Associations between TE and SUDs may be impacted by posttraumatic stress disorder (PTSD), a psychobiological reaction to a traumatic event that includes intrusive recollections, avoidance/numbing, and hyperarousal symptoms (7), which is highly comorbid with SUDs (9,16). Many studies suggest that PTSD, rather than TE alone, is associated with higher prevalence of SUDs among trauma-exposed persons (reviewed in 17). For example, compared to those without PTSD, male Vietnam veterans with PTSD were more likely to meet criteria for an alcohol use disorder (AUD) (18), and male Israeli war veterans with PTSD were more likely to report any SUD (19). Individuals with PTSD perceive that different substances have different effects on their symptoms (for review see 20); therefore, relationships between TE, PTSD, and SUDs could differ by type of substance. General population studies that include both genders and that differentiate between substance-specific SUDs are needed to understand whether associations between TE and SUDs are due only to PTSD.
