PTSD, Negative and Positive Emotion Dysfunction and Substance USE in IPV Victims

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PROJECT SUMMARY/ABSTRACT IPV is a pervasive and serious public health issue, affecting nearly one in three women nationally in their lifetime.1 IPV-exposed women have rates of drug and alcohol misuse that are 2–7 times higher than women nationally.2,3 As many as 70% are tobacco smokers.3 [IPV-exposed women have sex with more risky partners, including those who are HIV-positive, IV drug users, and nonmomgomous,4,5 and are more likely to engage in unprotected sex6-8 and trade sex,9 and report more sex partners.4,7] PTSD is highly prevalent among IPV-exposed women (31 to 84%),3,10 and IPV-related PTSD symptoms are positively associated with drug,11-13 alcohol,14,15 and tobacco use16,17 and HIV/sexual risk.18,19 Despite the clear clinical relevance of PTSD in this population, particularly with regard to substance use and risky sex, no studies have explicated mechanisms that may account for relations between PTSD symptoms and substance use and HIV/sexual risk behaviors among IPV-exposed women. Emotion dysfunction has been identified as a key mechanism in the pathogenesis of a wide range of psychological difficulties and maladaptive behaviors,20 including PTSD,21-24 substance use,25- 29 and HIV/sexual risk.25,30-32 Yet, research on mechanisms underlying these health outcomes generally, and the potential mechanism of emotion dysfunction in particular, is absent in this population. IPV-exposed women constitute a unique population distinct from other trauma-exposed populations. IPV is chronic; women are recurrently victimized by their partners and repeatedly exposed to potentially traumatic stimuli in their environment.33,34 This unique context poses increased risk for PTSD symptoms, emotion dysfunction, substance use, and HIV/sexual risk. Existing intervention models for treating PTSD and co-occurring substance use and/or risky sex (e.g., Seeking Safety,35 Project Connect36) were not developed for women who remain in unsafe situations, are seldom community-based, and do not have an integrated focus on IPV, PTSD, substance use, and HIV/sexual risk. Consistent with current initiatives (e.g., NIH strategic plans37), identifying mechanistic processes, across multiple systems (i.e., physiological and behavioral), underlying the relations among PTSD, substance use, and HIV/sexual risk in this population is a critical first step in developing targeted interventions that are safe for IPV-exposed women in the community.102,103 The proposed study addresses such critical gaps in the research with an innovative, context-specific, multi-method approach among 150 women currently experiencing IPV and using substances. Findings will [identify relations among physical, sexual, and psychological IPV and emotion dysfunction;] explicate the role of emotion dysfunction in PTSD symptoms and risk-taking propensity in the lab and substance use and HIV/sexual risk in the real-world; and test the convergent validity of lab and real-world data. The role of emotion dysfunction in PTSD symptoms and risk-taking propensity will be measured in the lab via a novel experimental paradigm and in the real world via daily assessments (i.e., experience sampling). Dr. Weiss is extremely well-qualified for the Mentored Patient-oriented Research Career Development Award from the National Institutes of Health. She is a highly productive NIDA-funded T32 Post-doctoral Fellow in Substance Abuse Prevention Research in the Department of Psychiatry at the Yale University School of Medicine. During the proposed training period, Dr. Weiss will be housed within the Department of Psychiatry at the Yale University School of Medicine. She will also draw from the rich resources provided through the Institute for Clinical and Translational Science at the University of Connecticut Health Center and the University of Colorado Denver Anschutz Medical Campus. Across these settings, she will have access to world-class expertise in research design, methodology, and analysis. Dr. Weiss' program of research focuses on the role of emotion dysfunction in posttraumatic stress disorder (PTSD) and related substance use and HIV/sexual risk. She has published [12] first-author and [8] co-author manuscripts on these topics. Her long- term goals are to be a leader in research aimed at preventing and reducing substance use and HIV/sexual risk among women with PTSD who experience intimate partner violence (IPV); to build strong multi-disciplinary partnerships to identify potential physiological mechanisms and behavioral processes underlying substance use and HIV/sexual risk among IPV-exposed women with PTSD; and to develop prevention and intervention efforts targeting substance use and HIV/sexual risk among IPV-exposed women with PTSD. Continued sponsorship, mentoring, and directed study will facilitate the development of advanced research skills so Dr. Weiss can be at the forefront of cutting-edge research in these areas. Short-term career objectives focus on the development of proficiency in (a) physiological (i.e., sympathetic, parasympathetic, and neuroendocrine) and behavioral assessments of negative and positive emotion dysfunction; (b) micro-longitudinal research design, methods, and analysis; and (c) [optimal design and implementation strategies, such as ethical and safety issues, pertinent to the conduct of research with women who experience IPV and use substances.]