Drug and alcohol use, abuse, or dependence are concerns for people with mental disorders due to their association with poor clinical and social outcomes such as high rates of suicide, HIV, homelessness, aggression, and incarceration. Comorbid substance use places additional burden on patients, families, psychiatric services, and government resources due to high rates of treatment non-adherence and relapse.

Tobacco smoking is also very common and poses considerable health risks, potential interference with the metabolism of psychotropic medications, and financial burden. Heavy cigarette use may contribute to the increased mortality and reduced life expectancy reported within the mental illness population.

What is the evidence for substance use in people with PTSD?

Moderate to high quality evidence finds a medium-sized increased rate of current smoking in people with PTSD, with the effect largest in males aged 20-30 years. Higher rates of drug and alcohol misuse were found in people with more severe PTSD symptoms compared to people with less severe PTSD symptoms. PTSD symptoms include intrusions, avoidance, hyperarousal, and negative thoughts and mood.

In prisoners with PTSD, there was a small to medium-sized increased rate of substance use disorders when compared to prisoners without PTSD. Rates were highest in male prisoners, in adult prisoners, and in prisoners with any lifetime rather than current PTSD diagnosis.

August 2021

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