Development and Validation of the Motives for Using Substances for Trauma Coping (MUST-Cope) Questionnaire: A Novel Multidimensional Scale to Assess Trauma-Specific Substance Use Coping Motives

Abstract

The present study sought to develop and validate a novel multidimensional assessment of substance use (SU) coping motives to manage trauma symptoms. In Study 1 (N = 326 trauma-exposed adults recruited from several online platforms), a set of questionnaire items was created and administered, and exploratory factor analysis was performed. A correlated four-factor structure represented by cognitive-affective motives, physiological motives, sleep motives, and social motives emerged. In Study 2 (N = 261 trauma-exposed adults recruited from ResearchMatch), confirmatory factor analysis cross-validated the correlated four-factor structure and additionally tested a five-factor higher-order structure. In tests of convergent, discriminant, and criterion validities, the subscales demonstrated differential correlations with previously validated measures of SU motives and positively correlated with higher PTSD symptom severity, functional impairment, and alcohol and drug use severity. The final 31-item Motives for Using Substances for Trauma Coping (MUST-Cope) Questionnaire offers a novel multifactorial measurement instrument to help researchers and clinicians assess and identify functional coping motives for SU that can be targeted in psychosocial treatment.

Keywords

trauma substance use scale development coping motives PTSD

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References

Adams

S. W.

Layne

C. M.

Contractor

A. A.

Allwood

M. A.

Armour

Inslicht

S. S.

Maguen

(2024). The middle-out approach to reconceptualizing, assessing, and analyzing traumatic stress reactions. Journal of Traumatic Stress, 37, 433–447.

Adams

S. W.

Possemato

Kuhn

(2024). Identifying transdiagnostic and multidimensional prognostic indicators among veterans with PTSD symptoms in brief integrated care settings. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://doi.org/10.1037/tra0001809

Alegría

Fortuna

L. R.

Lin

J. Y.

Norris

F. H.

Gao

Takeuchi

D. T.

Jackson

J. S.

Shrout

P. E.

Valentine

(2013). Prevalence, risk, and correlates of posttraumatic stress disorder across ethnic and racial minority groups in the United States. Medical Care, 51(12), 1114–1123.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association Publishing.

Back

S. E.

Killeen

T. K.

Mills

K. L.

Cotton

B. D.

(2014). Concurrent treatment of PTSD and substance use disorders using prolonged exposure (COPE): Therapist guide. Oxford University Press.

Bailey

Lin

Cook

Winter

Watson

Wright-Toussaint

Barrett

E. L.

Newton

Perry

Grummitt

Strauss

(2024). Substance use among trans and gender diverse young people in Australia: Patterns, correlates and motivations. Drug and Alcohol Review, 43(7), 1940–1953.

Bartlett

M. S.

(1951). The effect of standardization on a χ² approximation in factor analysis. Biometrika, 38, 337–344.

Basedow

L. A.

Kuitunen-Paul

Wiedmann

M. F.

Roessner

Golub

(2021). Self-reported PTSD is associated with increased use of MDMA in adolescents with substance use disorders. European Journal of Psychotraumatology, 12(1), 1968140.

Beavers

A. S.

Lounsbury

J. W.

Richards

J. K.

Huck

S. W.

Skolits

G. J.

Esquivel

S. L.

(2019). Practical considerations for using exploratory factor analysis in educational research. Practical Assessment, Research, and Evaluation, 18(1), 6.

10.

Berke

D. S.

Yeterian

Presseau

Rusowicz-Orazem

Kline

N. K.

Nash

W. P.

Litz

B. T.

(2019). Dynamic changes in marines’ reports of PTSD symptoms and problem alcohol use across the deployment cycle. Psychology of Addictive Behaviors, 33(2), 162–170.

11.

Berman

A. H.

Bergman

Palmstierna

Schlyter

(2003). DUDIT-E, the Drug Use Disorder Identification Test-E (Manual version, 1).

12.

Biolcati

Passini

(2019). Development of the Substance Use Motives Measure (SUMM): A comprehensive eight-factor model for alcohol/drugs consumption. Addictive Behaviors Reports, 10, 100199.

13.

Blanaru

Bloch

Vadas

Arnon

Ziv

Kremer

Haimov

(2012). The effects of music relaxation and muscle relaxation techniques on sleep quality and emotional measures among individuals with posttraumatic stress disorder. Mental Illness, 4(2), 59–65.

14.

Boals

Rubin

D. C.

(2011). The integration of emotions in memories: Cognitive-emotional distinctiveness and posttraumatic stress disorder. Applied Cognitive Psychology, 25(5), 811–816.

15.

