An emerging literature suggests a complex relationship between PTSD and self-reported reasons for using substances (also known as “expectancies,” or “the beliefs that individuals hold about the effects of substances on their behavior, moods, and emotions”).

We studied this topic in a sample of 52 women with current posttraumatic stress disorder (PTSD) and substance use disorder (SUD), using a cross-sectional design. Both PTSD and SUD tended to be chronic and severe, with the PTSD mostly arising from childhood repeated physical and/or sexual trauma.

Measures included the Alcohol Effects Questionnaire (Rosenhow et al., 1995), the Cocaine Expectancy Questionnaire (Jaffe & Kilby, 1994), as well as a new subscale of 12 items designed to address key PTSD symptoms (e.g., “I use substance(s) to relieve flashbacks of PTSD”).

Results indicated two main findings. First, of the 12 subscales we evaluated, the most highly rated expectancy subscales were: paranoia, grandiosity/euphoria, sexual enhancement, global positive changes, power and aggression, and PTSD. Relatively lower were: desire for drugs, social expression, social and physical pleasure, cognitive and physical impairment, relaxation/tension reduction, and careless unconcern. Second, our PTSD subscale showed significant correlations with just three subscales: power and aggression (r=.43), global positive changes (r=.41), relaxation/tension reduction (r=.31).

Discussion includes the importance of recognizing the varied reasons for using among women with PTSD/SUD (of which PTSD symptoms are just part of the picture, and not necessarily the most important reason). We also address measurement and sampling issues, and limitations of our design.