Increased risk of alcohol dependency in a cohort of National Guard troops with PTSD: A longitudinal study (original) (raw)
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Co-occurring Posttraumatic Stress Disorder and Alcohol Use Disorders in Veteran Populations
Journal of Dual Diagnosis, 2011
Co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorders have become increasingly prevalent in military populations. Over the past decade, PTSD has emerged as one of the most common forms of psychopathology among the 1.7 million American military personnel deployed to Iraq and Afghanistan in Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND). Among veterans from all eras, symptoms of PTSD have been highly correlated with hazardous drinking, leading to greater decreases in overall health and greater difficulties readjusting to civilian life. In fact, a diagnosis of co-occurring PTSD and alcohol use disorder has proven more detrimental than a diagnosis of PTSD or alcohol use disorder alone. In order to effectively address co-occurring PTSD and alcohol use disorder, both the clinical and research communities have focused on better understanding this comorbidity, as well as increasing treatment outcomes among the veteran population. The purpose of the present article is threefold: (1) present a case study that highlights the manner in which PTSD and alcohol use disorder co-develop after trauma exposure; (2) present scientific theories on co-occurrence of PTSD and alcohol use disorder; and (3) present current treatment options for addressing this common comorbidity. CASE PRESENTATION A 60 year-old, divorced, male Vietnam-era veteran was referred for substance use treatment following an alcohol-related arrest. He presented for outpatient treatment at a Veterans Affairs (VA) Medical Center with a chief complaint of longstanding anxiety symptoms and recent increase in heavy alcohol use after being laid off from his job. On the Alcohol Use Disorders Identification Test (AUDIT; Bush et al., 1998; WHO Brief Intervention Study Group, 1996), a brief screening tool for hazardous alcohol use, the veteran scored 10 out of 12 points, indicating that he was consuming alcohol at a level harmful to his health. The veteran scored a 50 on the PTSD Checklist for military populations (PCL-M; Weathers, Hushka, & Keane, 1991), indicating a positive screen and the need for a formal evaluation of PTSD.
Journal of Traumatic Stress, 2020
The present study examined the course of diagnosed alcohol use disorders (AUDs) in a cohort of Australian veterans of the Vietnam War (N = 388) who were assessed 22 and 36 years after returning home. Standardized interviews provided data on AUDs, posttraumatic stress disorder (PTSD), other psychiatric diagnoses, and combat exposure. Overall, 148 veterans (38.1%) had no history of alcohol-related diagnoses, 151 veterans (38.9%) had a past AUD diagnosis that was not current at the second assessment point, and 89 veterans (22.9%) had a current AUD diagnosis at the second assessment. Less education, lower intelligence test scores, and misconduct were individual risk factors for AUDs, as were first-interview diagnoses of PTSD, antisocial personality disorder, generalized anxiety, and dysthymia, but not depression; these variables were all nonsignificant after controlling for combat exposure and PTSD. Multinomial regression was used to assess the relative contributions of combat exposure and PTSD to the course of AUDs. Combat exposure and PTSD had different patterns of association with AUDs whereby combat exposure, but not PTSD, was associated with a history of AUDs, odds ratio (OR) = 1.02, but not with current AUDs, whereas PTSD, but not combat exposure, was associated with current AUDs, OR = 3.37. Current numbing and avoidance symptoms were associated with current AUDs, OR = 4.48. The results do not support a mutual maintenance model of PTSD and AUDs but are consistent with a self-medication model, which suggests treatment for PTSD may have beneficial effects on AUDs. Alcohol use disorders (AUDs) are among the most prevalent disorders among combat-exposed returned veterans (Bray et al.
