Interwoven oppression: A qualitative study of the contribution of racism and sexism to co-occurring PTSD and substance use disorder.

Racism and sexism are associated with posttraumatic stress disorder (PTSD) and substance use disorder (SUD), yet few studies examine their role in co-occurring PTSD/SUD. Through qualitative interviews with 23 people of color with PTSD/SUD, we found that racism and sexism influence the onset of men and women of color's PTSD/SUD in gendered ways. Women reported that sexism played a role in their exposure to sexual violence, and that concerns around being blamed or dismissed when reporting sexual trauma because of their gender and race, they used substances to cope. Men reported that racism rendered them vulnerable to gang, gun, and interpersonal violence. Sexism via gender stereotypes made them feel like they had to "tough it out," and the racist criminalization meant that they could not seek help for their traumas or substance use. Thus, each group's PTSD/SUD onset occurred through racism and sexism, yet in distinctly gendered ways. Our findings align with multiple jeopardy theory, which suggests that interlocking oppressions render people vulnerable to harm in unique ways. They highlight the need for community psychologists to center the experiences of people of color and to study, prevent, and treat the unique challenges giving rise to their PTSD/SUD.