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Hurt people who hurt people: The destructive cycle of trauma, substance use and violence

by Dr Emma Barrett
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Violence is a major global public health concern. Indeed, it is a leading cause of injury, disability, and mortality worldwide. Despite abundant literature demonstrating a need to identify and intervene with individuals at heightened risk for violence, effective treatments to reduce violence remain elusive. Two salient factors linked to violence perpetration are posttraumatic stress disorder (PTSD) and substance use disorder (SUD). This is particularly concerning given that these are the most common mental health disorders in the general population (6.4% and 5.1%, respectively) and they are very likely to co-occur. In fact, individuals with PTSD are five times more likely to also suffer from a SUD compared to those without PTSD. For these individuals, their SUD typically develops as a consequence of repeated “self-medication” of their PTSD symptoms.

My program of research aims to examine the associations between PTSD, substance use and violence with the ultimate goal of developing effective psychological treatments to reduce propensity for violence for these individuals. To date, I have carried out research among adolescents and adults in the community and have identified specific PTSD symptoms (i.e. hyperarousal symptoms) that play an integral role in violence perpetration. Subsequently, I trialled a psychological treatment for co-occurring PTSD and SUD among offenders in prison settings and this demonstrated very promising results.

I am currently a Co-Investigator on an NHMRC funded randomised controlled trial (led by Prof Tony Butler at The Kirby Institute) examining the effectiveness of a psychological treatment for PTSD, substance use and anger in a large sample of female violent offenders. I am also travelling to the US on a Fulbright Postdoctoral Scholarship this year to develop and trial a treatment for adolescents with co-occurring PTSD and SUD. The cycle of trauma exposure, PTSD, substance use and violence perpetration can start very early in the lifespan. This highlights the critical need to intervene during adolescence to reduce the enduring disability, personal and societal costs and to significantly improve treatment for this vulnerable population. 

This is a summary of a presentation given by Dr Emma Barrett at the NDARC In-house seminar on 25 February 2016.