title: Increased risk of alcohol dependency in a cohort of National Guard troops with PTSD: a longitudinal study.
abstract: Studies show high rates of co-morbid post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) but there is no consensus on the causal direction of the relationship. Some theories suggest AUD develops as a coping mechanism to manage PTSD symptoms and others that AUD is a vulnerability factor for PTSD. A third hypothesis posits independent developmental pathways stemming from a shared etiology, such as the trauma exposure itself. We examined these hypotheses using longitudinal data on 922 National Guard soldiers, representing a subsample (56%) of a larger pre- and post-deployment cross-sectional study of New Jersey National Guard soldiers deployed to Iraq. Measures included the PTSD Checklist (PCL), DSM-IV-based measures of alcohol use/misuse from the National Household Survey of Drug Use and Health and other concurrent mental health, military and demographic measures. Results showed no effect of pre-deployment alcohol status on subsequent positive screens for new onset PTSD. However, in multivariate models, baseline PTSD symptoms significantly increased the risk of screening positive for new onset alcohol dependence (AD), which rose 5% with each unit increase in PCL score (AOR = 1.05; 95% CI = 1.02-1.07). Results also supported the shared etiology hypothesis, with the risk of a positive screen for AD increasing by 9% for every unit increase in combat exposure after controlling for baseline PTSD status (AOR = 1.09; 95% CI = 1.03-1.15) and, in a subsample with PCL scores <34, by 17% for each unit increase in exposure (AOR = 1.17; 95% CI = 1.05-1.31). These findings have implications for prevention, treatment and compensation policies governing co-morbidity in military veterans.
authors: Department of Veterans Affairs-New Jersey Health Care System, Lyons, NJ, United States; Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States. Electronic address: Anna.kline@va.gov.
authors: Anna
authors: A
authors: Kline
authors: Bloustein Center for Survey Research, Rutgers University, New Brunswick, NJ, United States.
authors: Marc D
authors: MD
authors: Weiner
authors: University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ, United States.
authors: Donald S
authors: DS
authors: Ciccone
authors: Department of Veterans Affairs-New Jersey Health Care System, Lyons, NJ, United States; Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States.
authors: Alejandro
authors: A
authors: Interian
authors: Department of Veterans Affairs-New Jersey Health Care System, Lyons, NJ, United States; Bloustein Center for Survey Research, Rutgers University, New Brunswick, NJ, United States.
authors: Lauren
authors: L
authors: St Hill
authors: Lincoln Medical and Mental Health Center, New York, NY, United States.
authors: Miklos
authors: M
authors: Losonczy
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000453:epidemiology* / Q000523:psychology; D000818:Animals; D003130:Combat Disorders / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology; D008875:Middle Aged; D008889:Military Personnel; D015999:Multivariate Analysis; D009515:New Jersey / Q000453:epidemiology; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Alcohol misuse; Co-morbidity; Combat exposure; Military veterans; PTSD