ATLANTA – Increased vigilance for alcohol and substance misuse might be warranted for people with posttraumatic stress disorder, according to a study of 379 recent U.S. veterans.
Significantly higher hazardous or harmful drinking was reported among those with posttraumatic stress disorder (PTSD), compared with those without the diagnosis, for example. Current alcohol dependence and current substance use were each higher in those affected with the disorder, said Angela Meade Eggleston, Ph.D.
“The combination is particularly bad,” Dr. Eggleston said, noting that in a study of pregnant women, those with a substance use disorder and PTSD “are more likely to report suicidality, aggression, and psychosocial impairment, compared with patients with a substance use disorder and another psychiatric disorder, or a substance use disorder only” (Compr. Psychiatry 2009;50:415–23).
In the current study, some of the veterans reported abstinence when asked only about the previous month, “so it is important not to take just a snapshot,” Dr. Eggleston said at the annual meeting of the International Society for Trauma Stress Studies. Thirty percent of veterans with PTSD and 19% without reported symptoms of alcohol use disorders within the past year.
Recent veterans of Operation Enduring Freedom or Operation Iraqi Freedom were recruited from the Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), located on the Durham VA campus in North Carolina. The subjects had participated in Operation Enduring Freedom or Operation Iraqi Freedom and had experienced combat deployments, active duty, National Guard, and/or Reserve service since October 2001. Data were collected by questionnaire and an interview at least 28 days apart.
For this study, heavy drinking was defined as five or more drinks daily for men and four or more for women, as recommended by the National Institute of Alcohol Abuse and Alcoholism. Regular heavy drinking was one or more times per month. Substance use disorder was defined as regular use causing symptoms and/or dysfunction, Dr. Eggleston said.
The researchers found that a greater percentage of veterans with PTSD scored an 8 or higher on the Alcohol Use Disorder Identification Test (AUDIT), the cutoff for hazardous or harmful drinking, than did those without PTSD–35%, compared with 17%, respectively.
Of those with PTSD, 8% reported current alcohol dependence, compared with 2% without, and 12% reported a current substance use disorder, compared with 9% of the group without PTSD.
Generally, 22% to 75% of individuals with PTSD also meet criteria for a substance use disorder, Dr. Eggleston said. “Marijuana and other substance use increase following trauma exposure. For example, there was a huge increase in marijuana use in New York City after the 911 attacks. That kind of finding is seen across studies,” said Dr. Eggleston, a psychology fellow at the Durham (N.C.) VA Medical Center. She had no financial disclosures.
PTSD, but not trauma alone, increases risk for onset of drug abuse or dependence, according to findings from a previous study (Arch. Gen. Psychiatry 2003;60:289–94). They found 2.2% of trauma-only patients began abusing drugs, compared to 10% of those with PTSD.
The high rate of PTSD and alcohol misuse in the current study “really raises that red flag for us–what we need to tend to that as they go through their readjustments,” said Jean Beckham, Ph.D., a professor of medical psychology, department of psychiatry and behavioral sciences, Duke University Medical Center, Durham, N.C.