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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1041 — PTSD and Alcohol Misuse: What Is the Connection?

Kline A, and Interian A, VA New Jersey Healthcare System; Ciccone DS, University of Medicine and Dentistry of New Jersey; St. Hill L, and Falca-Dodson M, VA New Jersey Healthcare System;

Objectives:
Epidemiological research reveals high rates of co-morbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) but there is no consensus on the causal direction of the relationship. Some theories suggest SUD develops after trauma exposure to manage PTSD symptoms and others suggest that SUD is a vulnerability factor for subsequent PTSD. Few longitudinal studies have tested these hypotheses, especially in military populations. The current study capitalizes on a longitudinal survey of OEF/OIF Veterans to disentangle relationships between alcohol dependence and PTSD.

Methods:
Pre- and post-deployment surveys were obtained from 922 New Jersey National Guard soldiers deployed to Iraq in 2008. We measured PTSD using the PTSD Checklist (PCL-17) and alcohol dependence using questions/algorithms from the DSM-IV-based National Household Survey of Drug Use and Health. Bivariate and multivariate analyses assessed: 1) the contribution of pre-deployment PTSD to the development of new onset post-deployment alcohol dependence; and 2) the contribution of pre-deployment alcohol dependence to the development of new onset post-deployment PTSD.

Results:
Findings revealed a high prevalence of co-morbid post-deployment PTSD and alcohol problems. Among the 9.7% screening positive for PTSD, 38.2% met criteria for alcohol dependence and of the 12.5% with alcohol dependence, 29.6% screened positive for PTSD. We found no relationship between pre-deployment alcohol use, abuse, or dependence and new onset PTSD. However, soldiers screening positive for baseline PTSD were 3.4 times as likely to develop alcohol dependence as those without baseline PTSD (95% CI = 1.21-9.71). In a multivariate model, baseline PTSD predicted post-deployment alcohol dependence (AOR = 3.35; 95% CI = 1.10-10.29) after controlling for demographics, pre-deployment alcohol use, previous OEF/OIF deployments, and combat exposure. The contribution of baseline PTSD was reduced, however, after adjusting for post-deployment readjustment stress (AOR = 3.082; 95% CI = 0.97-9.9).

Implications:
This study confirms high rates of co-morbid PTSD and alcohol problems in OEF/OIF Veterans. Findings identify PTSD as a possible risk factor for alcohol problems, supporting hypotheses that alcohol use is a coping mechanism for managing PTSD symptoms. In contrast, pre-existing alcohol problems did not increase the risk for PTSD.

Impacts:
Our findings suggest the need for preventive interventions addressing substance use in those with PTSD, even before SUD symptoms develop.


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