(PS6-C53) Emotional Clarity Difficulties Mediate the Relationship Between PTSD Symptom Severity and Substance Use Treatment Persistence

Posttraumatic stress disorder (PTSD) negatively impacts the prognosis of substance use outcomes, particularly through challenges in emotion regulation (Kemmis, Wanigaratne, and Ehntholt,2017). Despite this evidence, research has yet to fully explicate the influence of PTSD symptoms and related emotion regulation difficulties on treatment persistence among those with substance use disorders. Given that treatment persistence may be key to better outcomes post-discharge, the present study tested the hypothesis that PTSD symptoms would negatively relate to treatment persistence through a path of emotion regulation difficulties. 
 
Methods
Participants (N = 462, m_age = 36, sd = 11.30, range = 18 to 62) were recruited from a non-hospitalized residential treatment facility for men recovering from SUDs in a city located in the Great Plains.
 
Results
At the bivariate level, PCL-C total score, PCL-C factors re-experiencing and avoidance/numbing and DERS awareness and clarity were positively associated with length of days in treatment (rs = .10 to .13, p < .05). However, at a multivariate level, results indicate that higher PCL-C hyperarousal (β = -0.16, p = .03) and DERS impulsivity scores (β = -0.25, p < .01) was associated with lower length of stay in treatment. Furthermore, impulsivity partially mediated the relationship between hyperarousal and length of days in treatment (indirect effect b = -1.59, p < .05; 95% C.I. = -2.63; -0.54). Moderation analysis indicated an interaction effect between DERS lack of emotional awareness and PCL-C avoidance/numbing and hyperarousal. Simple effects analyses indicated that the higher lack of emotional awareness and the higher hyperarousal leads to a much shorter treatment stay. Also, as DERS lack of emotional awareness increases, the relationship between PCL-C avoidance/numbing and treatment stay becomes more positive.