Substance Use to Regulate Affective Experiences in Posttraumatic Stress Disorder: A Review of Laboratory-Based Studies

Posttraumatic stress disorder (PTSD) and elevated levels of substance use (SU) regularly co-occur and are increasingly viewed as functionally related. While PTSD and SU may be comorbid for a variety of reasons, central theoretical work posits that individuals with PTSD use substances to regulate affective experiences. In particular, two theories of psychopathology and SU comorbidity - the Self Medication Hypothesis and the Negative Reinforcement Model - make distinct predictions about the role of SU in regulating affective or emotional experiences. Laboratory methods employed to study PTSD and SU are well suited to test these unique predictions by using in vivo, experimental paradigms. The current review delineates the distinct predications made by these models and reviews the common methods used to study PTSD-SU comorbidity in the laboratory. Studies that have employed these methods are then reviewed and discussed in relation to theoretical predictions. Evidence supports facets of both the Self Medication Hypothesis and the Negative Reinforcement Model, suggesting a complex relation between PTSD and SU, which may be influenced by the particular substance of use, type of affective experience, and related factors such as substance-related withdrawal and risk taking propensity.