The relationship between trauma and substance misuse in high-risk mentally disordered offenders
Publication Date
August 4, 2021
Creator
Abstract
This thesis aims to provide an original contribution to knowledge regarding the relationship between trauma and substance misuse in high-risk mentally disordered offenders (MDOs), and to determine if gender differences exist, in order to inform interventions. This was accomplished through ascertaining the prevalence of past trauma and past severity of substance misuse, and its relationship to current trauma-related distress in male and female MDOs, and subsequently undertaking a more detailed exploration with women to ascertain their views on the relationship.
Chapter 1 introduces the context of the study, exploring relevant research regarding substance misuse treatment and the connection between mental disorder, substance misuse, and trauma, and the significance of gender plus the implications for effective interventions.
Chapter 2 presents a systematic review investigating gender differences in substance-using convicted offenders to discern specific factors to facilitate gender-informed treatment. Due to the studies’ heterogeneity, a narrative synthesis was undertaken. Gender differences were found in seven areas including demographics, physical health, mental disorder, past trauma, substance use, offending, and treatment. In general, females were found to be younger, with greater social disadvantage concerning education, employment, income, and physical and mental health. Females also reported more historic trauma exposures, alongside higher rates of substance misuse. Men typically had more arrests, convictions, and longer imprisonments whilst women had received more treatment and therapy-related gains.
Chapter 3 provides a psychometric test critique of the Trauma Symptom Inventory-2 (TSI-2). The TSI-2 was utilised in the quantitative research to assess levels of current trauma-related distress, as described in Chapter 4.
Chapters 4 and 5 present a mixed methods research project conducted with MDOs detained in one high security hospital. Chapter 4 focusses on the quantitative study, aimed at determining the prevalence of past trauma and substance misuse, and their relationship to current trauma-related psychological sequelae and establishing if there are variations by gender. The 58 participants had experienced a minimum of two past traumas and an average of seven, ascertained via the Life Events Checklist for DSM-5 (LEC-5). Almost all (86.21%) had misused substances historically, determined through the Drug Abuse Screening Test (DAST-20), the Alcohol Use Disorder Identification Test (AUDIT), and a substance use severity score calculated from the DAST-20 and AUDIT results to reflect the level of past substance misuse. Current trauma-related symptomatology was gauged with the TSI-2. It was found participants had an average of three clinically elevated areas of trauma-related symptomatology; there were no gender differences. The findings indicated LEC-5 scores were unrelated to TSI-2 scores. Higher substance use severity scores were associated with higher levels of current Self-Disturbance, Posttraumatic Stress, Anxious Arousal, and Anxiety. No gender differences were discovered regarding past trauma levels, substance misuse history, or current trauma-related distress. Greater past substance use severity was associated with higher levels of current trauma-related psychological sequelae for men but not women.
Chapter 5 presents the qualitative study, which explored with a female subset (n=23) their perceptions about the relationship between their past substance misuse and trauma exposure. Thematic analysis of interviews identified three superordinate themes: substance misuse as a coping strategy, substance misuse linked to increased trauma/risk exposure, and coercion to misuse substances as instrumental to the trauma.
Chapter 6 provides an overall discussion of the work, implications for clinical practice, and future research recommendations.
Item Type
ethesis
Thesis Type
DForenPsy
Supervisors
Subjects (LC)
Associated Schools / Departments
School of Medicine
eprints ID
64104
UoN Repository URI
Except where otherwise noted, this item's license is described as
File(s)![Thumbnail Image]()
Name
REDACTED ETHESES UPLOAD ELAINE FEHRMAN 11.12.20.pdf
Type
Full-text
Description
Reader
Size
4.28 MB
Format
Adobe PDF
Checksum (MD5)
398eca89885376928160a3c781f67825