Using the Pictorial Representation of Illness and Self Measure (PRISM) to Quantify and Compare Suffering From Trauma and Addiction

ABSTRACT

Objective: In a sample of people with substance use disorder who had experienced psychological trauma, this study aimed to quantify differences in perceived suffering due to addiction-related problems and to trauma-related problems. Methods: The sample comprised 146 inpatients with substance use disorder: 25% had posttraumatic stress disorder (PTSD), 21% had subthreshold PTSD; and the remainder constituted the trauma-only group. PTSD, substance use disorder, and suffering were assessed using validated instruments. Suffering was measured using the Pictorial Representation of Illness and Self Measure (PRISM). Results: No differences were found among the PTSD, subthreshold PTSD, and trauma-only group in the suffering attributed to addiction-related problems. Those in the PTSD group appraised their suffering due to trauma-related problems as greater than the other groups. In the PTSD group, but not the subthreshold PTSD group, suffering due to trauma-related problems was appraised as greater than that due to addiction-related problems. Conclusions: This is the first study to demonstrate quantitative comparisons between different health problems using the “common currency” of suffering. Our results indicate that even among those in an inpatient substance use disorder treatment program, comorbid PTSD may be more personally salient and cause greater suffering, with implications for therapeutic interventions available on substance use disorder treatment programs.

KEYWORDS:

• PRISM
• substance use disorder
• comorbidity
• PTSD
• illness perception
• suffering

Acknowledgments

The authors would like to thank all the research assistants who were involved in the data collection and the patients for their time and efforts. We would also like to thank the four institutes—Tactus Addiction Treatment, Iriszorg, Vincent van Gogh Institute, and Novadic-Kentron—for their cooperation during the data collection process.

Disclosures

TS is shareholder in “prismium,” an organization aiming to foster the development of PRISM. He has received consultancy fees from AbbVie. None of the other authors has a conflict of interest to declare.

Funding

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.