Journal of Child & Adolescent Trauma

, Volume 12, Issue 3, pp 341–349 | Cite as

Interpersonal Trauma Exposure, Trauma Symptoms, and Severity of Substance Use Disorder among Youth Entering Outpatient Substance Abuse Treatment

  • Jennifer ColeEmail author
  • Ginny Sprang
  • Miriam Silman


A substantial body of literature has found associations between interpersonal victimization, trauma symptoms, and substance use disorders (SUD) among adolescents. Secondary data analysis was conducted on structured interview data collected by treatment providers as 172 adolescents (ages 12–19) entered outpatient substance abuse treatment. Results indicate high prevalence rates of interpersonal trauma exposure: 71.5% self-reported trauma exposure, specifically direct physical abuse or assault, sexual abuse or assault, and/or witnessing intimate partner violence of a parent. Severity of SUD, as measured by number of DSM-5 criteria endorsed, was not only associated with the number of types of criterion A events for Posttraumatic Stress Disorder but also more self-reported internalizing problems. There was no significant relationship between the severity of SUD and the severity of trauma symptoms at treatment intake, gender, or attention problems. Ongoing assessment of possible trauma symptoms is recommended throughout substance abuse treatment with youth who have reported trauma exposure, as well as continued screening of trauma exposure.


Interpersonal victimization Posttraumatic stress disorder Internalizing problems Adolescents 



This research was supported in part by the Kentucky Department of Behavioral Health, Developmental and Intellectual Disabilities, Division of Behavioral Health under a contract with the University of Kentucky Center on Drug and Alcohol Research.

Compliance with Ethical Standards

Disclosure of Interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical Standards and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation [institutional and national] and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.”


