title: Aggressive behavior among military veterans in substance use disorder treatment: the roles of posttraumatic stress and impulsivity.
abstract: This study examined posttraumatic stress disorder (PTSD) symptom severity and impulsivity as predictors of aggressive behavior among 133 male military veterans entering substance abuse treatment who endorsed difficulty controlling anger in the past year. At treatment intake, participants completed measures assessing PTSD symptom severity, impulsivity and aggressive behavior. Perpetration of aggressive behavior was reassessed 4 months later. Results from multivariate models indicated that PTSD symptom severity and impulsivity explained unique variance in aggressive behavior at intake but not follow-up. Mediation models indicated that the association between PTSD symptom severity and aggressive behavior was accounted for by impulsivity. The identification of impulsivity as a key mediator between trauma symptoms and aggressive behavior has significant clinical and research implications. Based on these findings, clinicians are encouraged to consider a standard assessment of impulsivity and the selection of interventions that target impulsivity as a trans-diagnostic process among at-risk client populations.
authors.affiliation: Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA; National Center for PTSD, Dissemination and Training Division, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA. Electronic address: adrienneheinz@gmail.com.
authors.forename: Adrienne J
authors.initials: AJ
authors.lastname: Heinz
authors.affiliation: National Center for PTSD, Dissemination and Training Division, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA.
authors.forename: Kerry
authors.initials: K
authors.lastname: Makin-Byrd
authors.affiliation: Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Blonigen
authors.affiliation: Department of Psychiatry, University of California, San Francisco, CA, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Reilly
authors.affiliation: Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Timko
mesh_terms: D000328:Adult; D000374:Aggression / Q000523:psychology*; D006801:Humans; D007175:Impulsive Behavior; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology*; D019966:Substance-Related Disorders / Q000523:psychology* / Q000628:therapy; D014728:Veterans / Q000523:psychology*
keywords: Aggression; Alcohol; Impulsivity; PTSD; Substance use disorder; Violence