Bovin

M. J.

Marx

B. P.

Weathers

F. W.

Gallagher

M. W.

Rodriguez

Schnurr

P. P.

Keane

T. M.

(2016). Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders–fifth edition (PCL-5) in veterans. Psychological Assessment, 28(11), 1379–1391.

16.

Carver

C. S.

(1997). You want to measure coping but your protocol is too long: Consider the Brief COPE. International Journal of Behavioral Medicine, 4(1), 92–100.

17.

Chentsova-Dutton

Maercker

(2019). Cultural scripts of traumatic stress: Outline, illustrations, and research opportunities. Frontiers in Psychology, 10, 2528.

18.

Clark

L. A.

Watson

(2019). Constructing validity: New developments in creating objective measuring instruments. Psychological Assessment, 31(12), 1412–1427.

19.

Cohen

(2013). Statistical power analysis for the behavioral sciences. Routledge.

20.

Ellis

(1962). Reason and emotion in psychotherapy. Lyle Stuart.

21.

Ferrie

M. L.

Lheureux

Vujanovic

A. A.

Zvolensky

M. J.

Raines

A. M.

(2023). Co-occurring posttraumatic stress disorder symptoms and alcohol use behaviors: The mediating role of drinking to cope with PTSD symptoms. Journal of Dual Diagnosis, 19(4), 221–230.

22.

Foa

E. B.

Jaycox

L. H.

(1999). Cognitive-behavioral theory and treatment of posttraumatic stress disorder. In Spiegel

(Ed.), Efficacy and cost-effectiveness of psychotherapy (pp. 23–61). American Psychiatric Publishing.

23.

Ford

J. D.

Grasso

D. J.

Elhai

J. D.

Courtois

C. A

. (2015). Social, cultural, and other diversity issues in the traumatic stress field. In Ford

J. D.

Grasso

D. J.

Elhai

J. D.

Courtois

C. A.

(Eds.), Posttraumatic stress disorder (pp. 503–546). Elsevier.

24.

Germain

McKeon

A. B.

Campbell

R. L.

(2017). Sleep in PTSD: Conceptual model and novel directions in brain-based research and interventions. Current Opinion in Psychology, 14, 84–89.

25.

Gordon

M. G. R.

(2013). Determining the number of factors to retain in EFA: Using the SPSS R-Menu 2.0 to make more judicious estimations. Practical Assessment, Research & Evaluation, 18, 1–14.

26.

Gorsuch

R. L.

(1983). Factor analysis (2nd ed.). Lawrence Erlbaum.

27.

Greene

Neria

Gross

(2016). Prevalence, detection and correlates of PTSD in the primary care setting: A systematic review. Journal of Clinical Psychology in Medical Settings, 23, 160–180.

28.

Haller

Chassin

(2014). Risk pathways among traumatic stress, posttraumatic stress disorder symptoms, and alcohol and drug problems: A test of four hypotheses. Psychology of Addictive Behaviors, 28(3), 841–851.

29.

Hawn

S. E.

Aggen

S. H.

Cusack

S. E.

, Spit for Science Working Group Dick

Amstadter

A. B

. (2020). Examination of a novel measure of trauma-related drinking to cope. Journal of Clinical Psychology, 76(10), 1938–1964.

30.

Hawn

S. E.

Bountress

K. E.

Sheerin

C. M.

Dick

D. M.

Amstadter

A. B.

(2020). Trauma-related drinking to cope: A novel approach to the self-medication model. Psychology of Addictive Behaviors, 34(3), 465–476.

31.

Hawn

S. E.

Cusack

S. E.

Amstadter

A. B.

(2020). A systematic review of the self-medication hypothesis in the context of posttraumatic stress disorder and comorbid problematic alcohol use. Journal of Traumatic Stress, 33(5), 699–708.

32.

Hawn

S. E.

Smith

Armitage

Ball

Lau-Barraco

Powers

Amstadter

A. B.

(2025). Evaluation of a 20-item version of the trauma-related drinking to Cope Questionnaire. Journal of Clinical Psychology, 81(10), 940–954.

33.

Hildebrand

(2015). The psychometric properties of the drug use disorders identification test (DUDIT): A review of recent research. Journal of Substance Abuse Treatment, 53, 52–59.

34.

Hinton

D. E.

Lewis-Fernández

(2011). The cross-cultural validity of posttraumatic stress disorder: Implications for DSM-5. Depression and Anxiety, 28(9), 783–801.

35.

Howard

M. C.

(2016). A review of exploratory factor analysis decisions and overview of current practices: What we are doing and how can we improve? International Journal of Human-Computer Interaction, 32(1), 51–62.

36.