  1. Allwood, M. A., Esposito-Smythers, C., Swenson, L. P., & Spirito, A. (2014). Negative cognitions as a moderator in the relationship between PTSD and substance use in a psychiatrically hospitalized adolescent sample. Journal of Traumatic Stress, 27, 208–216.Google Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association Publishing.Google Scholar
  3. Andersen, S. L., & Teicher, M. H. (2009). Desperately driven and no brakes: Developmental stress exposure and subsequent risk for substance abuse. Neuroscience Biobehavioral Reviews, 33(4), 516–524.Google Scholar
  4. Berenson, A. B., Wiemann, C. M., & McCombs, S. (2001). Exposure to violence and associated health-risk behaviors among adolescent girls. Archives of Pediatrics & Adolescent Medicine, 155(11), 1238–1242.Google Scholar
  5. Blumenthal, H., Blanchard, L., Feldner, M. T., Babson, K. A., Leen-Feldner, E. W., & Dixon, L. (2008). Traumatic event exposure, posttraumatic stress, and substance use among youth: A critical review of the empirical literature. Current Psychiatry Reviews, 4, 228–254.Google Scholar
  6. Brady, K. T., Back, S. E., & Coffey, S. F. (2004). Substance abuse and posttraumatic stress disorder. Current Directions in Psychological Science, 13(5), 206–209.Google Scholar
  7. Briere, J., Hodges, M., & Godbout, N. (2010). Traumatic stress, affect dysregulation and dysfunctional avoidance: A structural equation model. Journal of Traumatic Stress, 23(6), 767–774.Google Scholar
  8. Brody, J. L., & Waldron, H. B. (2000). Ethical issues in research on the treatment of adolescent substance abuse disorders. Addictive Behaviors, 25(2), 217–228.Google Scholar
  9. Brown, P. J., & Wolfe, J. (1994). Substance abuse and post-traumatic stress disorder comorbidity. Drug & Alcohol Dependence, 35(1), 51–59.Google Scholar
  10. Chan, Y. F., Dennis, M. L., & Funk, R. R. (2008). Prevalence and comorbidity of major internalizing and externalizing problems among adolescents and adults presenting to substance abuse treatment. Journal of Substance Abuse Treatment, 34(1), 14–24.Google Scholar
  11. Cisler, J. M., Amstadter, A. B., & Kilpatrick, D. G. (2011). PTSD symptoms, potentially traumatic event exposure, and binge drinking: A prospective study with a national sample of adolescents. Journal of Anxiety Disorders, 25(7), 978–987.Google Scholar
  12. Clark, D. B., Lesnick, L., & Hegedus, A. M. (1997). Traumas and other adverse life events in adolescents with alcohol abuse and dependence. Journal of American Academy of Child and Adolescent Psychiatry, 36(12), 1744–1751.Google Scholar
  13. Cohen, J. A., Mannarino, A. P., Zhitova, A. C., & Capone, M. E. (2003). Treating child abuse-related posttraumatic stress and comorbid substance abuse in adolescents. Child Abuse & Neglect, 27, 1345–1365.Google Scholar
  14. Cook, A., Spinazzola, J., Ford, J., Lanktree, C., & Blaustein, M. C. M. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35(5), 390–398.Google Scholar
  15. Copeland, W. E., Keeler, G., Angold, A., & Costello, E. J. (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry, 64, 577–584.Google Scholar
  16. Cooper, M.L., Frone, M.R., Russell, M., & Mudar, P. (1995). Drinking to regulate positive and negative emotions: a motivational model of alcohol use. Journal of Personal and Social Psychology, 69(5), 990–1005.Google Scholar
  17. Cornelius, J. R., Kirisci, L., Reynolds, M., Clark, D. B., Hayes, J., & Tarter, R. (2010). PTSD contributes to teen and young adult cannabis use disorders. Addictive Behaviors, 35(2), 91–94. Scholar
  18. De Bellis, M. (2002). Developmental traumatology: A contributory mechanism for alcohol and substance use disorders. Psychoneuroendorcrinology, 27, 155–170.Google Scholar
  19. Deykin, E. Y., & Buka, S. L. (1997). Prevalence and risk factors for posttraumatic stress disorder among chemically dependent adolescents. American Journal of Psychiatry, 154(6), 752–757.Google Scholar
  20. Drake, R. E., Mueser, K., Brunette, M., & McHugo, G. (2006). A review of treatments for people with severe mental illnesses and co-occurring substance use disorders. Psychiatric Rehabilitation Journal, 27(4), 360–374.Google Scholar
  21. Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles, W. H., & Anda, R. F. (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The adverse childhood experiences study. Pediatrics, 111(3), 564–572.Google Scholar
  22. Finkelhor, D., Hamby, S., Ormrod, R., & Turner, H. (2005). The juvenile victimization questionnaire: Reliability, validity, and national norms. Child Abuse & Neglect, 29, 383–412.Google Scholar
  23. Foa, E. B., Treadwell, K., Johnson, K., & Feeny, N. (2001). Child PTSD symptom scale (CPSS): Validation of a measure for children with PTSD. Journal of Clinical Child Psychology, 30, 376–384.Google Scholar
