Department of Psychology, Wayne State University, 5057 Woodward, 7th floor, Detroit, MI 48202, United States; Department of Psychiatry, Yale University, School of Medicine, 2 Church Street South, Suite 201, New Haven, CT 06519, United States. Electronic address: k.m.zumberg@gmail.com.
authors.forename: Kathryn Z
authors.initials: KZ
authors.lastname: Smith
authors.affiliation: Department of Psychiatry, Yale University, School of Medicine, 2 Church Street South, Suite 201, New Haven, CT 06519, United States.
authors.forename: Philip H
authors.initials: PH
authors.lastname: Smith
authors.affiliation: Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, 325 Kimball Tower, Buffalo, NY 14214, United States.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Cercone
authors.affiliation: Department of Psychiatry, Yale University, School of Medicine, 2 Church Street South, Suite 201, New Haven, CT 06519, United States.
authors.forename: Sherry A
authors.initials: SA
authors.lastname: McKee
authors.affiliation: Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, 325 Kimball Tower, Buffalo, NY 14214, United States.
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Homish
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Opioid use; Posttraumatic stress disorder; Substance use; U.S. population