The associations between traumatic experiences and subsequent onset of a substance use disorder: Findings from the World Health Organization World Mental Health surveys

Louisa Degenhardt, Chrianna Bharat, Meyer Glantz, Evelyn Bromet, Jordi Alonso, Ronny Bruffaerts, Brendan Bunting, Giovanni de Girolamo, Peter de Jonge, Silvia Florescu, Oye Gureje, Josep Maria Haro, Meredith G. Harris, Hristo Hinkov, Elie G. Karam, Georges Karam, Viviane Kovess-Masfety, Sing Lee, Victor Makanjuola, Maria Elena Medina-MoraFernando Navarro-Mateu, Marina Piazza, José Posada-Villa, Kate M. Scott, Dan J. Stein, Hisateru Tachimori, Nathan Tintle, Yolanda Torres, Maria Carmen Viana, Ronald C. Kessler

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Aim: Exposure to traumatic events (TEs) is associated with substance use disorders (SUDs). However, most studies focus on a single TE, and are limited to single countries, rather than across countries with variation in economic, social and cultural characteristics. We used cross-national data to examine associations of diverse TEs with SUD onset, and variation in associations over time. Methods: Data come from World Mental Health surveys across 22 countries. Adults (n=65,165) retrospectively reported exposure to 29 TEs in six categories: “exposure to organised violence”; “participation in organised violence”; “interpersonal violence”; “sexual-relationship violence”; “other life-threatening events”; and those involving loved ones (“network traumas”). Discrete-time survival analyses were used to examine associations with subsequent first SUD onset. Results: Most (71.0%) reported experiencing at least one TE, with network traumas (38.8%) most common and exposure to organised violence (9.5%) least. One in five (20.3%) had been exposed to sexual-relationship violence and 26.6% to interpersonal violence. Among the TE exposed, lifetime SUD prevalence was 14.5% compared to 5.1% with no trauma exposure. Most TE categories (except organised violence) were associated with increased odds of SUD. Increased odds of SUD were also found following interpersonal violence exposure across all age ranges (ORs from 1.56-1.78), and sexual-relationship violence exposure during adulthood (ORs from 1.33-1.44), with associations persisting even after >11 years. Conclusion: Sexual and interpersonal violence have the most consistent associations with progression to SUD; increased risk remains for many years post-exposure. These need to be considered when working with people exposed to such traumas.
Original languageEnglish
Article number109574
JournalDrug and Alcohol Dependence
Early online date16 Jul 2022
Publication statusPublished (in print/issue) - 1 Nov 2022

Bibliographical note

Funding Information:
This article was funded by support given to Daniel Martin by the Consolidated Research Group on Marine Benthic Ecology of the Generalitat de Catalunya (Ref. 2017SGR378), the CSIC Intramural Project 201630E020, and the ongoing project ‘‘Study of natural systems affected by coastal management and infrastructure projects in the open sea’’ involving the CEAB-CSIC and CREOCEAN. João Gil was funded by a collaborative agreement signed with CREOCEAN. Daniel Martin received funds supporting the payment of the PeerJ publication fees through the CSIC Open Access Publication Support Initiative from the CSIC Unit of Information Resources for Research (URICI). TotalEnergies E&P Congo partly sponsored the field surveys. Staff members of CREOCEAN participated in the study design and in sample collection cruises.

Publisher Copyright:
Copyright © 2022 Elsevier B.V. All rights reserved.

Funding Information:
N.T. received funding from the National Science Foundation - NSF-SMA 1560078. D.J.S. is supported by the Medical Research Council of South Africa (MRC).

