Graduate Studies, UNL

 

Dissertations and Doctoral Documents from University of Nebraska-Lincoln, 2023–

First Advisor

Dennis McMchargue

Degree Name

Doctor of Philosophy (Ph.D.)

Committee Members

David Hansen, Lisa Kort-Butler, Scott Stoltenberg

Department

Psychology

Date of this Version

2025

Document Type

Dissertation

Citation

A dissertation presented to the faculty of the Graduate College of the University of Nebraska in partial fulfillment of requirements for the degree Doctor of Philosophy (Ph.D.)

Major: Psychology

Under the supervision of Professor

Lincoln, Nebraska, December 2025

Comments

Copyright 2025, the author. Used by permission

Abstract

Childhood maltreatment (CM) is a profound public health crisis that significantly elevates the risk for substance use disorders (SUDs), including alcohol and opioid misuse. Adolescents exposed to CM are especially vulnerable, often turning to substances as maladaptive coping mechanisms during critical developmental periods. African American youth bear this disproportionate burden, yet research addressing their unique experiences remains strikingly limited. Furthermore, while the co-occurrence of trauma-related disorders and substance use is well documented, racial and ethnic minority groups continue to be underrepresented in this literature. Emotion regulation difficulties are increasingly recognized as a mechanism linking PTSD symptoms with substance use, yet their influence on treatment engagement is poorly understood.

This dissertation draws on three complementary studies to illuminate the pathways connecting trauma, substance use, and treatment outcomes among African Americans. The first study, a systematic review encompassing more than 14,000 participants, synthesized evidence on the association between CM and alcohol use in African American adolescents. A clear and consistent positive association emerged, underscoring the urgent need for prevention strategies that are both culturally responsive and developmentally sensitive. The second study, a meta-analysis of nine empirical investigations, examined the relationship between PTSD or trauma exposure and opioid use, with attention to racial comparisons. Results revealed a robust overall association and subtle racial differences, suggesting disparities that warrant deeper investigation. The third study analyzed data from African American men (n = 239) in residential SUD treatment to test whether emotion regulation difficulties mediated the link between PTSD symptoms and treatment duration. Counter to expectations, men with greater difficulties in emotional clarity remained in treatment longer when experiencing elevated PTSD symptoms, suggesting that structured treatment environments may buffer the impact of emotional dysregulation.

Together, these studies offer novel insights into the intersection of trauma, emotion regulation, and substance use among African Americans. They identify emotion regulation as a pivotal factor shaping treatment trajectories, highlight enduring gaps in racially inclusive research, and emphasize the critical importance of culturally competent, trauma-informed care. The findings call for prevention and intervention strategies that move beyond one-size-fits-all models, advancing equity and improving outcomes for African American communities disproportionately affected by trauma and addiction.

Advisor: Dennis McMchargue

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