Regular article Violent traumatic events and drug abuse severity H. Westley Clark, M.D., J.D. a,b, *, Carmen L. Masson, Ph.D. a , Kevin L. Delucchi, Ph.D. a , Sharon M. Hall, Ph.D. a , Karen L. Sees, D.O. a,b a Department of Psychiatry, Langley Porter Psychiatric Institute, University of California-San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA b Department of Psychiatry, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA Received 19 April 1999; received in revised form 17 July 2000; accepted 25 August 2000 Abstract We examined the occurrence of violent traumatic events, DSM-III-R diagnosis of posttraumatic stress disorder (PTSD), and PTSD symptoms, and the relationship of these variables to drug abuse severity. One-hundred fifty opioid-dependent drug abusers who were participants in a randomized trial of two methadone treatment interventions were interviewed using the Diagnostic Interview Schedule, the Addiction Severity Index, and the Beck Depression Inventory. Twenty-nine percent met diagnostic criteria for PTSD. With the exception of rape, no gender differences in the prevalence of violent traumatic events were observed. The occurrence of PTSD-related symptoms was associated with greater drug abuse severity after controlling for gender, depression, and lifetime diagnosis of PTSD. The high rate of PTSD among these methadone patients, the nature of the traumatic events to which they are exposed, and subsequent violence-related psychiatric sequelae have important implications for identification and treatment of PTSD among those seeking drug abuse treatment. D 2001 Elsevier Science Inc. All rights reserved. Keywords: Posttraumatic stress disorder; Depression; Drug abuse severity; Violence 1. Introduction Hard drug users (e.g., opioid users, cocaine users) are at high risk for experiencing violence, but the nature of the traumatic events that lead to the development of Posttrau- matic Stress Disorder (PTSD) among drug users, and their association with drug use severity, is not completely under- stood. Among victims of crime, experiencing events that are perceived as life-threatening (e.g., rape and physical assault) is associated with the development of PTSD and other psychiatric disorders (Kilpatrick et al., 1989; Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993). Also, indivi- duals exposed to violent traumatic events may be at increased risk of substance abuse and depressive symptoms (Kilpatrick et al., 1989; Villagomez, Meyer, Lin, & Brown, 1995). These associations are relevant for the treatment of substance abuse because untreated PTSD and psychiatric comorbidities may lead to poor treatment outcomes (Brady, Killeen, Saladin, Dansky, & Becker, 1994; Brown, Stout, & Mueller, 1996; Root, 1989). A greater understanding of the extent to which violence-related PTSD and psychiatric comorbidities contribute to increased substance use and to relapse after drug abuse treatment may assist in the devel- opment of treatment strategies for this high-risk group. This study examined the relationship among violent traumatic events, PTSD, and the severity of drug abuse. There is a strong association between violent assault, PTSD, and drug abuse (Breslau, Davis, Andreski, & Peter- son, 1991; Fullilove et al., 1993; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). In a general population study, Cottler, Compton, Mager, Spitznagel, and Janca (1992) found that opioid and cocaine abusers were three times more likely to meet DSM-III diagnostic criteria for PTSD, compared to individuals without a substance use disorder. Substance abusers were also more likely to report physical assault as the precipitating traumatic event leading to PTSD (Cottler et al., 1992). In one of the few studies examining the association of violent traumatic events and PTSD among patients presenting for methadone treatment, Villagomez et * Corresponding author. SAMHSA/CSAT, Rockwall II, Suite 615, 5600 Fishers Lane, Rockville, MD 20857, USA. Tel.: +1-301-443-5700; fax: +1-301-443-8751. E-mail address: wclark@samhsa.gov (H.W. Clark). Journal of Substance Abuse Treatment 20 (2001) 121 ± 127 0740-5472/01/$ ± see front matter D 2001 Elsevier Science Inc. All rights reserved. PII:S0740-5472(00)00156-2