{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T15:47:39Z","timestamp":1781970459074,"version":"3.54.5"},"reference-count":68,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T00:00:00Z","timestamp":1742947200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T00:00:00Z","timestamp":1742947200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100007502","name":"Stichting tot Steun Vereniging tot Christelijke Verzorging van Geestes- en Zenuwzieken","doi-asserted-by":"publisher","award":["244"],"award-info":[{"award-number":["244"]}],"id":[{"id":"10.13039\/501100007502","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alcohol, Clinical and Experimental Research"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Substance use disorder (SUD) frequently co\u2010occurs with posttraumatic stress disorder (PTSD). Feelings of shame and guilt are associated with either disorder but have not been studied in patients with both disorders. Index trauma characteristics are associated with PTSD severity and trauma\u2010related shame. This study examines the effects of trauma\u2010related guilt and shame, and index trauma on SUD and PTSD severity in a clinical sample of individuals with co\u2010occurring SUD and PTSD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Participants were SUD\u2010treatment\u2010seeking patients with co\u2010occurring PTSD (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009209) who completed the Clinician\u2010Administered PTSD scale for Diagnostic and Statistical Manual of Mental Disorders (DSM\u20105; CAPS\u20105), Alcohol Use Disorder Identification Test (AUDIT), Drug Use Disorders Identification Test (DUDIT), Trauma\u2010Related Guilt Inventory (TRGI) and Trauma\u2010Related Shame Inventory (TRSI). Regression analyses examined the predictive values of PTSD severity, trauma\u2010related guilt, and shame on alcohol and drug use problems, and the predictive values of trauma\u2010related guilt and shame on PTSD severity. One\u2010way ANOVA and follow\u2010up\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests examined the effects of index trauma on PTSD severity and trauma\u2010related shame.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>PTSD severity was significantly associated with drug use disorder (DUD) severity and showed a curvilinear relationship to alcohol use disorder (AUD) severity. Trauma\u2010related guilt was not significantly associated with SUD severity, while trauma\u2010related shame was significantly associated with DUD severity (but not AUD severity). Both trauma\u2010related guilt and shame were significantly associated with PTSD severity; however, only trauma\u2010related shame showed an independent association. Interpersonal (especially sexual) index traumas were associated with increased trauma\u2010related guilt and shame, while childhood index traumas were associated with increased PTSD severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Trauma\u2010related guilt and shame might be important focus points in PTSD treatment, but for SUD problems, this study only showed an association between trauma\u2010related shame and drug use problems. Trauma\u2010related shame seems to be a more important treatment focus point than trauma\u2010related guilt in the treatment of PTSD. It becomes particularly relevant for interpersonal index traumas (especially sexual trauma). Childhood traumas require attention in SUD\u2010PTSD co\u2010occurrence, given the higher severity of PTSD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acer.70028","type":"journal-article","created":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T05:50:42Z","timestamp":1743227442000},"page":"1064-1075","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Trauma\u2010related guilt, shame, and trauma type among patients with co\u2010occurring\n                    <scp>PTSD<\/scp>\n                    and\n                    <scp>SUD<\/scp>"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-1143-5980","authenticated-orcid":false,"given":"Nathalie N. 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