Purpose Cognitive models emphasise trauma-related appraisals in relation to post-traumatic stress symptoms. Cognitive-emotional processes may also shape symptom presentation, yet these processes are rarely examined together. This study aims to address these gaps by examining the associations between overall and cluster-specific PTSD severity and the severity of trauma-related beliefs (i.e. negative post-traumatic cognitions about the self, others and the world) and transdiagnostic processes (perseverative thinking, emotion regulation and distress tolerance) in treatment-seeking youth. Design/methodology/approach Data were drawn from 55 adolescents and young adults (M age = 19.49, SD = 3.27; 38 female) enrolled in a randomised controlled trial evaluating an integrated treatment for co-occurring PTSD and substance use. Participants completed baseline assessments of trauma-related beliefs, perseverative thinking, distress tolerance, emotion regulation and PTSD symptom severity. Findings PTSD severity was strongly associated with the severity of trauma-related cognitions. Beliefs about a fragile self and perceptions of permanent disturbing change evidence the strongest associations with overall PTSD severity, and re-experiencing, negative cognitions/mood and hyperarousal. No variables were significantly associated with avoidance. Rumination, emotion regulation and distress tolerance were not significantly associated with PTSD severity once trauma-related cognitions were included in the models. These findings highlight associations between maladaptive trauma-related beliefs about the self and the world and PTSD severity. Originality/value To the best of the authors’ knowledge, this study is among the first to examine trauma-related cognitions and cognitive-emotional processes in youth with PTSD and substance use. It advances existing research by examining their associations with overall and cluster-specific PTSD severity and highlights the need to examine temporal and mediating pathways in future work.
Purpose Coercive control is an overarching term describing repeated patterns of psychological, emotional, verbal, sexual, financial and technology-enabled abuse. The term “substance use (SU) coercion” is an aspect of coercive control that identifies how substances can be used as tactics of abuse. This paper, which is both empirical and conceptual, aims to examine whether the language of “substance use coercion” could provide a more nuanced conceptualisation of the intersection of SU with domestic and family violence (DFV) to lay the foundations for enhanced inter-sectoral collaboration. Design/methodology/approach An action research approach, implemented through guided group workshops, was conducted with a Policy Stakeholder Group (PSG) comprising senior representatives primarily from the SU and DFV sectors, as well as those with lived experience. The PSG met six times during 2022 and 2023. Approximately 15 h of audio content were transcribed and thematically analysed. Findings Data analysis identified three key themes: contested understandings of the relationship between violence and SU; the agency of victim-survivors who use substances; and potential for the language of SU coercion to mobilise advocacy, creating a bridge to greater collaboration. In each theme, similarities and differences in inter-sectoral understanding were noted. Originality/value The language of “SU coercion” provides a more sophisticated analytical lens to advance policy and practice beyond notions of co-occurrence or causation towards a stronger foundation for collaboration across sectors.
Purpose The co-occurrence of post-traumatic stress disorder (PTSD) and substance use disorder (SUD) presents significant challenges for substance-use treatment services. There is mixed evidence, however, regarding how this presentation impacts on treatment engagement and outcome, and no existing research has examined this in the context of ICD-11 PTSD and Complex PTSD (CPTSD). This study aims to then examine associations between trauma-related disorders, treatment engagement and substance use outcomes – in the context of the ICD-11 diagnostic system. Design/methodology/approach In all, 72 individuals entering substance use treatment were recruited into this prospective cohort study. Data on treatment engagement were obtained from medical records and was available for all participants. Data on trauma-related symptoms and substance use outcomes were obtained via interviews undertaken at baseline and three-month follow-up (n = 40, follow-up rate = 55.6%). Findings Both PTSD- and CPTSD-related functional impairment were associated with higher levels of treatment engagement; however, no trauma-related symptoms demonstrated associations to premature disengagement from treatment. There was little evidence of reliable changes in trauma-related symptoms or substance use outcomes. Changes in CPTSD- but not PTSD-related symptoms were associated with changes in psychological dependence. Neither PTSD- nor CPTSD-related symptom changes were associated with changes in recent substance use. Individuals presenting with comorbid trauma-related symptoms are no more likely to disengage from treatment; however, those with greater functional impairment related to their symptoms will likely require higher levels of service. Further research is required to determine the added benefit of trauma-focussed treatment in addition to substance-use treatment alone. Originality/value This study provides the first examination of how symptoms of ICD-11 PTSD and Complex PTSD change during substance use treatment. The results of this study can inform the expansion of trauma-informed and trauma-focussed treatment approaches embedded in substance use treatment.
Purpose Women with co-occurring post-traumatic stress disorder (PTSD) and substance use disorder (SUD) demonstrate high attrition during integrated prolonged exposure (PE) psychotherapy. Existing exposure therapies identify an index trauma, which serves as the primary focus of exposure during treatment. The timing of trauma exposure (childhood vs adulthood) is known to influence symptom severity and treatment outcomes. Yet, whether the same is true for the timing of index trauma (childhood vs adulthood) is not well understood. The purpose of this study was to examine the impact of timing of index trauma on treatment retention, SUD severity, and mental health symptoms. Design/methodology/approach This retrospective cross-sectional observational study examined whether the timing of index trauma (childhood vs adulthood) was associated with treatment retention, SUD severity and baseline mental health among 55 women participating in integrated PE treatment for PTSD–SUD. Treatment retention was defined as completion of four or more sessions. SUD severity was measured using the Severity of Dependence Scale. Mental health was assessed based on symptoms of stress, anxiety and depression and borderline symptomatology at baseline. Findings There were no statistically significant associations between timing of index trauma and treatment retention, SUD severity or severity of mental health symptoms at baseline. Research limitations/implications The lack of a significant relationship in this study warrants further exploration of factors influencing treatment attrition and highlights a need for further research into the mechanisms of identification and operationalisation of index trauma in exposure therapy. Originality/value To the best of the authors’ knowledge, this is the first study to explore the relationship of the timing of index trauma (childhood vs adulthood) with treatment retention, SUD severity and baseline mental health symptoms. In addition, this study offers a unique perspective from its setting in a routine treatment clinic.
Purpose Cognitive impairment is common among people accessing alcohol and other drug (AOD) treatment and can adversely affect engagement and outcomes. However, little is known about clients’ subjective cognitive concerns. The purspose of this study was to examine AOD clients’ interest in cognitive training (practice-based activities targeting attention, memory and executive functions), or preferred intervention formats. Design/methodology/approach An anonymous cross-sectional survey was conducted with 163 clients from four public AOD services in New South Wales, Australia (December 2021–July 2023). Participants reported demographics, cognitive concerns, interest in cognitive training, preferred delivery modes and digital access and literacy. Analyses included descriptive statistics, chi-square and Fisher’s exact tests and non-parametric comparisons with post hoc corrections. Findings Most participants reported concerns about memory (76.7%) and thinking clearly (64.5%). Interest in cognitive training was high (96.9%), particularly among those seeking treatment for alcohol (86.4%) and opioid use (52.6%). Participants preferred cognitive training delivered individually, in weekly sessions of about 1 h. Smartphone access was high (89.9%) and smartphone literacy was moderate-to-high (76.6%). Computer access (41.1%) and literacy (50%) were more limited, especially among older clients and those seeking treatment for opioid use. Originality/value A one-size-fits-all approach to cognitive remediation is unlikely to meet client needs. Tailored interventions that combine individual support with digital and low-tech options, and that reflect client preferences and circumstances, may enhance engagement and accessibility in AOD services. Results offer practical guidance for clinicians and services aiming to integrate cognitive remediation into routine care.
