Natural Course of Co‐Occurring PTSD and Alcohol Use Disorder Among Recent Combat Veterans

Abstract

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) commonly co-occur in veterans, yet little is known about the longitudinal course of PTSD and drinking in comorbid populations. This study assessed the natural course of daily alcohol consumption and weekly changes in PTSD symptoms in 112 recent combat veterans over the course of 11 months. Latent class growth mixture modeling was used to classify individuals into distinct classes with similar PTSD symptom and alcohol use growth trajectories. We then investigated theorized predictors of class membership including sociodemographics; pre-, peri-, and postdeployment factors; coping; symptom severity; and number of mental health/substance use appointments attended. Results revealed that most participants had severe and nonremitting PTSD. Trajectories for alcohol use included gradual and drastic declines, and chronic low-level drinking. The use of behavioral health services (odds ratio = 2.47) and fewer current stressors (odds ratio = 0.42) predicted AUD remission. Because little variation was observed in the PTSD course, our study did not observe coordinated fluctuations of PTSD symptoms and heavy drinking. Our findings suggest that treatment impacts the course of AUD and that recent combat veterans who do not seek PTSD treatment may have chronic and severe PTSD symptoms.

Parallel process modeling of posttraumatic stress disorder symptoms and alcohol use severity in returning veterans.

“…Conversely, initial levels of alcohol use severity did not predict the rate of change in PTSD symptoms. As such, these findings provide compelling evidence of directionality regarding the association between PTSD symptoms and alcohol use severity among returning veterans and extend previous research of shorter study duration (e.g., Berke et al, 2019;Possemato et al, 2017).…”

“…Due to lack of variability in their study, they were unable to detect significant covariation between PTSD and alcohol use trajectories over time. They suggested that subsequent research examine the degree to which PTSD and alcohol symptoms covary over a longer time interval to model the natural course of co-occurring PTSD and alcohol use (Possemato et al, 2017).…”

“…Thus, co-occurring PTSD symptoms clearly represent considerable barriers to effective treatment, as well as critical intervention points in terms of promoting alcohol use recovery and quality of life among returning veterans. Unfortunately, the majority of returning veterans with PTSD and alcohol use concerns who might benefit from treatment do not seek it (Hoge et al, 2004), and lack of treatment can result in chronic and unremitting disorder (Possemato et al, 2017). For these reasons, it is of both scientific interest and clinical importance to examine the longitudinal and potentially enduring course of co-occurring PTSD symptoms and alcohol use over time.…”

“…In a powerful demonstration of the impact of within-day effects of PTSD, Possemato and colleagues found that within-day increases in PTSD symptom severity significantly predicted higher levels of daily alcohol consumption among returning veterans (Possemato et al, 2015). Possemato and colleagues (2017) also examined the link between PTSD and alcohol use in a study of returning combat-deployed veterans over a span of 11 months. Due to lack of variability in their study, they were unable to detect significant covariation between PTSD and alcohol use trajectories over time.…”

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

“…Many reports recognize that AUDs are associated with posttraumatic stress disorder (PTSD; Banducci et al., 2019; Carter et al., 2011; Heltemes et al., 2014; Langdon et al., 2016; Possemato et al., 2017; Walton et al., 2018). The findings from a study of 8 years of consecutive new treatment‐seekers ( N = 456,502) in the U.S. Veterans Affairs (VA) network (Seal et al., 2010) demonstrated that alcohol and other drug use disorders were 3–4.5 times more likely in veterans with compared to without PTSD or depression.…”