Relationship between Anxiety, Depression, and Trauma Exposure and Relapse to Substance Use following Residential Treatment

Prior studies suggest that trauma, anxiety disorders, and depressive disorders contribute to relapse after substance abuse treatment (SAT). Researchers examined the relationship between lifetime and recent (past-year) anxiety symptoms, depressive symptoms, and trauma exposure and a return to substance use in 322 men and women recruited from 11 residential SAT programs in Los Angeles, CA.

All participants had completed at least an initial detoxification period and were seeking or receiving additional mental-health services. Fifty-one percent of participants were male. All participants reported similar demographic variables, past drug use, and lifetime mental-health treatment. Lifetime trauma exposure was reported by 98.5% of participants, and one-half met criteria for post-traumatic stress disorder (PTSD) at treatment entry. Drug use was assessed by follow-up interview and urinalysis at 6 and 12 months following treatment.

• One-third of participants reported re-exposure to trauma at 12-month follow-up.
• Few behavioral characteristics were associated with reduction in relapse risk with the exception of employment in the year preceding baseline and supervised housing over the follow-up period.
• Women were more likely to resume substance use over the follow-up period than men, and whites were more likely to resume substance use than Latinos.
• Baseline anxiety/depressive symptoms, lifetime trauma, and diagnosis of PTSD were not associated with relapse, while recent trauma exposure and anxiety/depressive symptoms that occurred during follow-up were. This association was not moderated by gender.

Comments by Norma Finkelstein, PhD
This research once again demonstrates an association between high rates of trauma exposure, substance use, and anxiety and depressive disorders. The finding that recent trauma exposure and anxiety/depressive symptoms occurring after SAT increase the risk of relapse emphasizes the importance of continuing to assess for these issues following treatment. The results also underscore the importance of targeting continuing care interventions to help patients identify and avoid situations that may be retraumatizing or that may increase anxiety or depression.