PTSD symptoms mediate the relationship between traumatic experiences and drinking behavior among women attending alcohol-serving venues in a South African township

BACKGROUND: South Africa has high rates of traumatic experiences and alcohol abuse, especially among women. Traumatic experiences often result in symptoms of post-traumatic stress disorder (PTSD), and PTSD has been associated with hazardous drinking. We examine the relationship between traumatic events and hazardous drinking among women who patronized alcohol-serving venues in South Africa, and explore PTSD as a mediator of this relationship. METHODS: 560 women were recruited from a Cape Town township and completed a computerized assessment that included alcohol consumption, history of traumatic events, and PTSD symptoms. Mediation analysis examined whether PTSD symptoms mediated the relationship between the number of traumatic event categories experienced (range 0-7) and drinking behavior. RESULTS: The mean AUDIT score in the sample was 12.15 (range 0-34, sd=7.3), with 70.9% reaching criteria for hazardous drinking. The mean PTSD score was 36.32 (range 17-85, sd=16.3), with 20.9% meeting criteria for PTSD (PCL-C>50). Endorsement of traumatic experiences was high, including adult emotional (51.8%), physical (49.6%) and sexual (26.3%) abuse, childhood physical (35.0%) and sexual (25.9%) abuse, and other types of trauma (83%). All categories of traumatic experiences were associated with hazardous drinking. PTSD symptoms mediated 46% of the relationship between number of traumatic categories experienced and drinking behavior. CONCLUSIONS: There was a strong relationship between traumatic exposure and drinking levels, which was largely mediated by PTSD symptoms. Substance abuse interventions should address histories of abuse in this population, where alcohol may be used in part to cope with past traumas.