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 D. Glantz, Evelyn J. Bromet, Jordi Alonso, Jordi Alonso, Jordi Alonso, Ronny Bruffaerts, Brendan Bunting, Giovanni de Girolamo, Peter de Jonge, Peter de Jonge, Silvia Florescu, Oye Gureje, Josep Maria Haro, Meredith G. Harris, Hristo Hinkov, Elie G. Karam, Georges Karam, Viviane Kovess-MasfetySing Lee, Victor Makanjuola, Maria Elena Medina-Mora, Fernando Navarro-Mateu, Fernando Navarro-Mateu, Fernando 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, Sergio Aguilar-Gaxiola, Ali Al-Hamzawi, Mohammed Salih Al-Kaisy, Jordi Alonso, Yasmin Altwaijri, Laura Helena Andrade, Lukoye Atwoli, Corina Benjet, Guilherme Borges, Evelyn J. Bromet, Ronny Bruffaerts, Brendan Bunting, Jose Miguel Caldas-de-Almeida, Graça Cardoso, Somnath Chatterji, Alfredo H. Cia, Louisa Degenhardt, Koen Demyttenaere, Silvia Florescu, Giovanni de Girolamo, Oye Gureje, Josep Maria Haro, Hristo Hinkov, Chi yi Hu, Peter de Jonge, Aimee Nasser Karam, Norito Kawakami, Ronald C. Kessler, Andrzej Kiejna, Viviane Kovess-Masfety, Sing Lee, Jean Pierre Lepine, John McGrath, Maria Elena Medina-Mora, Zeina Mneimneh, Jacek Moskalewicz, Fernando Navarro-Mateu, Marina Piazza, Jose Posada-Villa, Kate M. Scott, Tim Slade, Juan Carlos Stagnaro, Margreet ten Have, Maria Carmen Viana, Daniel V. Vigo, Harvey Whiteford, David R. Williams, Bogdan Wojtyniak

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


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 to 1.78), and sexual-relationship violence exposure during adulthood (ORs from 1.33 to 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
Publication statusPublished - 1 Nov 2022


  • Child maltreatment
  • Substance use disorders
  • Trauma
  • World mental health surveys


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