Complex posttraumatic stress disorder in trauma-exposed adults receiving public sector outpatient substance abuse disorder treatment

Adults with substance use disorders (SUD) often have experienced multiple psychological traumas and suffer from posttraumatic stress disorder (PTSD) and complex PTSD impairments (e.g., dissociation, affect dysregulation). Among adult addiction treatment outpatients with self-reported trauma histories, 50% had PTSD alone, 41% had comorbid PTSD and complex PTSD, and 4% had complex PTSD alone. Compared to PTSD alone, comorbid PTSD/complex PTSD was associated with a history of childhood sexual trauma, sexual retraumatization in adulthood, and more severe PTSD and depression symptoms. Patients with alcohol-related SUDs were at increased risk for PTSD, while those with cocaine or opiate SUDs had a reduced risk of comorbid PTSD/complex PTSD. Gender and ethnicity were unrelated to PTSD or complex PTSD except that women were at lower risk than men for PTSD alone. Complex PTSD may warrant clinical and research evaluation, particularly for patients with histories of childhood sexual trauma and retraumatization.