Skip to main content

Advertisement

SpringerLink
Log in

Self-medication among traumatized youth: structural equation modeling of pathways between trauma history, substance misuse, and psychological distress

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

In an effort to self-medicate psychological distress stemming from exposure to traumatic life events, at-risk youth may be likely to seek intoxication via substance use. Concomitantly, self-medication with psychoactive substances is theorized to confer risk of developing future psychiatric and substance use disorders. The present study employed structural equation modeling to examine self-medication among a sample of 723 youth in residential treatment for antisocial behavior via recursive and non-recursive relationships between trauma history, substance misuse, and psychological distress. Results supported study hypotheses that: (a) the effects of trauma history on psychological distress are partially mediated by substance misuse, and (b) exposure to traumatic life events drives a feedback loop between substance misuse and psychological distress. Findings from this large-scale survey of adolescents exhibiting behavioral dysfunction suggest that identification of self-medication processes among traumatized youth may be crucial for developing targeted prevention and treatment initiatives.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • Abram, K. M., Teplin, L. A., Charles, D. R., Longworth, S. L., McClelland, G. M., & Dulcan, M. K. (2004). Posttraumatic stress disorder and trauma in youth in juvenile detention. Archives of General Psychiatry, 61, 403.

    Article  PubMed  Google Scholar 

  • Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., et al. (2006). The enduring effects of abuse and related adverse experiences in childhood—A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256, 174–186.

    Article  PubMed  Google Scholar 

  • Baker, T. B., Piper, M. E., McCarthy, D. E., Majeskie, M. R., & Fiore, M. C. (2004). Addiction motivation reformulated: An affective processing model of negative reinforcement. Psychological Review, 111, 33–51.

    Article  PubMed  Google Scholar 

  • Bremne, J. D., & Vermetten, E. (2001). Stress and development: Behavioral and biological consequences. Developmental Psychopathology, 13, 473–489.

    Article  CAS  Google Scholar 

  • Breslau, N., Davis, G. C., Andreski, P., & Peterson, E. (1991). Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry, 48, 216–222.

    Article  Google Scholar 

  • Brewin, C. R., Gregory, J. D., Lipton, M., & Burgess, N. (2010). Intrusive images in psychological disorders: Characteristics, neural mechanisms, and treatment implications. Psychological Review, 117, 210–232.

    Article  PubMed  Google Scholar 

  • Bryant, R. A., Friedman, M. J., Spiegel, D., Ursano, R., & Strain, J. (2011). A review of acute stress disorder in DSM-5. Depression and Anxiety, 28, 802–817.

    Article  PubMed  Google Scholar 

  • Brook, J. S., Cohen, P., & Brook, D. W. (1998). Longitudinal study of co-occurring psychiatric disorders and substance use. Journal of American Academy of Child and Adolescent Psychiatry, 37, 322–330.

    Article  CAS  Google Scholar 

  • Brook, J. S., Katten, N. S., Zhang, C., & Brook, D. W. (2009). Psychosocial antecedents and adverse health consequences resulting from tobacco use, alcohol, and other drug-related problems. American Journal of Public Health, 99, 563.

    Article  PubMed  Google Scholar 

  • Brosschot, J. F., Gerin, W., & Thayer, J. F. (2006). The perseverative cognition hypothesis: A review of worry, prolonged stress-related physiological activation, and health. Journal of Psychosomatic Research, 60, 113–124.

    Article  PubMed  Google Scholar 

  • Buka, S. L., Stichick, T. L., Birdthistle, I., & Earls, F. J. (2001). Youth exposure to violence: Prevalence, risks, and consequences. American Journal of Orthopsychiatry, 71, 298–310.

    Article  PubMed  CAS  Google Scholar 

  • Byrne, B. M. (2012). Structural equation modeling with Mplus. New York: Routledge.

    Google Scholar 

  • Curran, P. J., West, S. G., & Finch, J. F. (1996). The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychological Methods, 1, 16–29.

    Article  Google Scholar 

  • Derogatis, L. R., & Melisaratos, N. (1983). The brief symptom inventory: An introductory report. Psychological Medicine, 13, 595–605.

    Article  PubMed  CAS  Google Scholar 

  • Ehlers, A., Hackmann, A., Steil, R., Clohessy, S., Wenninger, K., & Winter, H. (2002). The nature of intrusive memories after trauma: The warning signal hypothesis. Behavior Research and Therapy, 40, 995–1002.

