Elsevier

Addictive Behaviors

Volume 50, November 2015, Pages 117-123
Addictive Behaviors

Family composition and symptom severity among Veterans with comorbid PTSD and substance use disorders

https://doi.org/10.1016/j.addbeh.2015.06.019Get rights and content

Highlights

  • Family composition is important to consider for Veterans with PTSD/SUD.

  • Children in the home accounted for unique variance in PTSD symptom severity.

  • Children in the home did not account for unique variance in SUD symptom severity.

  • Care for Veterans with comorbid PTSD/SUD should be family-informed.

Abstract

Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) frequently co-occur and affect a substantial proportion of military Veterans. Although the impact of parental PTSD and SUD on child development is well-documented, little is known about the influence of family composition on PTSD/SUD symptom severity. The present study investigated children in the home as an independent risk factor for symptom severity in a sample of treatment-seeking Veterans (N = 94; 92% male) with comorbid PTSD/SUD. Twenty-seven percent of the sample had minor children (age 18 or younger) living in the home. Veterans with children in the home evidenced significantly higher PTSD symptomatology as measured by the Clinical Administered PTSD Scale (CAPS; M = 82.65 vs. M = 72.17; t =  2.18; p < .05), and reported using marijuana more frequently than Veterans without children in the home (34% vs. 13% of past 60 days; t =  2.35, p < .05). In a multivariate model, having children in the home accounted for unique variance (ΔR2 = .07) in PTSD severity after accounting for a range of covariates; however, having children in the home did not account for unique variance in substance use. Directions for future research as well as potential clinical implications for parents seeking treatment for PTSD/SUD are discussed.

Introduction

Parenting involves numerous challenges and there is evidence that these challenges are amplified among parents diagnosed with posttraumatic stress disorder (PTSD; Berz et al., 2008, Samper et al., 2004), substance use disorders (SUD; Bagner et al., 2009), and mental health problems in general (Crnic and Low, 2002, Nicholson et al., 2001). Little is known, however, regarding the family composition of individuals with comorbid PTSD/SUD, and how family composition might influence their clinical profile. The present study was designed, therefore, to preliminarily investigate PTSD and SUD symptomatology among treatment-seeking Veterans with and without children living in the home.

Section snippets

Parental PTSD/SUD and child development: a bidirectional relation?

There is a large body of literature substantiating the adverse impact of parental psychopathology on child development. Children of parents with PTSD are at significantly increased risk for emotional and behavioral problems, including the development of PTSD following trauma exposure, evidenced as early as infancy and continuing into adulthood (Leen-Feldner et al., 2013). Similarly, children of parents with alcohol use disorders are at increased risk for conduct disorder, emotional problems,

Treatment of comorbid PTSD/SUD: does parenting status matter?

It is estimated that up to half of adults seeking treatment for SUD also meet criteria for PTSD (Mills et al., 2005), and that the clinical course of this comorbidity is characteristically more severe and difficult to treat than either disorder alone (Back et al., 2000, Back et al., 2005). Specifically, research has shown poorer treatment outcomes in comorbid patients (compared to those with either disorder alone) related to worse compliance with aftercare (Brady et al., 1994), quicker relapse (

Participants

Participants were 94 treatment-seeking Veterans (92% male; 52% Caucasian, 45% African American) completing a baseline interview as part of a randomized controlled trial (RCT) targeting the integrated behavioral treatment of Veterans with comorbid PTSD/SUD. Inclusion criteria for the RCT included: (1) Veteran, Active-duty Military, Reservist, or member of the National Guard; (2) aged 18–65; (3) meet DSM-IV (APA, 1994) diagnostic criteria for current (i.e., past 6 months) PTSD and have a score of

Descriptive statistics

Approximately 25% of the sample reported no children, 23% reported adult children only, 21% reported having minor children (i.e., age 18 or younger) who did not live in the home, and 27% reported having minor children living in the home. Table 1 includes descriptive statistics regarding the number, age, biological status, and living arrangements for all children 18 years old and under. Across all participants, 114 total children ages 18 and under were described (see Table 1), and 203 total

Discussion

As hypothesized, the presence of children living in the home accounted for unique variance in PTSD symptom severity. Having children in the home accounted for 7% of variance in the model predicting PTSD symptom severity. To contextualize the clinical significance of this finding, the prior step in the model which included total number of traumatic events and co-morbid substance use severity similarly accounted for 7% of the variance in PTSD symptoms. In this sample, our model accounted for 24%

Role of funding sources

Funding for this study was provided by R01 DA030143. LJS's preparation of this manuscript was supported by the National Institute of Mental Health (T32 MH018869; PI Kilpatrick). JF's preparation of this manuscript was supported by the National Institute of Child and Human Development and Office of Research on Women's Health (K12HD055885; PI Brady). NIDA/NICHD had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit

Contributors

SB and TK designed and completed the RCT. LJS, JF, and SB conceived this project. LJS conducted the analysis and wrote the first draft of the manuscript. All authors contributed to and approved the final manuscript.

Conflict of interest

All authors declare that they have no conflicts of interest.

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