  24. Ford, J. D., Elhai, J. D., Connor, D. F., & Frueh, B. C. (2010). Poly-victimization and risk of posttraumatic, depressive, and substance use disorders and involvement in delinquency in a national sample of adolescents. Journal of Adolescent Health, 46(6), 545–552.Google Scholar
  25. Funk, R. R., McDermeit, M., Godley, S. H., & Adams, L. (2003). Maltreatment issues by level of adolescent substance abuse treatment: The extent of the problem at intake and relationship to early outcomes. Child Maltreatment, 8(1), 36–45.Google Scholar
  26. Gardner, W., Murphy, M., Childs, G., Kelleher, K., Pagano, M., Jellinek, M., et al. (1999). The PSC-17: A brief pediatric symptom checklist with psychosocial problem subscales. A report from PROS and ASPN. Ambulatory Child Health, 5, 225–236.Google Scholar
  27. Gardner, W., Lucas, A., Kolko, D. J., & Campo, J. V. (2007). Comparison of the PSC-17 and alternative mental health screens in an at-risk primary care sample. Journal of American Academy of Child & Adolescent Psychiatry, 46(5), 611–618.Google Scholar
  28. Giaconia, R. M., Reinherz, H. Z., Silverman, A. B., Pakiz, B., Frost, A. K., & Cohen, E. (1995). Traumas and posttraumatic stress disorder in a community population of older adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 34(10), 1369–1380.Google Scholar
  29. Giaconia, R.M., Reinherz, H.Z., Hauf, A.C., Paradis, A.D., Wasserman, M.S., & Langhammer, D.M. (2000). Comorbidity of substance use and post-traumatic stress disorders in a community sample of adolescents. American Journal of Orthopsychiatry, 70(2), 253–262.Google Scholar
  30. Gillihan, S. J., Aderka, I. M., Conklin, P. H., Capaldi, S., & Foa, E. B. (2013). The child PTSD symptom scale: Psychometric properties in female adolescent sexual assault survivors. Psychological Assessment, 25(1), 23–31.Google Scholar
  31. Gilreath, T. D., Astor, R. A., Estrada, J. N., Benbenishty, R., & Unger, J. B. (2014). School victimization and substance use among adolescents in California. Prevention Science, 15(6), 897–906.Google Scholar
  32. Goldstein, A., Wekerle, C., Tonmyr, L., Thornton, T., Waechter, R., Pereira, J., & Chung, R. (2011). The relationship between post-traumatic stress symptoms and substance use among adolescents involved with child welfare: Implications for emerging adulthood. International Journal of Mental Health & Addiction, 9(5), 507–524. Scholar
  33. Greeson, J. K., Briggs, E. C., Kisiel, C. L., Layne, C. M., Ake III, G. S., Ko, S. J., et al. (2011). Complex trauma and mental health in children and adolescents placed in foster care: Findings from the National Child Traumatic Stress Network. Child Welfare, 90(6), 91–108.Google Scholar
  34. Grella, C. E., & Joshi, V. (2003). Treatment processes and outcomes among adolescents with a history of abuse who are in drug treatment. Child Maltreatment, 8(1), 7–18.Google Scholar
  35. Haller, M., & Chassin, L. (2014). Risk pathways among traumatic stress, posttraumatic stress disorder symptoms, and alcohol and drug problems: A test of four hypotheses. Psychology of Addictive Behavior, 28(3), 841–851.Google Scholar
  36. Hamburger, M. E., Leeb, R. T., & Swahn, M. H. (2008). Childhood maltreatment and early alcohol use among high-risk adolescents. Journal of Studies on Alcohol and Drugs, 69(2), 291–295. Scholar
  37. Hasin, D., Trautman, K., Miele, G., Samet, S., Smith, M., & Endicott, J. (1996). Psychiatric research interview for substance and mental disorders (PRISM): Reliability for substance abusers. American Journal of Psychiatry, 153(9), 1195–1201.Google Scholar
  38. Hawke, J. M., Ford, J. D., Kaminer, Y., & Burke, R. (2008). Trauma and PTSD among youths in outpatient treatment alcohol use disorders. Journal of Child & Adolescent Trauma, 2(1), 1–14.Google Scholar
  39. Hides, L., Lubman, D. I., Cosgrave, E. M., Buckby, J. A., Killackey, E., & Yung, A. R. (2008). Motives for substance use among young people seeking mental health treatment. Early Intervention in Psychiatry, 2, 188–194.Google Scholar
  40. Horton, J., Compton, W., & Cottler, L. (2000). Reliability of substance use disorder diagnoses among African-Americans and Caucasians. Drug and Alcohol Dependence, 57(3), 203–209.Google Scholar
  41. Jacobsen, L. K., Southwick, S. M., & Kosten, T. R. (2001). Substance use disorders in patients with posttraumatic stress disorder: A review of the literature. American Journal of Psychiatry, 158(8), 1184–1190.209.Google Scholar
  42. Jaycox, L. H., Ebener, P., Damesek, L., & Becker, K. (2004). Trauma exposure and retention in adolescent substance abuse treatment. Journal of Traumatic Stress, 17(2), 113–121.Google Scholar