Jinkerson

J. D.

(2016). Defining and assessing moral injury: A syndrome perspective. Traumatology, 22(2), 122–130.

37.

Kaiser

H. F.

(1960). The application of electronic computers to factor analysis. Educational and Psychological Measurement, 20, 141–151.

38.

Kaiser

H. F.

(1974). An index of factorial simplicity. Psychometrika, 39, 31–36.

39.

Kelly

Meredith

P. J.

Taylor

Morphett

Wilson

(2021). Substances and your senses: The sensory patterns of young people within an alcohol and drug treatment service. Substance Abuse, 42(4), 998–1006.

40.

Khantzian

E. J.

(1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231–244.

41.

Kleiman

S. E.

Bovin

M. J.

Black

S. K.

Rodriguez

Brown

L. G.

Brown

M. E.

Lunney

C.A.

Weathers

F.W.

Schnurr

P.P.

Spira

Marx

B. P.

(2020). Psychometric properties of a brief measure of posttraumatic stress disorder–related impairment: The Brief Inventory of Psychosocial Functioning. Psychological Services, 17(2), 187.

42.

Kotov

Krueger

R. F.

Watson

Achenbach

T. M.

Althoff

R. R.

Bagby

R. M.

Brown

T. A.

Carpenter

W. T.

Caspi

Clark

L. A.

Eaton

N. R.

Forbes

M. K.

Forbush

K. T.

Goldberg

Hasin

Hyman

S. E.

Ivanova

M. Y.

Lynam

D. R.

Markon

. . . Zimmerman

(2017). The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126(4), 454–477.

43.

Kulka

R. A.

(2014). Trauma and the Vietnam war generation: Report of findings from the National Vietnam Veterans Readjustment Study. Routledge.

44.

Lac

Luk

J. W.

(2023). The Alcohol Relief Questionnaire: Development and validation of a multidimensional scale to measure the psychological, interpersonal, sleep, and physical relief effects of drinking. Psychological Assessment, 35(6), 533–545.

45.

Lebeaut

Zegel

Steinberg

Zvolensky

M. J.

Vujanovic

A. A.

(2024). The development and initial validation of the Trauma-Related Alcohol Use Coping Measure (TRAC). Psychology of Addictive Behaviors, 38, 616–627.

46.

Liautaud

M. M.

Rendina

H. J.

Berke

D. S.

(2024). Examining the impact of daily discrimination on alcohol use among racially diverse, trauma-exposed sexually minoritized adults: A pilot study. Psychological Trauma: Theory, Research, Practice, and Policy, 16(6), 913–921.

47.

Lim

Jahng

(2019). Determining the number of factors using parallel analysis and its recent variants. Psychological Methods, 24(4), 452–467.

48.

Livingston

N. A.

Farmer

S. L.

Mahoney

C. T.

Marx

B. P.

Keane

T. M.

(2022). The role of PTSD symptom clusters and criterion in predicting future high-risk drug and alcohol use among returning veteran men and women. Psychological Services, 19(2), 386–395.

49.

Luciano

M. T.

Acuff

S. F.

Olin

C. C.

Lewin

R. K.

Strickland

J. C.

McDevitt-Murphy

M. E.

Murphy

J. G.

(2022). Posttraumatic stress disorder, drinking to cope, and harmful alcohol use: A multivariate meta-analysis of the self-medication hypothesis. Journal of Psychopathology and Clinical Science, 131(5), 447–456.

50.

Maercker

Horn

A. B.

(2013). A socio-interpersonal perspective on PTSD: The case for environments and interpersonal processes. Clinical Psychology & Psychotherapy, 20(6), 465–481.

51.

Mahoney

C. T.

Dixon

K. E.

Daugherty

Y. T.

Bindbeutel

K. M.

Horne

S. D.

Littleton

Dworkin

E. R.

Livingston

N. A.

Galano

M. M.

(2024). Structural pathways between PTSD symptoms and alcohol use consequences among women. International Journal of Mental Health and Addiction, 22, 3586–3604.

52.

Mahoney

C. T.

Livingston

N. A.

Wong

M. M.

Rosen

R. C.

Marx

B. P.

Keane

T. M.

(2020). Parallel process modeling of posttraumatic stress disorder symptoms and alcohol use severity in returning veterans. Psychology of Addictive Behaviors, 34(5), 569–578.

53.

McFarlane

A. C.

Atchison

Rafalowicz

Papay

(1994). Physical symptoms in post-traumatic stress disorder. Journal of Psychosomatic Research, 38(7), 715–726.

54.

Meredith

(1993). Measurement invariance, factor analysis and factorial invariance. Psychometrika, 58(4), 525–543.

55.

