Post-traumatic stress disorder and opioid use disorder: a narrative review of conceptual models
Abstract
Post-traumatic stress disorder is highly prevalent among individuals who suffer from opioid use disorder. Compared to individuals with opioid use disorder alone, those with post-traumatic stress disorder have a worse course of illness, occupational functioning, and physical health. The neurobiological pathways underlying each disorder overlap substantially, and there are multiple pathways through which these disorders may interact. This narrative review explores evidence underpinning 3 explanatory perspectives on comorbid post-traumatic stress disorder and opioid use disorder: The opioid susceptibility model (a.k.a.: the Self-Medication Hypothesis), the post-traumatic stress disorder susceptibility model, and the common factors model. Diagnostic implications, treatment implications, and directions for future research are discussed.
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Physical changes associated with trauma create increased risk for substance use disorder.
“It appears likely that physical changes associated with trauma create increased risk for SUD, lending support to the BPS Perspective (path E).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [69]
Opioids are distinctly reinforcing to individuals with PTSD.
“The trauma theory suggests that opioids are distinctly reinforcing to individuals with PTSD (69).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [69]
The self-medication hypothesis suggests individuals turn to opioids to reduce stress, pain, and unresolved psychological trauma.
“However, the more common theory is the “self-medication hypothesis” (69, 82) which suggests individuals turn to opioids to reduce stress, pain, and unresolved psychological trauma (path C–F).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [69]
The trauma theory of addiction suggests that opioids are strongly reinforcing to individuals with PTSD and may initially treat the aversive symptoms.
“The trauma theory of addiction suggests that opioids are strongly reinforcing to individuals with PTSD (69) and may initially treat the aversive symptoms.”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [69]
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References 78 · Cited by 55
- Authors
- Danovitch, I.
- Affiliations
- Cedars-Sinai Medical Center (US)
- Corresponding author
- Danovitch, Itai
- ORCID
- Danovitch, Itai
- Venue
- Journal of Addictive Diseases
- Publisher
- Informa UK Limited
- Published
- 2016-03-24
- Volume
- 35
- Issue
- 3
- Pages
- 169-179
- ISSN
- 1055-0887 (ISSN-L)
- 1545-0848
- OpenAlex
- W2358626353
- Cited by
- 55
- References
- 78
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 9 · 2023: 2 · 2022: 5 · 2021: 8 · 2020: 5 · 2019: 6 · 2018: 4 · 2017: 1
- FWCI
- 0.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Addictive Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- post-traumatic stress disorder, opioid use disorder, comorbidities, self-medication hypothesis, neurobiological pathways, diagnostic implications, therapeutic implications
- MeSH terms
- Humans, Models, Neurological, Models, Psychological, Opioid-Related Disorders, Self Medication, Stress Disorders, Post-Traumatic
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