Exploring the Role of Reward Functioning in the Overlap of Post-Traumatic Stress and Cocaine Use Disorder

Authors

Kate Hull
Hanaan Bing-Canar
Krista Miloslavich
Christopher Holden
Aneet Ahluwalia
Scott D Lane
Joy M Schmitz
Margaret C Wardle

Language

English

Publication Date

1-1-2025

Journal

Substance Use & Misuse

DOI

10.1080/10826084.2025.2465983

PMID

39967049

PMCID

PMC11949698

PubMedCentral® Posted Date

2-18-2026

PubMedCentral® Full Text Version

Author MSS

Abstract

Background: Posttraumatic stress disorder (PTSD) symptoms are common in people with cocaine use disorder (CUD), and even sub-threshold PSTD symptoms result in worse treatment outcomes. Difficulties with reward functioning may drive this comorbidity. Impairments in reward functioning are prominent in both PTSD and CUD and contribute to development of substance use problems after trauma. There are three distinct reward processes that may be involved in the PTSD/CUD overlap: consummatory reward (ability to experience pleasure), motivational reward (willingness to exert effort for rewards), and reward learning (adapting behavior based on reward history). Here we test whether impairments in these reward functions account for the relationship between PTSD and CUD symptoms.

Methods: This is a secondary analysis of data from a clinical trial (NCT02773212) that measured of PTSD symptoms, CUD severity, consummatory reward, motivational reward, and reward learning in 53 treatment-seeking people with CUD.

Results: Greater PTSD symptoms related to (1) more severe CUD and (2) less ability to learn from reward; however, impaired reward learning did not significantly account for the overlap in PTSD and CUD symptom severity.

Conclusions: The observed relationship between PTSD and CUD symptoms was not accounted for by reduced ability to experience pleasure from rewards, reduced motivation for rewards, or reduced ability to learn from rewards. Thus, treatments that attempt to enhance reward functioning seem unlikely to address this complex comorbidity.

Keywords

Adult, Female, Humans, Male, Middle Aged, Cocaine-Related Disorders, Comorbidity, Motivation, Reward, Stress Disorders, Post-Traumatic, cocaine use disorder, posttraumatic stress, anhedonia, reward functioning

Published Open-Access

yes

Recommended Citation

Hull, Kate; Bing-Canar, Hanaan; Miloslavich, Krista; et al., "Exploring the Role of Reward Functioning in the Overlap of Post-Traumatic Stress and Cocaine Use Disorder" (2025). Faculty, Staff and Student Publications. 6047.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/6047