A small qualitative study offers a detailed look at how some adults of color understood the development of posttraumatic stress disorder (PTSD) and substance use disorder (SUD). In interviews, 21 of 23 participants connected their race and gender to their experiences of both conditions.
The findings do not show that racism or sexism caused PTSD or SUD. Instead, they describe how participants made sense of events that occurred before they received treatment, including violence, pressure to remain silent and alcohol or drug use as a way of coping.
What the interviews explored
The 2026 study included 23 adults with clinician-diagnosed PTSD and SUD: 16 women, including two transgender women, and seven men. Participants identified as 10 Latine, eight Black, four multiracial and one Asian.
They were recruited through community mental health clinics in Michigan, Georgia, New Mexico and California. Flyers were posted between November 2023 and March 2024. Researchers conducted 23 first interviews lasting about an hour, followed by five additional interviews.
All participants had eventually received treatment for PTSD, SUD or both. Their interviews focused on the period before treatment.
Recurring patterns in participants’ accounts
Researchers identified three recurring themes: violence, silence surrounding violence and alcohol or drug use to cope.
Women commonly described sexual or partner violence, stalking or sexual assault. These experiences were often followed by fears of being disbelieved or blamed, according to the accounts, and then by alcohol or drug use as a coping response.
Men commonly described gun, gang, street, child or family violence. Their accounts included pressure connected to masculinity to stay silent, along with fears of police or arrest. Alcohol or drug use also appeared in these accounts as a way of coping.
The researchers used the concept of multiple jeopardy to describe how racism and sexism may combine to produce harms linked to intersecting identities. The analysis was guided by intersectionality and feminist theory, which influenced the study questions and the way themes were labeled.
What the wider evidence suggests
The interview findings are consistent with associations reported in larger studies, although those studies also cannot establish cause and effect.
A 2025 meta-analysis of 130 studies found that racial discrimination was linked to 16 of 17 alcohol and drug outcomes among racial and ethnic minority groups. For SUD, the reported correlation was r = 0.25.
In a five-year study of 152 African American and 139 Latinx adults with anxiety disorders, more frequently reported discrimination predicted having PTSD, but not other anxiety or mood disorders. Another study of 55 trauma-exposed Black women found that more experiences of racial discrimination were linked to stronger brain responses to threat cues after accounting for trauma and PTSD symptoms.
These quantitative studies were mostly observational. They show relationships between experiences and outcomes, not proof that one caused the other.
Why the findings are limited
The interview study was designed to understand personal accounts rather than measure how often particular pathways occur. It had a small, specific sample, included only seven men, recruited through clinics with an existing tie to the lead researcher and had no comparison group.
Participants described past events retrospectively, and the researchers noted that their understanding of those events may have changed over time. The study also grouped Black, Latine, Asian and multiracial participants under the broad category of people of color, which may conceal important differences between communities.
Two coders agreed about 83% of the time when analyzing transcripts, and participants reviewed their own transcripts for accuracy. Even with those checks, the study cannot determine how common the described experiences are or whether the pathways apply to all people of color with PTSD and SUD.
Relevance for care and future research
The researchers said that understanding participants’ fears—including fear of disbelief, blame, police or arrest—may help clinicians reach people of color living with PTSD and SUD. The study does not test whether services designed around these concerns improve outcomes.
The authors called for larger studies within specific communities to test how common the described pathways are and whether services that address them lead to better outcomes.
People dealing with trauma and substance use can contact the SAMHSA National Helpline at 1-800-662-4357 for free, confidential treatment referrals around the clock.
AI tools were used to assist with the preparation of this article under our editorial standards.
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