Drug and Alcohol Dependence, 2013
Background: This study aims to: (a) follow-up the prevalence of comorbidity of posttraumatic stress disorder (PTSD), anxiety and depression; (b) determine the chronological relations between these disorder; and (c) examine whether PTSD comorbid with anxiety and depression is implicated in more impaired functioning than PTSD by itself. Methods: 664 war veterans were followed up 1, 2, and 20 years after their participation in the 1982 Lebanon War. Comorbidity was assessed by self reported PTSD, anxiety, and depression symptoms; impairment in psychosocial functioning was assessed by self reported problems in occupational, social, sexual and family functioning. Results: At each point of assessment, rates of triple comorbidity (PTSD, anxiety and depression; 26.7-30.1%) were higher than rates of PTSD, either by itself (9.3-11.1%), or comorbid with depression (1.2-4.5%) or anxiety (2.9-4.5%). PTSD predicted depression, anxiety, and comorbid disorders, but not vice versa. At time 1 and 2 assessments, triple comorbidity was associated with more impaired functioning than PTSD alone. In addition, triple comorbidity at Time 2 was associated with more impaired functioning than double comorbidity. Limitations: Since measurements did not cover the entire span of 20 years since the war, the entire spectrum of changes could not be monitored. Conclusions: Almost one half of war veterans would endorse a lifetime triple comorbidity, and those who do, are likely to have more impaired functioning. The findings support the perspective that views PTSD as the dominant disorder following traumatic events, which impels the development of comorbid anxiety and depression.
Trauma-Related Correlates of Alcohol Use in Recently Deployed OEF/OIF Veterans
Journal of Traumatic Stress, 2013
The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorders (AUDs) is well documented. Little is known about the factors that contribute to alcohol use and the development of AUDs among military personnel following deployment. The primary aim of this study was to examine trauma-related correlates of alcohol use in recently deployed Operation Enduring Freedom/Operation Iraqi Freedom veterans. Members of the Rhode Island National Guard and Army Reserves (N = 238) completed an in-person, initial assessment an average of 6 months postdeployment. Multiple regression analyses examined predictors of drinking outcomes (combat exposure, total PTSD symptoms, and PTSD symptom clusters) after accounting for gender, age, and history of AUD. Results indicated that total PTSD symptoms, but not combat exposure, significantly predicted alcohol use at the initial assessment. When PTSD symptom clusters were considered separately, reexperiencing symptoms (Cluster B) were the strongest predictor of total alcohol use (B = 3.58, p = .002) and heavy drinking episodes (B = 0.31, p = .005). Implications for these findings include early identification of risk factors that could lead to the development of AUDs, and the importance of integrated treatment approaches for co-occurring PTSD and AUD among veterans postdeployment.
Journal of Dual …, 2011
Co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorders have become increasingly prevalent in military populations. Over the past decade, PTSD has emerged as one of the most common forms of psychopathology among the 1.7 million American military personnel deployed to Iraq and Afghanistan in Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND). Among veterans from all eras, symptoms of PTSD have been highly correlated with hazardous drinking, leading to greater decreases in overall health and greater difficulties readjusting to civilian life. In fact, a diagnosis of co-occurring PTSD and alcohol use disorder has proven more detrimental than a diagnosis of PTSD or alcohol use disorder alone. In order to effectively address co-occurring PTSD and alcohol use disorder, both the clinical and research communities have focused on better understanding this comorbidity, as well as increasing treatment outcomes among the veteran population. The purpose of the present article is threefold: (1) present a case study that highlights the manner in which PTSD and alcohol use disorder co-develop after trauma exposure; (2) present scientific theories on co-occurrence of PTSD and alcohol use disorder; and (3) present current treatment options for addressing this common comorbidity. CASE PRESENTATION A 60 year-old, divorced, male Vietnam-era veteran was referred for substance use treatment following an alcohol-related arrest. He presented for outpatient treatment at a Veterans Affairs (VA) Medical Center with a chief complaint of longstanding anxiety symptoms and recent increase in heavy alcohol use after being laid off from his job. On the Alcohol Use Disorders Identification Test (AUDIT; Bush et al., 1998; WHO Brief Intervention Study Group, 1996), a brief screening tool for hazardous alcohol use, the veteran scored 10 out of 12 points, indicating that he was consuming alcohol at a level harmful to his health. The veteran scored a 50 on the PTSD Checklist for military populations (PCL-M; Weathers, Hushka, & Keane, 1991), indicating a positive screen and the need for a formal evaluation of PTSD.
