The experience of a traumatic event can have a negative impact on the way people think and feel about themselves, others, and the world in which they live (Dalgleish, 2004
). Insomuch that thoughts and feelings are often related (Jayawickreme, Yasinski, Williams, & Foa, 2011
), trauma cognitions may play a role in choices made surrounding alcohol use and abuse. Alcohol dependence (AD) can be maintained as a maladaptive attempt to manage posttraumatic anxiety through drinking (e.g., Coffey, Stasiewicz, Hughes, & Brimo, 2006
), and it is no surprise that higher rates of posttraumatic stress disorder (PTSD) have been found among those who report AD, and vice versa (e.g., Najavits, Weiss, & Shaw, 1997
; Langeland & Hartgers, 1998
). The co-occurrence of these two disorders results in worse physical and mental health consequences and poorer treatment outcomes than either alone (Saladin, Brady, Dansky & Kilpatrick, 1995
; Oimette, Wolfe, & Chrestman, 1996; Read, Brown & Kahler, 2005).
While there have been studies that have examined the role of race in the development and symptom presentation of PTSD (see Pole, Gone, & Kulkani, 2008 for a review), there has been scarce research focused on racial differences in patients with a dual diagnosis of PTSD and AD. One large study found that 15.8% of people with PTSD also suffer from co-morbid AD, with white persons at a higher risk than black persons for alcohol abuse and AD (Breslau, Davis, & Schultz, 2003
). However, there is some evidence that symptoms in African Americans may be more severe; Penk et al. (1989)
found that African American alcohol and drug abusers who experienced heavy combat in Vietnam suffered from greater post-war dysfunction compared to a similar group of European Americans. Furthermore, African Americans in this sample scored higher on the Minnesota Multiphasic Personality Inventory (MMPI) scales for paranoid and psychotic symptoms (Penk et al., 1989
), which could be interpreted as an indication of greater negative cognitions about others and decreased beliefs about a safe world.
No studies have explored racial differences in trauma-related beliefs and cognitions in a dually-diagnosed PTSD and AD sample. Numerous theories as well as a growing body of research have noted the importance such cognitions play in the development and maintenance of PTSD (Ehlers & Clark, 2000
; Foa & Kozak, 1986
; Janoff-Bulman, 1992
; see Dalgleish, 2004
for a review). In particular, Foa and colleagues have used emotional processing theory (Foa & Kozak, 1986
) to explain how PTSD develops when a trauma changes pre-existing beliefs about competence and safety in the world. Specifically, if the trauma disconfirms rigid perceptions either that the self is completely competent or that the world is completely safe, or confirms pre-existing beliefs that the self is completely incompetent and the world is completely dangerous, then PTSD is likely to develop (Foa & Cahill, 2001
). Foa and colleagues developed the Posttraumatic Cognitions Inventory (PTCI; Foa, Ehlers, Clark, Tolin, & Orsillo, 1999
) to measure three categories of these negative, trauma-related cognitions: negative cognitions about self, negative cognitions about the world, and self-blame. Each of these three categories have, in various studies, been shown to be correlated with PTSD severity and depression (Foa, et al., 1999
; Beck, et al, 2004
; Moser, Hajack, Simons, & Foa, 2007
). In particular, Foa et al. (1999)
found that individuals with a diagnosis of PTSD had more negative beliefs about the world and themselves compared to individuals who had experienced a trauma but did not meet criteria for PTSD. Additionally, Zoellner, Feeny, Fitzgibbons, and Foa (1999)
found that female African American had lower expectations about the benevolence of the world in general, compared to European American women, and these beliefs did not change after treatment.
In their review of PTSD among racial minorities, Pole, Gone and Kulkarni (2008)
argued that future research looking at racial differences should focus, among other things, on trauma variables that have been shown to be important predictors of PTSD overall. Such an approach will allow researchers to examine whether race moderates the impact between established predictors, such as negative trauma cognitions, PTSD, and other comorbid disorders. This will allow us to better understand the impact of race on PTSD, and therefore better identify and address the psychotherapeutic needs of an increasingly diverse population.
There is scarce research on mechanisms that explain racial differences in the onset and presentation of comorbid PTSD and AD. Several large studies (the National Vietnam Veterans Readjustment Study [Kulka et al., 1990
]; a community sample of individuals affected by the Buffalo Creek dam collapse [Green et al., 1990
]; a sample drawn from four cities in the Southern USA [Norris, 1992
]) indicate that African Americans have higher rates of PTSD and more severe symptoms. It is possible that one such mechanism that may explain these racial differences may be variations in trauma cognitions. Furthermore, these same trauma cognitions may also impact drinking behavior in those with a dual diagnosis of PTSD and AD.
The current study examines black-white differences in trauma cognitions as measured by the PTCI in patients with PTSD and their relationship to symptoms of AD. We examined alcohol craving even though it is not a DSM-IV (American Psychological Association, 1994
) criteria for AD, as research indicates that craving is a hallmark symptom of AD and is related to withdrawal, treatment outcome and relapse (Ludwig & Wikler, 1974
, Singleton & Gorelick, 1998
; Sinha & O’Malley, 1999
). Based on prior research (e.g. Zoellner et al., 1999
), we hypothesize racial differences in trauma-related cognitions, with African Americans exhibiting greater negative cognitions about the world than European Americans. We also predict that African Americans will evidence greater negative consequences as a result of drinking. Due to the scarcity of research conducted on these constructs, we have no hypothesis regarding racial differences in alcohol cravings, thus this study is exploratory in that regard.