title: Using the Pictorial Representation of Illness and Self Measure (PRISM) to Quantify and Compare Suffering From Trauma and Addiction.
abstract: OBJECTIVE
  In a sample of people with substance use disorder who had experienced psychological trauma, this study aimed to quantify differences in perceived suffering due to addiction-related problems and to trauma-related problems.
  
  
  METHODS
  The sample comprised 146 inpatients with substance use disorder: 25% had posttraumatic stress disorder (PTSD), 21% had subthreshold PTSD; and the remainder constituted the trauma-only group. PTSD, substance use disorder, and suffering were assessed using validated instruments. Suffering was measured using the Pictorial Representation of Illness and Self Measure (PRISM).
  
  
  RESULTS
  No differences were found among the PTSD, subthreshold PTSD, and trauma-only group in the suffering attributed to addiction-related problems. Those in the PTSD group appraised their suffering due to trauma-related problems as greater than the other groups. In the PTSD group, but not the subthreshold PTSD group, suffering due to trauma-related problems was appraised as greater than that due to addiction-related problems.
  
  
  CONCLUSIONS
  This is the first study to demonstrate quantitative comparisons between different health problems using the "common currency" of suffering. Our results indicate that even among those in an inpatient substance use disorder treatment program, comorbid PTSD may be more personally salient and cause greater suffering, with implications for therapeutic interventions available on substance use disorder treatment programs.
authors.affiliation: a Tactus Addiction Treatment and Nijmegen Institute for Scientist-Practitioners in Addiction , Enschede , The Netherlands.
authors.forename: Tim
authors.initials: T
authors.lastname: Kok
authors.affiliation: a Tactus Addiction Treatment and Nijmegen Institute for Scientist-Practitioners in Addiction , Enschede , The Netherlands.
authors.forename: Hein A
authors.initials: HA
authors.lastname: De Haan
authors.affiliation: b Centre for Mental Health , Imperial College London , London , United Kingdom.
authors.forename: Tom
authors.initials: T
authors.lastname: Sensky
authors.affiliation: c Verslavingszorg Noord Nederland , Groningen , The Netherlands.
authors.forename: Margreet
authors.initials: M
authors.lastname: van der Meer
authors.affiliation: a Tactus Addiction Treatment and Nijmegen Institute for Scientist-Practitioners in Addiction , Enschede , The Netherlands.
authors.forename: Cornelis A J
authors.initials: CAJ
authors.lastname: De Jong
mesh_terms: D000328:Adult; D057189:Checklist; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012649:Self Concept; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*; D019966:Substance-Related Disorders / Q000523:psychology*
keywords: PRISM; PTSD; comorbidity; illness perception; substance use disorder; suffering