Funding Information:
The 2007 Australian National Survey of Mental Health and Wellbeing was funded by the Australian Government Department of Health and Ageing. The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP) Thematic Project Grant 03/00204–3. The Bulgarian Epidemiological Study of common mental disorders EPIBUL is supported by the Ministry of Health and the National Center for Public Health Protection. The Colombian National Study of Mental Health (NSMH) is supported by the Ministry of Social Protection. The Mental Health Study Medellín – Colombia was carried out and supported jointly by the Center for Excellence on Research in Mental Health (CES University) and the Secretary of Health of Medellín. The ESEMeD project is funded by the European Commission (Contracts QLG5–1999-01042; SANCO 2004123, and EAHC 20081308), (the Piedmont Region (Italy)), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAS 2000–158-CE), Departament de Salut, Generalitat de Catalunya, Spain, DIUE de la Generalitat de Catalunya (2017 SGR 452; 2014 SGR 748), Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP), and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. The Israel National Health Survey is funded by the Ministry of Health with support from the Israel National Institute for Health Policy and Health Services Research and the National Insurance Institute of Israel. The World Mental Health Japan (WMHJ) Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013, H25-SEISHIN-IPPAN-006) from the Japan Ministry of Health, Labour and Welfare. The Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation (L.E.B.A.N.O.N.) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), National Institute of Health / Fogarty International Center (R03 TW006481–01), anonymous private donations to IDRAAC, Lebanon, and unrestricted grants from, Algorithm, AstraZeneca, Benta, Bella Pharma, Eli Lilly, Glaxo Smith Kline, Lundbeck, Novartis, OmniPharma, Pfizer, Phenicia, Servier, UPO. The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544- H), with supplemental support from the Pan American Health Organization (PAHO). Te Rau Hinengaro: The New Zealand Mental Health Survey (NZMHS) is supported by the New Zealand Ministry of Health, Alcohol Advisory Council, and the Health Research Council. The Nigerian Survey of Mental Health and Wellbeing (NSMHW) is supported by the WHO (Geneva), the WHO (Nigeria), and the Federal Ministry of Health, Abuja, Nigeria. The Northern Ireland Study of Mental Health was funded by the Health & Social Care Research & Development Division of the Public Health Agency. The Peruvian World Mental Health Study was funded by the National Institute of Health of the Ministry of Health of Peru. The South Africa Stress and Health Study (SASH) is supported by the US National Institute of Mental Health (R01-MH059575) and National Institute of Drug Abuse with supplemental funding from the South African Department of Health and the University of Michigan. The Psychiatric Enquiry to General Population in Southeast Spain – Murcia (PEGASUS-Murcia) Project has been financed by the Regional Health Authorities of Murcia (Servicio Murciano de Salud and Consejería de Sanidad y Política Social) and Fundación para la Formación e Investigación Sanitarias (FFIS) of Murcia. The Ukraine Comorbid Mental Disorders during Periods of Social Disruption (CMDPSD) study is funded by the US National Institute of Mental Health (RO1-MH61905). The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the National Institute of Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044708), and the John W. Alden Trust.

Funding Information:
This work was supported by an Australian National Health and Medical Research Council (NHMRC) project grant (no. 1081984 ). L.D. is supported by an NHMRC Senior Principal Research Fellowship ( 1135991 ) and a US National Institute of Health (NIH) National Institute on Drug Abuse (NIDA) grant ( R01DA1104470 ). C.B. is supported by a UNSW Scientia PhD scholarship and a National Drug and Alcohol Research Centre (NDARC) scholarship. NDARC, UNSW Sydney, is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Program. Dr. Glantz’s role on this study is through his involvement as a Science Officer on U01-MH60220. He had no involvement in the other cited grants. N.T. is the supported by National Science Foundation award (NSF-SMA 1560078).

Publisher Copyright:
© 2022 Elsevier B.V.

Copyright © 2022 Elsevier B.V. All rights reserved.


  • Child maltreatment
  • Substance use disorders
  • Trauma
  • World mental health surveys
  • World Health Organization
  • Health Surveys
  • Humans
  • Adult
  • Retrospective Studies
  • Substance-Related Disorders/epidemiology


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