Crack users and violence. What is the relationship between trauma, antisocial personality disorder and posttraumatic stress disorder?

Title: Crack users and violence. What is the relationship between trauma, antisocial personality disorder and posttraumatic stress disorder?

Background: Crack use is frequently related to severe social and psychiatric conditions including Antisocial Personality Disorder (ASPD) and Posttraumatic Stress Disorder (PTSD). Social vulnerabilities increase the frequency of traumatic exposure. The relationship of trauma and psychiatric disorders among crack users is still unclear.

Objectives: To describe the characteristics of crack users with ASPD and to verify of the association between ASPD and PTSD, ASPD and each type of traumatic event and the temporality of these events.

Methods: Data from a multicenter cross-sectional sample of 733 crack users under treatment in six Brazilian capitals was obtained via interviews with Addiction Severity Index (ASI) 6 and Mini International Neuropsychiatric Interview (MINI). Demographic characteristics, psychiatric diagnosis and trauma history were examined. Descriptive and bivariate analyses were used to assess the relationship between the studied variables.

Results: More than 80% of crack users with ASPD and >65% without this diagnosis report traumatic experiences. The prevalence of PTSD disorder among those with ASPD (47.3%) is lower than among those without (52.7%) this diagnosis. The traumatic experiences occur either before or after the first episode of drug use.

Conclusions: The high prevalence of ASPD and PTSD among crack users and their frequent exposure to severe traumatic events was verified as well as the fact that they are often victims and sometimes perpetrators of violence illustrating the complexity of the relationships between crack use, trauma and comorbidities.