2012
Background: Although alcohol problems are common in military personnel, data examining the relationship between psychiatric conditions and alcohol abuse occurring de novo peri-/post-deployment are limited. We examined whether pre-existing or coincident depression and post-traumatic stress disorder (PTSD) predicted new onset peri-/post-deployment alcohol abuse among Ohio Army National Guard (OHARNG) soldiers. Methods: We analyzed data from a sample of OHARNG who enlisted between June 2008 and February 2009. Participants who had ever been deployed and who did not report an alcohol abuse disorder prior to deployment were eligible. Participants completed interviews assessing alcohol abuse, depression, PTSD, and the timing of onset of these conditions. Logistic regression was used to determine the correlates of peri-/post-deployment alcohol abuse. Results: Of 963 participants, 113 (11.7%) screened positive for peri-/post-deployment alcohol abuse, of whom 35 (34.0%) and 23 (32.9%) also reported peri-/post-deployment depression and PTSD, respectively. Soldiers with coincident depression (adjusted odds ratio [AOR] = 3.9, 95%CI: 2.0-7.2, p < 0.01) and PTSD (AOR = 2.7, 95%CI: 1.3-5.4, p < 0.01) were significantly more likely to screen positive for peri-/postdeployment alcohol abuse; in contrast, soldiers reporting pre-deployment depression or PTSD were at no greater risk for this outcome. The conditional probability of peri-/post-deployment alcohol abuse was 7.0%, 16.7%, 22.6%, and 43.8% among those with no peri-/post-deployment depression or PTSD, PTSD only, depression only, and both PTSD and depression, respectively. Conclusions: Coincident depression and PTSD were predictive of developing peri-/post-deployment alcohol abuse, and thus may constitute an etiologic pathway through which deployment-related exposures increase the risk of alcohol-related problems.
Psychology of Addictive Behaviors, 2012
Alcohol use in the military is a significant problem. The goal of this study was to examine the associations between personality, posttraumatic stress disorder (PTSD) symptoms, and postdeployment alcohol use disorders (AUDs) among a group of Operation Iraqi Freedom (OIF) deployed National Guard soldiers, with a focus on differentiating predeployment and postdeployment onset AUDs. Participants were 348 National Guard soldiers deployed to Iraq from March 2006 to July 2007 drawn from the Readiness and Resilience in National Guard Soldiers (RINGS) study. Participants completed self-report measures one month before deployment and 3 to 6 months postdeployment; current and lifetime history of AUDs were assessed 6 to 12 months postdeployment, using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (4th ed. text rev.; DSM-IV; American Psychiatric Association, 2000). Overall, 13% of the panel was diagnosed with a current AUD. Of those who met criteria for a current AUD, 38% had an AUD that developed following return from deployment (new onset AUD). The development of new onset AUDs was uniquely predicted by higher levels of PTSD symptom severity, higher levels of avoidance-specific PTSD symptoms, and lower levels of positive emotionality. AUDs with onset prior to deployment were predicted by higher levels of negative emotionality and disconstraint. Results of this study suggest that combat deployed soldiers with current AUDs are a heterogeneous group and point to the influence of combat-related PTSD symptoms in the development of AUDs following deployment.
The Relationship Between Postdeployment Factors and PTSD Severity in Recent Combat Veterans
Military Psychology, 2014
Combat traumas precipitate PTSD, however non-traumatic deployment and post-deployment factors may also contribute to PTSD severity. The Deployment Risk and Resilience Inventory was used to investigate pre, peri and post-deployment factors associated with current PTSD severity in 150 recent combat veterans with PTSD and hazardous alcohol use. Hierarchal linear regression analyzed what factors independently predicted PTSD severity when controlling for sociodemographic characteristics and combat specific variables. Four post-deployment factors independently predicted PTSD severity: unemployment, alcohol use, social support, stressful (non-traumatic) life events. The centrality of trauma in the maintenance of PTSD and clinical implications for treatment providers are discussed.
