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Trauma Exposure Predicts Alcohol, Nicotine, and Drug Problems Beyond the Contribution of PTSD and Depression in Patients with Cardiovascular Disease: Data from the Heart and Soul Study

Authors

  • Angela E. Waldrop PhD,

    Corresponding author
    1. San Francisco VA Medical Center, San Francisco, California
    2. University of California, San Francisco, San Francisco, California
    • Address correspondence to Dr Waldrop, 4150 Clement Street, 116P San Francisco, CA 94121. E-mail: mailto:angela.waldrop@ucsf.edu.

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  • Beth E. Cohen MD, MAS

    1. San Francisco VA Medical Center, San Francisco, California
    2. University of California, San Francisco, San Francisco, California
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Abstract

Background and Objectives

This study examined the role of lifetime trauma exposure in a longitudinal study of adults with cardiovascular disease to determine the unique contribution of trauma exposure to risk for drug and alcohol problems and smoking.

Methods

Data were drawn from the Heart and Soul Study, a prospective cohort study designed to determine the mechanisms of associations between psychological factors and increased risk of cardiovascular events in high-risk patients (n = 1,022).

Results

Lifetime exposure to a higher number of trauma types predicted substance use outcomes beyond risk explained by PTSD and depression. In addition, across trauma types, interpersonal traumas were most strongly associated with substance use problems.

Conclusions

Our results suggest that, though PTSD and depression play a role in the association between trauma exposure and substance use, many other factors also contribute; therefore focusing on these psychological comorbidities alone is not sufficient.

Scientific Significance

The integration of mental health care and/or case management support with primary and specialty medical care may improve detection and treatment for patients with substance use and comorbid mental and physical health problems. Screening for trauma exposure is an important part of good clinical care. (Am J Addict 2014;23:53–61)

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