P-14 - Dissociative Mechanisms of Formation of Alcoholism in Patients With Co-morbid Posttraumatic Stress Disorder

Abstract

Relevance

In PTSD, phenomenon of dissociation is associated with massive emotionally disorganizing experience of extreme traumatic stress. In alcoholism dissociation is a result of psychopharmacological effects of alcohol. Common dissociative mechanisms of formation of alcoholism co-morbid with PTSD and alcoholism with alcoholic psychoses condition compatible likelihood of their further highly progression.

Material and methods

Persons with dual diagnosis - PTSD and alcoholism (F43.1, F10.2) have been examined (n = 78). Control group included 82 healthy persons without mental and addictive disorders. The examined were persons of male and female gender (25–45 years, mean age was 34,89 ± 7,76 years). We used DES - Dissociation Experiences Scale (E. M. Bernstein, F. W. Putnam; 1986); scales CIWA-Ar, ТАS (Toronto Alexithymia Scale).

Results

In alcoholic patients with co-morbid PTSD there is accelerated formation of compulsive component of primary craving to alcohol that is associated with specific motivation to use psychotropic effects of ethanol as an agent of “self-medication”, as palliative variant of stress coping-strategy. The most often motivation to use alcohol is ataractic (82,0%). Obligatory character of interrelationship of alcoholic dissociation with initial massive psychotraumatization in PTSD and disturbances in affective domain is confirmed by high indices (DES - 19,2 ± 2,4 and ТАS - 70,2 ± 4,2), on one hand, and high correlation of TAS with indices of TSQ − questionnaire of traumatic stress (г = 0,48, p < 0,01) - on another.

Discussion

In alcoholism co-morbid with PTSD, symptoms of alcohol withdrawal have comprehensive character (CIWA-Ar − 62,2 ± 1,4 scores) and reinforce symptoms of psycho-physiologic hyper-activation that provokes continuous cycles of relapsing.