  43. Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2006). Monitoring the future national survey results on drug use, 1975–2005: Volume I secondary school students 2005. Bethesda: National Institute on Drug Abuse.Google Scholar
  44. Kaminer, Y., Bukstein, O., & Tarter, R. E. (1991). The teen-addiction severity index: Rationale and reliability. The International Journal of Addictions, 26, 219–226.Google Scholar
  45. Kaminer, Y., Wagner, E., Plummer, B., & Seifer, R. (1993). Validation of the teen addiction severity index (T-ASI). American Journal of Addictions, 2, 250–254.Google Scholar
  46. Khantzian, E. J. (1990). Self-regulation and self-medication factors in alcoholism and the addictions. In M. Galanter (Ed.), Recent developments in alcoholism. New York: Plenum.Google Scholar
  47. Khantzian, E. J. (2003). The self-medication hypothesis revisited: The dually diagnosed patient. Primary Psychiatry, 10, 47–54.Google Scholar
  48. Kilpatrick, D. G., Acierno, R., Saunders, B., Resnick, H. S., Best, C. L., & Schnurr, P. P. (2000). Risk factors for adolescent substance abuse and dependence: Data from a national sample. Journal of Consulting and Clinical Psychology, 68(1), 19–30.Google Scholar
  49. Kilpatrick, D. G., Ruggiero, K. J., Acierno, R., Saunders, B. E., Resnick, H. S., & Best, C. L. (2003). Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: Results from the National Survey of adolescents. Journal of Consulting and Clinical Psychology, 71, 692–700. Scholar
  50. Kobulsky, J. M., Holmes, M. R., Yoon, S., & Perzynski, A. T. (2016). Physical abuse after child protective services investigation and adolescent substance use. Children and Youth Services Review, 71, 36–44. Scholar
  51. Koob, G. F., & Le Moal, M. (2008). Addiction and the brain antireward system. Annual Review of Psychology, 59, 29–53.Google Scholar
  52. Lipschitz, D. S., Rasmussen, A. M., Anyan, W., Guerorguieva, R., Billingslea, E. M., Cromwell, P. F., & Southwick, S. M. (2003). Posttraumatic stress disorder and substance use in inner-city adolescent girls. Journal of Nervous and Mental Disease, 191, 714–721.Google Scholar
  53. Lubman, D. I., Allen, N. B., Rogers, N., Cementon, E., & Bonomo, Y. (2007). The impact of co-occurring mood and anxiety disorders among substance-abusing youth. Journal of Affective Disorders, 103, 105–112.Google Scholar
  54. Macdonald, A., Danielson, C. K., Resnick, H. S., Saunders, B. E., & Kilpatrick, D. G. (2010). PTSD and comorbid disorders in a representative sample of adolescents: The risk associated with multiple exposures to potentially traumatic events. Child Abuse & Neglect, 34(10), 773–783. Scholar
  55. Malone, M., & Hoffmann, N. (2016). A comparison of DSM-IV versus DSM-5 substance use disorder diagnoses in adolescent populations. Journal of Child & Adolescent Substance Abuse, 25(5), 399–408.Google Scholar
  56. McCart, M. R., Zajac, K., Danielson, C. K., Strachan, M., Ruggiero, K. J., Smith, D. W., Saunders, B. E., & Kilpatrick, D. G. (2011). Interpersonal victimization, posttraumatic stress disorder, and change in adolescent substance use prevalence over a ten-year period. Journal of Clinical Child and Adolescent Psychology, 40(1), 136–143.Google Scholar
  57. McCart, M. R., Zajac, K., Kofler, M. J., Smith, D. W., Saunders, B. E., & Kilpatrick, D. G. (2012). Longitudinal examination of PTSD symptoms and problematic alcohol use as risk factors for adolescent victimization. Journal of Clinical Child & Adolescent Psychology, 41(6), 822–836.Google Scholar
  58. Messman-Moore, T. L., Coates, A. A., Gaffey, K. J., & Johnson, C. F. (2008). Sexuality, substance use, and susceptibility to victimization: Risk for rape and sexual coercion in a prospective study of college women. Journal of Interpersonal Violence, 23(12), 1730–1746.Google Scholar
  59. Meyer, R. M. L., Gold, J. I., Beas, V. N., Young, C. M., & Kassam-Adams, N. (2015). Psychometric evaluation of the child PTSD symptom scale in Spanish and English. Child Psychiatry and Human Development, 46(3), 438–444. Scholar
  60. Moran, P. B., Vuchinich, S., & Hall, N. K. (2004). Associations between types of maltreatment and substance use during adolescence. Child Abuse & Neglect, 28(5), 565–574.Google Scholar
  61. Mulvey, K. P., Atkinson, D. D., Avula, D., & Luckey, J. W. (2005). Using the internet to measure program performance. American Journal of Evaluation, 26, 587–597.Google Scholar
  62. Murphy, A., Steele, H., Steele, M., Allman, B., Kastner, T., & Dube, S. R. (2016). The clinical adverse childhood experiences (ACEs) questionnaire: Implications for trauma-informed behavioral healthcare. In R. D. Briggs (Ed.), Integrated early childhood behavior health in primary care: A guide to implementation and evaluation. Switzerland: Springer International Publishing.Google Scholar