    Article  Google Scholar 

  • Elliott, D. S., Huizinga, D., & Menard, S. (1989). Multiple problem youth: Delinquency, substance use, and mental health problems. New York: Springer.

    Book  Google Scholar 

  • Field, M., & Powell, H. (2007). Stress increases attentional bias for alcohol cues in social drinkers who drink to cope. Alcohol and Alcoholism, 42, 560–566.

    Article  PubMed  Google Scholar 

  • Floden, D., Alexander, M. P., Kubu, C. S., Katz, D., & Stuss, D. T. (2008). Impulsivity and risk-taking behavior in focal frontal lobe lesions. Neuropsychologia, 46, 213–223.

    Article  PubMed  CAS  Google Scholar 

  • Garland, E. L., & Howard, M. O. (2011). Adverse consequences of acute inhalant intoxication. Experimental and Clinical Psychopharmacology, 19, 134.

    Article  PubMed  Google Scholar 

  • Garland, E. L., & Roberts-Lewis, A. (2011). Differential roles of dispositional mindfulness and thought suppression in post-traumatic stress symptoms and craving. Addictive Behaviors. doi:10.1016/j.bbr.2011.03.031.

  • Garland, E. L., Gaylord, S. A., Boettiger, C. A., & Howard, M. O. (2010). Mindfulness training modifies cognitive, affective, and physiological mechanisms implicated in alcohol dependence: Results from a randomized controlled pilot trial. Journal of Psychoactive Drugs, 42, 177–192.

    Article  PubMed  Google Scholar 

  • Garland, E. L., Boettiger, C. A., & Howard, M. O. (2011). Targeting cognitive-affective risk mechanisms in stress-precipitated alcohol dependence: An integrated, biopsychosocial model of allostasis, automaticity, and addiction. Medical Hypotheses, 76, 745–754.

    Article  PubMed  CAS  Google Scholar 

  • Grisso, T., & Barnum, R. (2000). Massachusetts youth screening instrument-second version: User’s manual and technical reports. Boston, MA: University of Massachusetts Medical School.

    Google Scholar 

  • Hodgins, S., Larm, P., Molero-Samuleson, Y., Tengström, A., & Larsson, A. (2009). Multiple adverse outcomes over 30 years following adolescent substance misuse treatment. Acta Psychiatrica Scandinavica, 119, 484–493.

    Article  PubMed  CAS  Google Scholar 

  • Hofstra, M. B., Van Der Ende, J., & Verhulst, F. C. (2002). Child and adolescent problems predict DSM-IV disorders in adulthood: A 14-year follow-up of a Dutch epidemiological sample. Journal of American Academy of Child and Adolescent Psychiatry, 41, 182–189.

    Article  Google Scholar 

  • Holmes, E. A., Grey, N., & Young K. A. (2005). Intrusive images and “hotspots” of trauma memories in posttraumatic stress disorder: An exploratory investigation of emotions and cognitive themes. Journal of Behavioral Therapy and Experimental Psychiatry, 36, 3–17.

    Article  Google Scholar 

  • Hu, L., Bentler, P. M., & Kano, Y. (1992). Can test statistics in covariance structure analysis be trusted? Psychological Bulletin, 112, 351–362.

    Article  PubMed  CAS  Google Scholar 

  • 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, 1184–1190.

    Article  PubMed  CAS  Google Scholar 

  • Kaye, J. M., & Lightman, S. L. (2005). Psychological stress and endocrine axes. In K. Vedhara & M. Irwin (eds.), Human Psychoneuroimmunology. New York: Oxford University Press.

    Google Scholar 

  • Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048–1060.

    Article  PubMed  CAS  Google Scholar 

  • Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4, 231–244.

    Article  PubMed  CAS  Google Scholar 

  • 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, 692–700.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Kline, R. B. (1998). Principles and practice of structural equation modeling. NY, USA: Guilford Press.

    Google Scholar 

  • Koob, G. F. (2003). Alcoholism: Allostasis and beyond. Alcoholism, Clinical and Experimental Research, 27, 232–243.

