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Trauma and posttraumatic stress disorder symptoms in drug users

LETTER TO THE EDITORS

Trauma and posttraumatic stress disorder symptoms in drug users* * Research carried out at Instituto de Prevenção e Pesquisa em Álcool e Outras Dependências (IPPAD) and approved by the Research Ethics Committee at Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil (CEP 06/03028 on 03/13/06).

Sibele FallerI; Gilda PulcherioII; Marlene StreyIII

IPsychologist, Instituto de Prevenção e Pesquisa em Álcool e Outras Dependências (IPPAD) and Centro de Pesquisa em Álcool e Drogas (CEPAD), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

IIPsychiatrist, IPPAD, Porto Alegre, RS, Brazil. MSc. in Social and Personality Psychology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil

IIIPsychologist, IPPAD, Porto Alegre, RS, Brazil. Professor, Graduate Program in Psychology, PUCRS, Porto Alegre, RS, Brazil

Correspondence Correspondence: Gilda Pulcherio Rua Dona Lida Monteiro, 450, Bairro São Caetano CEP 91720-300 - Porto Alegre, RS, Brazil E-mail: gilda@ippad.com.br

Dear Editors,

It is estimated that the prevalence of posttraumatic stress disorder (PTSD) in the population ranges from 1 to 14%1 and it may reach 60-80% in traumatized populations.2 Investigations using specific groups of people that seek treatment have found that 30-50% of psychoactive substance users have PTSD.3

Exposure to trauma is the sine qua non condition for the development of PTSD, and an American epidemiological study found that around 90% of the population had been exposed to some sort of traumatic event.4 Due to risk behaviors, chemically dependent patients are a group of great vulnerability for trauma and PTSD.

The comorbid condition between use of psychoactive substances and PTSD is still little studied in our country, so we proposed to investigate the occurrence of psychosocial trauma and presence of PTSD in a sample of chemically dependent patients. In the first appointment, 23 patients with at least 1 month in the abstinence period who presented at Instituto de Prevenção e Pesquisa em Álcool e outras Dependências (IPPAD) for treatment were assessed, considering the period from March to July 2006. They responded to the Specific Traumatic Events,4 a list of events developed in accordance with the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DMS-IV) and Davidson Trauma Scale5 (DTS), which investigates frequency and severity of PTSD symptoms.

The patients were male, aged between 18-30 years (39.1%), incomplete elementary school (30.4%), and only used alcohol (13%). All presented severe dependence of the psychoactive substance and previous hospitalizations, and 38.1% were hospitalized more than three times.

All patients (100%) were exposed to some traumatic event throughout their lives. The most prevalent event was being "stolen or threatened with a gun," reported by 56.5% of chemically dependent patients. "Sudden and unexpected death of a relative or close friend" was experienced by 54.5% of the sample, being reported as the "worst" event by 28.6% of respondents. Epidemiological studies have shown high prevalence of this trauma in the population, with moderate risk for PTSD.4

A PTSD symptom was reported by all participants, and 47.6% had "images, memories or painful thoughts about the event" over the past week, with 9.5% experiencing this symptom daily. Of the total patients, 24% felt moderately to extremely disturbed. More than half (57%) reported "difficulties in feeling satisfied with things in their lives." Of these, 19% felt very disturbed, and 14.3% classified themselves as extremely disturbed.

This symptom can be mistaken by depressive disorder, which occurs at a high prevalence, both in traumatized people who did not develop PTSD and in those with PTSD and chemically dependent patients. Hence, it is important to perform a judicious comorbid investigation and draw attention to trauma in chemically dependent patients to prevent the development of PTSD.

REFERENCES

1. American Psychiatric Association. DSM-IV: manual diagnóstico e estatístico de transtornos mentais. 4.ed. Porto Alegre; Artmed; 1995.

2. Kapczinski F, Margis R. Transtorno de estresse pós-traumático: critérios diagnósticos. Rev Bras Psiquiatr. 2003;25(Supl 1):3-7.

3. Brady KT, Randall CL. Gender differences in substance use disorders. Psychiatr Clin North Am. 1999;22(2):241-52.

4. Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P. Trauma and posttraumatic stress disorder in the community. Arch Gen Psychiatry. 1998;55(7):626-32.

5. Davidson JR, Book SW, Colket JT, Tupler LA, Roth S, David D, et al. Assessment of a new self-rating scale for post-traumatic stress disorder. Psychol Med. 1997;27(1):153-60.

  • Correspondence:
    Gilda Pulcherio
    Rua Dona Lida Monteiro, 450, Bairro São Caetano
    CEP 91720-300 - Porto Alegre, RS, Brazil
    E-mail:
  • *
    Research carried out at Instituto de Prevenção e Pesquisa em Álcool e Outras Dependências (IPPAD) and approved by the Research Ethics Committee at Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil (CEP 06/03028 on 03/13/06).
  • Publication Dates

    • Publication in this collection
      04 Apr 2007
    • Date of issue
      Dec 2006
    Sociedade de Psiquiatria do Rio Grande do Sul Av. Ipiranga, 5311/202, 90610-001 Porto Alegre RS Brasil, Tel./Fax: +55 51 3024-4846 - Porto Alegre - RS - Brazil
    E-mail: revista@aprs.org.br