title: The impact of intolerance of emotional distress and uncertainty on veterans with co-occurring PTSD and substance use disorders.
abstract: The risk of developing a substance use disorder (SUD) is significantly higher among veterans with posttraumatic stress disorder (PTSD). Veterans with this co-occurrence have poorer outcomes than singly diagnosed veterans, which may be related to two risk factors: intolerance uncertainty (IU) and low tolerance of emotional distress (TED). We hypothesized low TED and high IU would independently and interactively relate to heightened PTSD symptomatology and trauma-cue elicited SUD cravings. A sample of 70 veterans (M age=50; 95% men; 65% Black) with co-occurring PTSD-SUD was recruited. The Posttraumatic Stress Disorder Checklist (PCL), Craving Questionnaire, Distress Tolerance Scale, and Intolerance of Uncertainty Scale were administered. In general, low TED and high IU were significantly correlated with the PCL total and subscale scores. When examined within regression models, low TED was associated with elevated PCL scores and trauma-cue elicited SUD cravings; IU was not. However, there was a significant interaction between IU and TED; veterans with elevated IU and low TED had higher PCL Total, Hyperarousal, and Intrusions scores. This highlights the importance of assessing TED and IU among veterans with co-occurring PTSD-SUD, as these risk factors may not only be prognostic indicators of outcomes, but also treatment targets.
authors.affiliation: G.V. (Sonny) Montgomery Veterans Affairs Medical Center, 1500 E Woodrow Wilson Ave, Jackson, MS 39216, United States; University of Mississippi Medical Center, 2500N State St. Jackson, MS 39216, United States; National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, United States. Electronic address: anne.banducci@va.gov.
authors.forename: Anne N
authors.initials: AN
authors.lastname: Banducci
authors.affiliation: G.V. (Sonny) Montgomery Veterans Affairs Medical Center, 1500 E Woodrow Wilson Ave, Jackson, MS 39216, United States; University of Mississippi Medical Center, 2500N State St. Jackson, MS 39216, United States.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Bujarski
authors.affiliation: National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, United States; Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, United States; Center of Excellence in Substance Abuse Treatment and Education, Philadelphia VA Medical Center, 3900 Woodland Ave., Philadelphia, PA 19104, United States; Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3440 Market St, Suite 370, Philadelphia, PA 19104, United States.
authors.forename: Marcel O
authors.initials: MO
authors.lastname: Bonn-Miller
authors.affiliation: G.V. (Sonny) Montgomery Veterans Affairs Medical Center, 1500 E Woodrow Wilson Ave, Jackson, MS 39216, United States; University of Mississippi Medical Center, 2500N State St. Jackson, MS 39216, United States.
authors.forename: Amee
authors.initials: A
authors.lastname: Patel
authors.affiliation: G.V. (Sonny) Montgomery Veterans Affairs Medical Center, 1500 E Woodrow Wilson Ave, Jackson, MS 39216, United States; University of Mississippi Medical Center, 2500N State St. Jackson, MS 39216, United States.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Connolly
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology*; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology*; D011795:Surveys and Questionnaires; D035501:Uncertainty; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: Distress tolerance; Intolerance of uncertainty; PTSD; Substance use disorders; Veterans