    Article  PubMed  CAS  Google Scholar 

  • Koob, G. F., & Le Moal, M. (2001). Drug addiction, dysregulation of reward, and allostasis. Neuropsychopharmacology, 24, 97–129.

    Article  PubMed  CAS  Google Scholar 

  • Koob, G. F., & Le Moal, M. (2008). Addiction and the brain antireward system. Annual Review of Psychology, 59, 29–53.

    Article  PubMed  Google Scholar 

  • Leeies, M., Pagura, J., Sareen, J., & Bolton, J. M. (2010). The use of alcohol and drugs to self-medicate symptoms of posttraumatic stress disorder. Depression and Anxiety, 27, 731–736.

    PubMed  Google Scholar 

  • Liston, C., McEwen, B. S., & Casey, B. J. (2009). Psychosocial stress reversibly disrupts prefrontal processing and attentional control. Proceedings of the National Academy of Science USA, 106, 912–917.

    Article  CAS  Google Scholar 

  • Little, R. J. A., & Rubin, D. A. (2002). Statistical analysis with missing data (2nd ed.). New York: Wiley.

    Google Scholar 

  • McEwen, B. S. (1998). Stress, adaptation, and disease: Allostasis and allostatic load. Annals of New York Academy of Sciences, 840, 33–44.

    Article  CAS  Google Scholar 

  • McEwen, B. S. (2003). Mood disorders and allostatic load. Biological Psychiatry, 54, 200–207.

    Article  PubMed  Google Scholar 

  • McEwen, B. S. (2007). Physiology and neurobiology of stress and adaptation: Central role of the brain. Physiological Review, 87, 873–904.

    Article  Google Scholar 

  • McEwen, B. S., & Wingfield, J. C. (2003). The concept of allostasis in biology and biomedicine. Hormones and Behavior, 43, 2–15.

    Article  PubMed  Google Scholar 

  • Muthén, B., & Muthén, L. (2010). Mplus user’s guide (6th ed.). Los Angeles, CA: Muthén and Muthén.

    Google Scholar 

  • Robinson, J., Sareen, J., Cox, B. J., & Bolton, J. M. (2011). Role of self-medication in the development of comorbid anxiety and substance use disorders: A longitudinal investigation. Archives of General Psychiatry, 68, 800.

    Article  PubMed  Google Scholar 

  • Sinha, R. (2007). The role of stress in addiction relapse. Current Psychiatry Reports, 9, 388–395.

    Article  PubMed  Google Scholar 

  • Slawik, H., Salmond, C. H., Taylor-Tavares, J. V., Williams, G. B., Sahakian, B. J., & Tasker, R. C. (2009). Frontal cerebral vulnerability and executive deficits from raised intracranial pressure in child traumatic brain injury. Journal of Neurotrauma, 26, 1891–1903.

    Article  PubMed  Google Scholar 

  • Stice, E., Myers, M. G., & Brown, S. A. (1998). A longitudinal grouping analysis of adolescent substance use escalation and de-escalation. Psychology of Addictive Behaviors, 12, 14–27.

    Article  Google Scholar 

  • Wothke, W. (1998). Longitudinal and multi-group modeling with missing data. In T. D. Little, K. U. Schnabel, & J. Baumert (Eds.), Modeling longitudinal and multiple group data: Practical issues, applied approaches and specific examples. Mahwah, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Zimmermann, U. S., Blomeyer, D., Laucht, M., & Mann, K. F. (2007). How gene-stress-behavior interactions can promote adolescent alcohol use: The roles of predrinking allostatic load and childhood behavior disorders. Pharmacology, Biochemistry and Behavior, 86, 246–262.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Trinity Institute for the Addictions, Florida State University, University Center, Building C, Tallahassee, FL, 32306-2570, USA

    Eric L. Garland

  2. Washington University of Saint Louis, St. Louis, MO, USA

    Carrie Pettus-Davis

  3. University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Matthew O. Howard

Authors
  1. Eric L. Garland
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carrie Pettus-Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew O. Howard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eric L. Garland.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Garland, E.L., Pettus-Davis, C. & Howard, M.O. Self-medication among traumatized youth: structural equation modeling of pathways between trauma history, substance misuse, and psychological distress. J Behav Med 36, 175–185 (2013). https://doi.org/10.1007/s10865-012-9413-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-012-9413-5

Keywords

Search

Navigation