Morin

C. M.

(2006). Cognitive-behavioral therapy of insomnia. Sleep Medicine Clinics, 1(3), 375–386.

56.

Pacella

M. L.

Hruska

Delahanty

D. L.

(2013). The physical health consequences of PTSD and PTSD symptoms: A meta-analytic review. Journal of Anxiety Disorders, 27(1), 33–46.

57.

Park

C. G.

(2023). Implementing alternative estimation methods to test the construct validity of Likert-scale instruments. Korean Journal of Women Health Nursing, 29(2), 85–90.

58.

Possemato

Maisto

S. A.

Wade

Barrie

McKenzie

Lantinga

L. J.

Ouimette

(2015). Ecological momentary assessment of PTSD symptoms and alcohol use in combat veterans. Psychology of Addictive Behaviors, 29(4), 894–905.

59.

Prins

Bovin

M. J.

Smolenski

D. J.

Marx

B. P.

Kimerling

Jenkins-Guarnieri

M. A.

Kaloupek

D. G.

Schnurr

P. P.

Pless Kaiser

Leyva

Y. E.

Tiet

Q. Q.

(2016). The primary care PTSD screen for DSM-5 (PC-PTSD-5): Development and evaluation within a veteran primary care sample. Journal of General Internal Medicine, 31(10), 1206–1211.

60.

Raftery

Kelly

P. J.

Deane

F. P.

Baker

A. L.

Ingram

Goh

M. C.

McKetin

(2020). Insight in substance use disorder: A systematic review of the literature. Addictive Behaviors, 111, 106549.

61.

Rasmussen

Verkuilen

Jayawickreme

McCluskey

S. T.

(2019). When did posttraumatic stress disorder get so many factors? Confirmatory factor models since DSM–5. Clinical Psychological Science, 7(2), 234–248.

62.

Resick

P. A.

Schnicke

M. K.

(1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60(5), 748–756.

63.

Roehrs

Roth

(2001). Sleep, sleepiness, sleep disorders and alcohol use and abuse. Sleep Medicine Reviews, 5(4), 287–297.

64.

Saunders

J. B.

Aasland

O. G.

Babor

T. F.

De la Fuente

J. R.

Grant

(1993). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction, 88(6), 791–804.

65.

Scoglio

A. A.

Reilly

E. D.

Girouard

Quigley

K. S.

Carnes

Kelly

M. M.

(2022). Social functioning in individuals with post-traumatic stress disorder: A systematic review. Trauma, Violence, & Abuse, 23(2), 356–371.

66.

Scotland-Coogan

Davis

(2016). Relaxation techniques for trauma. Journal of Evidence-Informed Social Work, 13(5), 434–441.

67.

Substance Abuse and Mental Health Services Administration. (2021). Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/reports/rpt35319/2020NSDUHFFR1PDFW102121.pdf

68.

Tripp

J. C.

Jones

J. L.

Back

S. E.

Norman

S. B.

(2019). Dealing with complexity and comorbidity: Comorbid PTSD and substance use disorders. Current Treatment Options in Psychiatry, 6, 188–197.

69.

Ullman

S. E.

Relyea

Peter-Hagene

Vasquez

A. L.

(2013). Trauma histories, substance use coping, PTSD, and problem substance use among sexual assault victims. Addictive Behaviors, 38(6), 2219–2223.

70.

U.S. Department of Health and Human Services. (2016, February 25). NIDA-modified alcohol, smoking, and Substance Involvement Screening Test. National Institutes of Health.

71.

Van den Brink

. (2015). Substance use disorders, trauma, and PTSD. European Journal of Psychotraumatology, 6(1), 27632.

72.

Vandrey

Babson

K. A.

Herrmann

E. S.

Bonn-Miller

M. O.

(2014). Interactions between disordered sleep, post-traumatic stress disorder, and substance use disorders. International Review of Psychiatry, 26(2), 237–247.

73.

Weathers

F. W.

Blake

D. D.

Schnurr

P. P.

Kaloupek

D. G.

Marx

B. P.

Keane

T. M.

(2013). The Life Events Checklist for DSM-5 (LEC-5). https://www.ptsd.va.gov

74.

Weathers

F. W.

Litz

B. T.

Keane

T. M.

Palmieri

P. A.

Marx

B. P.

Schnurr

P. P.

(2013). The PTSD Checklist for DSM-5 (PCL-5). https://www.ptsd.va.gov

75.

Whealin

J. M.

Ruzek

J. I.

Southwick

(2008). Cognitive–behavioral theory and preparation for professionals at risk for trauma exposure. Trauma, Violence, & Abuse, 9(2), 100–113.

76.

World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.).

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