Posttraumatic stress disorder (PTSD) and unhealthy alcohol use are commonly associated conditions. It is unknown whether specific symptoms of PTSD are associated with subsequent initiation of unhealthy alcohol use.
Data from the first 3 enrollment panels (n = 151,567) of the longitudinal Millennium Cohort Study of military personnel were analyzed (2001–2012). Complementary log-log models were fit to estimate whether specific PTSD symptoms and symptom clusters were associated with subsequent initiation of 2 domains of unhealthy alcohol use: risky and problem drinking (experience of 1 or more alcohol-related consequences). Models were adjusted for other PTSD symptoms and demographic, service, and health-related characteristics.
Eligible study populations included those without risky (n = 31,026) and problem drinking (n = 67,087) at baseline. In adjusted analyses, only 1 PTSD symptom—irritability/anger—was associated with subsequent increased initiation of risky drinking (relative risk [RR] 1.05, 95% confidence interval [CI] 1.00–1.09) at least 3 years later. Two symptom clusters (dysphoric arousal [RR 1.17, 95% CI 1.11–1.23] and emotional numbing [RR 1.30, 95% CI 1.22–1.40]) and 5 symptoms (restricted affect [RR 1.13, 95% CI 1.08–1.19], sense of foreshortened future [RR 1.12, 95% CI 1.06–1.18], exaggerated startle response [RR 1.07, 95% CI 1.01–1.13], sleep disturbance [RR 1.11, 95% CI 1.07–1.15], and irritability/anger [RR 1.12, 95% CI 1.07–1.17]) were associated with subsequent initiation of problem drinking.
Findings suggest that specific PTSD symptoms and symptom clusters are associated with subsequent initiation of unhealthy alcohol use.
Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA (KMB, ADS, AJL, CCM, EJB); Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD (RFA, ACR, IGJ); Department of Epidemiology, University of Washington School of Public Health, Seattle, WA (AJL, EJB); Department of Health Services, University of Washington School of Public Health, Seattle, WA (KMB, CCM, ECW); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA (KMB, AJL, CCM, ECW); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (AVP, JBB); Military Population Health Directorate, Naval Health Research Center, San Diego, CA (RPR); Department of Biostatistics, University of Washington School of Public Health, Seattle, WA (AVP); Department of Psychology, University of Washington, Seattle, WA (JBB); Department of Kinesiology, College of Education, Health and Human Services, California State University, San Marcos (RFA).
Send correspondence to Kara M. Bensley, PhD, MSc, Department of Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, S-152E, Seattle, WA 98108. E-mail: email@example.com.
Received 20 October, 2017
Accepted 18 April, 2018
Disclaimer: I am an employee of the US Government. This work was prepared as part of my official duties. Report No. 17-671 supported by the Military Operational Medicine Research Program of the US Army Medical Research and Materiel Command and the US Navy Bureau of Medicine and Surgery under work unit no. 60002. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of the Army, Department of the Air Force, Department of Veterans Affairs, Department of Defense, or the US Government. Approved for public release; distribution unlimited. Human subjects participated in this study after giving their free and informed consent. This research has been conducted in compliance with all applicable federal regulations governing the protection of human subjects in research (Protocol NHRC.2000.0007).
Funding: The Millennium Cohort Study is funded through the Military Operational Medicine Research Program of the US Army Medical Research and Materiel Command, Fort Detrick, MD, and the US Navy Bureau of Medicine and Surgery under work unit no. 60002. This work was supported in part by Merit Review from the US Department of Veterans Affairs (VA) Clinical Sciences Research and Development Service (award ZDA1-04-W10). Dr Williams is supported by a Career Development Award from VA Health Services Research and Development (CDA 12-276). Dr. Littman is supported by the Rehabilitation Research and Development Services Career Development Award (award 6892).
The authors declare no conflicts of interest.
Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.journaladdictionmedicine.com).