Addictive Behaviors, 2019
Overview. Alcohol use is common following traumatic military deployment experiences. What is less clear is why, and for whom, particular deployment experiences lead to alcohol use. Method. The current study explored associations between deployment stressors (Warfare, Military Sexual Trauma, and Concerns about Life and Family Disruptions-"Life Disruptions"), PTSD (PCL-5), and alcohol use (CAGE) post-deployment, stratified by gender among 2,344 male and female veterans (1,137 men; Mage=35). Conditional process analyses examined the indirect effect of traumatic deployment experiences on alcohol use, via PTSD symptom severity, with Life Disruptions as a moderator. Results. More severe Warfare and military sexual trauma (MST) were associated with greater PTSD symptom severity, which was associated with higher problematic alcohol use. PTSD symptom severity accounted for the associations between trauma type (i.e., MST or Warfare) and alcohol use. Among women, but not men, Life Disruptions moderated the associations between trauma type (i.e., MST, Warfare) and PTSD symptom severity, such that elevated Life Disruptions amplified the associations between trauma type and PTSD symptom severity. Moderated mediation was significant for MST among women, indicating that the strength of the indirect effect (MST PTSD problematic alcohol use) was
Neuropsychiatric Disease and Treatment, 2020
Background: Previously we reported a genetic risk score significantly improved PTSD prediction among a trauma-exposed civilian population. In the current study, we sought to assess this prediction among a trauma-exposed military population. Methods: We examined current PTSD diagnosis and PTSD symptom severity among a random sample of 1042 community-based US military veterans. Main effects and interaction effects were assessed for PTSD genetic risk by trauma exposure using cross-product terms for PTSD x trauma exposures, including combat, lifetime trauma, and adverse childhood exposures. The PTSD risk variants studied were within genetic loci previously associated with PTSD, including CRHR1, CHRNA5, RORA, and FKBP5 genetic variants, which were used to calculate a total PTSD genetic risk score (range=0-8, mean=3.6, SD=1.4). Results: Based on DSM-5 PTSD criteria, 7.1% of veterans (95% CI=5.6-8.8) met criteria for current PTSD. The PTSD genetic risk count was significantly higher among PTSD cases vs noncases (3.92 vs 3.55, p=0.027). Since the PTSD genetic risk score was not significant in the PTSD diagnosis model, we assessed this association using PTSD symptom severity. Because these symptom data were skewed (mean=9.54, SD=12.71, range=0-76), we used negative binomial regression to assess this outcome. This symptom model included a PTSD genetic risk score, demographic factors, trauma exposures, current insomnia, current depression, concussion history, and attention-deficit disorder, expressed as incident rate ratios (IRR), which is an estimate of oneunit increase in PTSD severity, given other variables are held constant. Variables in the final model included age and sex (both p<0.001), PTSD genetic risk (IRR=1.02, p=0.028), warzone tours (IRR=0.94, p=0.003), childhood abuse (IRR=1.50, p<0.0001), current depression (IRR=1.89, p<0.0001), current insomnia (IRR=2.58, p<0.0001), low social support (IRR=1.19, p<0.0001), attention-deficit disorder (IRR=1.51, p<0.0001), agreeable personality (IRR=0.77, p<0.0001), and concussion (IRR=1.38, p<0.0001). Significant interactions were detected for combat and lifetime trauma exposure by PTSD genetic risk (both p<0.0001), suggesting that the impact of trauma exposures on PTSD severity was lower when the PTSD genetic risk was higher. Conclusion: Both warzone and non-warzone factors predicted current PTSD symptoms among veterans, including a PTSD genetic risk score. Interaction effects were detected for combat exposure and lifetime trauma by genetic risk score for PTSD symptoms, suggesting that PTSD symptom manifestation was more dependent on PTSD risk variants than the level of trauma or combat exposure. This suggests that controlling for other factors, the absence of genetic risk variants may confer PTSD resilience. Further research is planned.