  63. Nooner, K., Linares, L., Batinjane, J., Kramer, R., Silva, R., & Cloitre, M. (2012). Factors related to posttraumatic stress disorder in adolescence. Trauma, Violence, & Abuse, 13(3), 153–166.Google Scholar
  64. Oshri, A., Rogosch, F., Burnette, M., & Cicchetti, D. (2011). Developmental pathways to adolescent cannabis abuse and dependence: Child maltreatment, emerging personality, and internalizing versus externalizing psychopathology. Psychology of Addictive Behaviors, 25(4), 634–644.Google Scholar
  65. Pilowsky, D. J., & Wu, L. T. (2006). Psychiatric symptoms and substance use disorders in a nationally representative sample of American adolescents involved with foster care. Journal of Adolescent Health, 38(4), 351–358.Google Scholar
  66. Reed, P. L., Anthony, J. C., & Breslau, N. (2007). Incidence of drug problems in young adults exposed to trauma and posttraumatic stress disorder: Do early life experiences and predispositions matter? Archives of General Psychiatry, 64(12), 1435–1442.Google Scholar
  67. Scheidell, J., Quinn, K., McGorray, S., Frueh, B., Beharie, N., Cottler, L., & Khan, M. (2018). Childhood traumatic experiences and the association with marijuana and cocaine use in adolescence through adulthood. Addiction, 113(1), 44–56.Google Scholar
  68. Shane, P., Diamond, G., Mensinger, J., Shera, D., & Wintersteen, M. (2006). Impact of victimization on substance abuse treatment outcomes for adolescents in outpatient and residential substance abuse treatment. American Journal on Addictions, 15, 34–42.Google Scholar
  69. Snyder, S. M., & Smith, R. E. (2015). Do physical abuse, depression, and parental substance use influence patterns of substance use among child welfare involved youth? Substance Use & Misuse, 50(2), 226–235. Scholar
  70. Stevens, S. J., Murphy, B. S., & McKnight, K. (2003). Traumatic stress and gender differences in relationship to substance abuse, mental health, physical health, and HIV risk behavior in a sample of adolescents enrolled in drug treatment. Child Maltreatment, 8(1), 46–57. Scholar
  71. Stewart, S. H., Conrod, P. J., Pihl, R. O., & Dongier, M. (1999). Relations between posttraumatic stress symptom dimensions and substance dependence in a community-recruited sample of substance-abusing women. Psychology of Addictive Behaviors, 13, 78–88.Google Scholar
  72. Titus, J., Dennis, M., White, W., Scott, C., & Funk, R. (2003). Gender differences in victimization severity and outcomes among adolescents treated for substance abuse. Child Maltreatment, 8(1), 19–35.Google Scholar
  73. Tonmyr, L., Thornton, T., Draca, J., & Wekerle, C. (2010). A review of childhood maltreatment and adolescent substance use relationship. Current Psychiatry Reviews, 6, 223–234.Google Scholar
  74. Traube, D. T., James, S., Zhang, J., & Landsverk, J. (2012). A national study of risk and protective factors for substance use among youth in the child welfare system. Addictive Behaviors, 37(5), 641–650.Google Scholar
  75. Tull, M. T., Bardeen, J. R., DiLillo, D., Messman-Moore, T., & Gratz, K. L. (2015). A prospective investigation of emotion dysregulation as a moderator of the relation between posttraumatic stress symptoms and substance use severity. Journal of Anxiety Disorders, 29, 52–60.Google Scholar
  76. van Emmerik-van Oortmerssen, K., van de Glind, G., van den Brink, W., Smit, F., Crunelle, C. L., Swets, M., & Schoevers, R. A. (2012). Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: A meta-analysis and meta-regression analysis. Drug & Alcohol Dependence, 122(1–2), 11–19. Scholar
  77. Widom, C. S., Weiler, B. L., & Cottler, L. B. (1999). Childhood victimization and drug abuse: A comparison of prospective and retrospective findings. Journal of Consulting and Clinical Psychology, 67(6), 867–880.Google Scholar
  78. Wu, P., Bird, H. R., Liu, X., Duarte, C. S., Fuller, C., Fan, B., Shen, S., & Canino, G. J. (2010). Trauma, posttraumatic stress symptoms, and alcohol-use initiation in children. Journal of Studies on Alcohol and Drugs, 71(3), 326–334.Google Scholar
  79. Yoon, S., Kobulsky, J. M., Yoon, D., & Kim, W. (2017). Developmental pathways from child maltreatment to adolescent substance use: The roles of posttraumatic stress symptoms and mother-child relationships. Children and Youth Services Review, 82, 271–279.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Center on Drug and Alcohol Research, Department of Behavioral ScienceUniversity of KentuckyLexingtonUSA
  2. 2.Department of Psychiatry, Center on Trauma and ChildrenUniversity of KentuckyLexingtonUSA
  3. 3.Center on Trauma and ChildrenUniversity of KentuckyLexingtonUSA

Personalised recommendations