Over 90% of drug users report having experienced at least one traumatic event in their lifetime, and often many more than one.1,2
Traumatic events cause considerable psychiatric distress and increase risk of subsequent psychiatric problems, including posttraumatic stress disorder3
(PTSD). Indeed, drug users have one of the highest rates of PTSD among any clinical population, with most prevalence estimates ranging over 25%.1,2
PTSD and other psychiatric disorders precipitated by traumatic events convey considerable disease burden to drug users, through the direct effects of psychiatric symptoms and the indirect effects of these symptoms on drug use and response to substance abuse treatment.4,5
In view of the high rates of lifetime traumatic event exposure in drug users, it is remarkable that so little is known about rates of trauma re-exposure in this high-risk population. The few studies using general community-based samples show a 3- to 5-year re-exposure rate of 20-40%, with no gender differences.6,7
The clinical relevance of these data is clear from studies that show that traumatic event re-exposure alone or followed by PTSD increases the risk of further psychiatric impairment, including both PTSD and drug use.6–8
There is good reason to believe that urban drug users experience a considerable amount of traumatic event re-exposure. Drug use, urban living, and low income are each associated with elevated risk of traumatic event exposure and re-exposure.9–12
In addition to these risk factors, past trauma exposure alone, which is present in nearly all drug users, further increases the risk for re-exposure.6,13,14
For example, a history of physical or sexual assault is associated with a 2- to 6-fold increase in risk for re-exposure to another violent event.15
That women are more likely to experience re-exposure to sexual and some other violent assaults than men7
suggests that within drug user populations they might be at higher risk for traumatic event re-exposure.
Nevertheless, only two studies have reported on traumatic event re-exposure rates in drug users. Dansky and colleagues16
provide data to show that 44% of a sample of 34 drug users in outpatient treatment had been re-exposed to a traumatic event over a 6-month follow-up. And more recently, Gil-Rivas et al.17
reported that in a larger sample of 322 drug users finishing residential treatment, 24% were re-exposed in the first 6 months of follow-up, and 29% reported re-exposure in the second 6 months. Both of these studies reported only on drug users in treatment, and few of the study participants used heroin or other injected drugs. Neither study reported rates by gender, leaving the question of gender differences unanswered. Thus, no data are currently available on traumatic event re-exposure in men and women injecting drug users out of treatment.
The present study is the first known prospective study to characterize the frequency and type of traumatic event re-exposure in urban male and female injecting drug users. A convenience sample of new registrants to a community syringe exchange program who were not currently in treatment was recruited and assessed for traumatic event re-exposure each month for 16 months. The purpose of this longitudinal study was to describe the monthly incidence of traumatic event re-exposure, to identify specific high-rate events, and to examine gender differences in re-exposure.