Military Combat, Posttraumatic Stress Disorder, and the Course of Alcohol Use Disorders in a Cohort of Australian Vietnam War Veterans

Abstract

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.

Self-management with alcohol over lifespan: psychological mechanisms, neurobiological underpinnings, and risk assessment

“…Social anxiety enhances the risk of developing AUD and reduces the use of protective behavioural strategies [ 177 ]. Virtually all psychiatric disorders that manifest in adulthood are associated with enhanced risk of AUD, such as depression [ 178 ], bipolar disorders [ 179 ], anxiety disorders [ 180 ], PTSD [ 181 ], schizophrenia [ 182 ], BPD [ 183 ] and ADHD [ 184 ]. There is also high comorbidity between chronic pain, alcohol abuse and AUD [ 185 ].…”

Molecular Toxicology and Pathophysiology of Comorbid Alcohol Use Disorder and Post-Traumatic Stress Disorder Associated with Traumatic Brain Injury

“…(3) A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. (4) There is a craving, strong desire, or urge to drink alcohol. (5) Recurrent alcohol use results in a failure to fulfill major role obligations at work, school, or home.…”

“…In recent years, the unsettling prevalence of a feature in most veterans with a history of traumatic brain injury (TBI) has been that a high proportion of post-war veterans diagnosed with a psychiatric problem so-called post-traumatic stress disorder (PTSD) also suffer from alcohol use disorder (AUD) [1][2][3][4]. Compared with patients with either AUD or PTSD alone [5,6], the clinical manifestations of the co-occurrence of AUD and PTSD (AUD/PTSD) are more serious and the prognosis is more devastating [7,8].…”

Emphasizing the Crosstalk Between Inflammatory and Neural Signaling in Post-traumatic Stress Disorder (PTSD)

“…It is well documented that veterans and members of the armed forces are at greater risk of PTSD (Moore et al 2021 ). The primary progenitor of PTSD among war veterans has certainly combated trauma (O’Toole et al 2020 ). Around 8% of the general population suffers from posttraumatic stress disorder (PTSD).…”