A PROSPECTIVE EXAMINATION OF POSTTRAUMATIC STRESS AND ALCOHOL USE DISORDERS AMONG RETURNING VETERANS

Abstract

The traumatic effects of combat on psychological functioning have long been recognized. Operation Iraqi Freedom and Operation Enduring Freedom have amplified the need for a better understanding of the association between posttraumatic stress disorder (PTSD) and alcohol use disorders (AUD). We prospectively examined PTSD and AUD symptoms and investigated relations between combat exposure (CE) and relationship status (RS) on these outcomes. We hypothesized that CE would have a main effect on both PTSD and AUD symptoms while RS would have a main effect on AUD symptoms but not PTSD. We also examined CE X RS interactions as well as hypothesized reciprocal prospective PTSD and AUD associations. Participants (N=238, 92% men) were National Guard and Reserve Soldiers returning from deployment, recruited as part of a larger study. Twelve month data were available for 66.8% of the initial sample with no evidence of differential attrition according to baseline AUD, PTSD or CE. We examined both PTSD and AUD symptoms for months one, six and 12 post-deployment, derived from initial and follow-up clinical interviews. Assessments consisted of the Clinician Administered PTSD Scale (CAPS) and the Longitudinal Interval Follow-up Evaluation (LIFE). We conducted separate (RS X CE X Time) mixed-design ANOVAs on our primary measures of interest (PTSD & AUD). RS was coded as single/divorced vs. married/cohabitating and CE was categorized according to “minimal”, “moderate” and “severe” levels. CE was significantly associated with PTSD but no other main or interaction effects emerged. To examine hypothesized reciprocal associations between PTSD and AUD we conducted cross-lagged panel path models with RS, CE and the RS X CE interaction as manifest exogenous variables. In separate models we examined alcohol abuse or dependence vs. dependence alone. CE consistently predicted Time 1 PTSD symptoms and RS predicted Time 1 alcohol dependence, but in contrast to our hypotheses no other main or interaction effects were observed including anticipated reciprocal relations between PTSD and AUD. In large part, this is due to strong (i.e., > .8) autoregressive effects across the three time points. Findings support hypothesized effects of CE on PTSD symptoms but the lack of observed hypothesized associations elsewhere suggests the need for longer measurement intervals in prospective research, as well as larger and more diverse samples. Supported by Department of Defense grant (W81XWH-06-1-0573).