Hurt people who hurt people: anger and violence among individuals with substance use disorder and post traumatic stress disorder

摘要

Substance use disorder (SUD) and post traumatic stress disorder (PTSD) are chronic disabling disorders that frequently co-occur. This comorbidity (SUD+PTSD) has been associated with a range of harms, however, little research has examined the association between these disorders, anger and violence; outcomes with devastating effects for the individual and for society. This thesis aims to address this gap in literature by investigating the relationship between, anger, violence and SUD+PTSD.Study 1 involved an examination of data collected as part of the 2007 National Survey of Mental Health and Wellbeing. It is the first epidemiological investigation of the mental health correlates of anger in the Australian general population. Diagnoses of SUD and PTSD were among the only disorders to demonstrate a consistent and independent association with anger after controlling for demographics and mental health comorbidity. Study 2 examined correlates of anger and violence among individuals entering SUD treatment. Comorbid anxiety and trait anger were independently associated with recent anger, whereas childhood trauma and trait physical aggression were uniquely associated with violence perpetration. This study is the first to identify correlates of both anger and violence in one SUD sample while controlling for trait aggression, depression and anxiety.Studies 3 and 4 are the first to investigate violence perpetration in a heterogeneous sample of individuals with SUD+PTSD. Cross-sectional and longitudinal analyses were conducted to examine factors specific to SUD and PTSD that may place individuals with this comorbidity at increased risk of violence. Self-report and court record data revealed high rates of violence perpetration among those with SUD+PTSD. After controlling for demographics, substance use and other comorbidity, PTSD hyperarousal symptoms and trait physical aggression were found to be independent predictors of violence in both the cross-sectional and longitudinal analysis. It is concluded that PTSD hyperarousal symptoms specifically need to be addressed by interventions aimed at reducing violence in this population.These four novel empirical studies provide crucial information for clinicians identifying those most prone to anger and violence and developing targeted intervention programs designed to reduce these adverse outcomes. Such interventions have the potential to break the destructive cycle of trauma, substance use and violence.