Patients with childhood trauma and PTSD started cannabis younger, used more, and had worse psychiatric outcomes than those without trauma
A study of 459 substance use disorder patients found a graded association between trauma history and outcomes: those with childhood trauma plus PTSD had the worst outcomes (earliest cannabis initiation, most cannabis use, most overdoses), followed by trauma-only, then no-trauma patients.
Quick Facts
What This Study Found
Researchers divided 459 patients with substance use disorders into three groups: childhood trauma plus PTSD (CT-PTSD, n=95), childhood trauma without PTSD (CT-only, n=134), and no trauma (n=209).
A graded pattern emerged across nearly all outcomes, with CT-PTSD worst, CT-only intermediate, and no-trauma best.
Both trauma groups reported significantly higher anxiety, depression, suicidal thoughts, and suicide attempts than the no-trauma group.
The CT-PTSD group had significantly younger age at first cannabis and alcohol use, more cannabis use in the past month, and more lifetime drug overdoses compared to the no-trauma group.
The authors concluded that both childhood trauma and PTSD independently contribute to substance use severity, and treatment programs should assess and address both domains rather than focusing on one alone.
Key Numbers
459 patients: 95 CT-PTSD, 134 CT-only, 209 no trauma. CT-PTSD group had younger age at first cannabis and alcohol use, more past-month cannabis use, and more lifetime overdoses than no-trauma group. Graded association across all three groups.
How They Did This
Cross-sectional study of 459 SUD patients. PTSD diagnosed via IDCL and PDS. Childhood trauma assessed with CTQ. Substance use and psychiatric symptoms assessed with EuropASI. Three-group comparison (CT-PTSD, CT-only, no trauma).
Why This Research Matters
Many addiction treatment programs screen for PTSD but not for childhood trauma in the absence of PTSD. This study shows that childhood trauma alone (without meeting PTSD criteria) is associated with worse outcomes, suggesting that trauma-informed treatment should be broader than just PTSD treatment.
The Bigger Picture
The graded dose-response pattern (more trauma burden = worse outcomes) reinforces the concept that trauma is not binary but exists on a spectrum that proportionally affects substance use trajectories.
What This Study Doesn't Tell Us
Cross-sectional design cannot establish causal direction. Self-reported childhood trauma may be affected by current mental state. The CT-only group may include people with sub-threshold PTSD. Cannabis-specific effects are embedded within broader substance use patterns.
Questions This Raises
- ?Would trauma-specific therapy reduce cannabis use in these patients?
- ?Does childhood trauma cause earlier substance initiation, or do shared genetic/environmental factors drive both?
- ?Is the CT-only group an under-treated population?
Trust & Context
- Key Stat:
- Childhood trauma alone (without PTSD) was associated with worse substance use outcomes than no trauma
- Evidence Grade:
- Moderate. Adequate sample with validated instruments and clear dose-response pattern, but cross-sectional design limits causal conclusions.
- Study Age:
- Published in 2018. Trauma-informed approaches to substance use treatment have continued to gain evidence and adoption.
- Original Title:
- Differential relationships of PTSD and childhood trauma with the course of substance use disorders.
- Published In:
- Journal of substance abuse treatment, 93, 57-63 (2018)
- Authors:
- Mergler, Michaela, Driessen, Martin, Havemann-Reinecke, Ursula(2), Wedekind, Dirk, Lüdecke, Christel, Ohlmeier, Martin, Chodzinski, Claudia, Teunißen, Sibylle, Weirich, Steffen, Kemper, Ulrich, Renner, Walter, Schäfer, Ingo
- Database ID:
- RTHC-01759
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Why does childhood trauma affect substance use?
Childhood trauma can alter stress response systems, emotional regulation, and brain development in ways that increase vulnerability to substance use. People with trauma histories may use substances to manage difficult emotions, sleep problems, or intrusive memories.
Should trauma be treated before or alongside addiction?
This study supports integrated treatment that addresses both. The graded association suggests that treating only the substance use while ignoring trauma may miss an important driver of continued use and psychiatric symptoms.
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Cite This Study
https://rethinkthc.com/research/RTHC-01759APA
Mergler, Michaela; Driessen, Martin; Havemann-Reinecke, Ursula; Wedekind, Dirk; Lüdecke, Christel; Ohlmeier, Martin; Chodzinski, Claudia; Teunißen, Sibylle; Weirich, Steffen; Kemper, Ulrich; Renner, Walter; Schäfer, Ingo. (2018). Differential relationships of PTSD and childhood trauma with the course of substance use disorders.. Journal of substance abuse treatment, 93, 57-63. https://doi.org/10.1016/j.jsat.2018.07.010
MLA
Mergler, Michaela, et al. "Differential relationships of PTSD and childhood trauma with the course of substance use disorders.." Journal of substance abuse treatment, 2018. https://doi.org/10.1016/j.jsat.2018.07.010
RethinkTHC
RethinkTHC Research Database. "Differential relationships of PTSD and childhood trauma with..." RTHC-01759. Retrieved from https://rethinkthc.com/research/mergler-2018-differential-relationships-of-ptsd
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.