Alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) often co-occur in military veterans. Having both disorders is associated with a more severe clinical profile (e.g., more co-occurring physical and mental health problems, worse functioning and quality of life, and worse treatment engagement, compliance and response) than having either disorder alone. Understanding risk and resilience factors associated with AUD-PTSD comorbidity can help elucidate potential mechanisms that contribute to this clinical profile, and help inform prevention and treatment efforts. Using data from a nationally representative sample of 3,157 U.S. military veterans who completed an online survey, we examined how veterans with comorbid AUD-PTSD differed from veterans with AUD alone on modifiable risk and resilience factors.
Weighted prevalence analyses indicated that 14.8% of participants screened positive for AUD (≥5 on the AUDIT-C). Of these veterans, 20.3% screened positive for PTSD (≥30 on the PCL-S). Results of a multivariable logistic regression analysis of coping strategies revealed that, relative to veterans with AUD alone, veterans with AUD-PTSD were significantly more likely to endorse use of maladaptive coping styles such as behavioral disengagement (18.4% vs. 3.8%) and self-blame (18.4% vs. 4.4%); and less likely to endorse use of adaptive coping styles such as planning (3.4% vs. 8.8%), active coping (6.9% vs. 18.2%), positive reframing (8.1% vs. 16.1%), use of emotional support (13.8% v. 29.9%), and acceptance (32.2% vs. 42.8%). Veterans with AUD and PTSD also scored lower on composite measures of protective psychosocial characteristics (Cohen d=0.34; comprised of measures of resilience, purpose in life, dispositional gratitude, dispositional optimism, curiosity, and community integration) and social connectedness (d=0.27; comprised of measures of structural social support, perceived social support, and attachment style). Post-hoc analysis of these factors indicated that, relative to veterans with AUD alone, veterans with AUD-PTSD scored significantly lower on measures of resilience (d=0.84) and purpose in life (d=0.69), and were less likely to report having a secure attachment style (27.9% vs. 69.0%).
Taken together, results of this study suggest that U.S. military veterans with comorbid AUD and PTSD had more risk factors and fewer resilience factors than those with AUD alone. This may contribute to why AUD-PTSD comorbidity is associated with more functional problems and lower quality of life as well as why treatment engagement and response may be worse than among those with AUD only. Interventions to reduce risk and increase resilience factors may improve treatment outcomes for comorbid AUD-PTSD.
Sonya Norman– Director, PTSD Mentoring Program / Professor, Department of Psychiatry, National Center for PTSD; Center of Excellence for Stress and Mental Health and VA San Diego Healthcare, San Diego, California
Moira Haller– Assistant Clinical Professor, University of California, San Diego
Jessica Hamblen– National Center for PTSD
Robert Pietrzak– U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder
Director, PTSD Mentoring Program / Professor, Department of Psychiatry
National Center for PTSD; Center of Excellence for Stress and Mental Health and VA San Diego Healthcare
San Diego, California