Alcohol Use Disorder and Posttraumatic Stress Disorder: An Introduction.

Abstract

Alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) are two of the most common, chronic and debilitating mental health disorders in our society. Epidemiologic data indicate that lifetime rates of AUD and PTSD in the general population are 29.1% and 7.8%, respectively (Grant et al., 2015; Kessler et al., 1995). These two disorders frequently co-occur and are associated with substantial suffering and functional impairment. This paper introduces a virtual issue of Alcoholism: Clinical and Experimental Research (ACER) which is focused on the co- occurrence of AUD and PTSD. This introduction is not a comprehensive review of the topic, but rather a focused review of recent papers published in ACER that address treatments for comorbid AUD and PTSD, and discuss special populations at increased risk of developing AUD and PTSD. To begin, two systematic reviews discuss the current state of behavioral (Simpson et al., 2017) and pharmacological (Petrakis & Simpson, 2017) treatments for comorbid AUD/PTSD. The Simpson et al. (2017) article extends prior reviews of behavioral treatments for AUD/PTSD by considering whether comparison treatment conditions are matched to the experimental treatment condition on time and attention, and by reporting on alcohol and drug use outcomes separately when possible. The Petrakis and Simpson (2017) review of pharmacological treatments is specific to the comorbidity of PTSD and AUD, as compared to other substance use disorders, and it includes several more recently published randomized controlled trials that are not included in prior reviews on this topic. In the next section, two studies focus on the prevalence and correlates of AUD and PTSD in racial and ethnic minority communities. Werner and colleagues (2016) report on the increased rates of trauma exposure and PTSD among African American (AA) women as compared to European American (EA) women, and examine differences in the relationship between PTSD and AUD among AA and EA women. This study extends prior work by examining the unique contributions of specific types of trauma and PTSD on alcohol involvement in AA and EA women, and identifying racial/ethnic disparities in the prevalence and timing of first alcohol use, AUD symptoms and AUD diagnostic progression. The Emerson et al. (2017) study is the first to examine the association between AUD and PTSD in American Indian and Alaskan Natives (AIAN) as compared to non-Hispanic Whites. High rates of PTSD among AIAN women and high rates of comorbid AUD/PTSD among AIAN men, in particular, are highlighted and discussed in terms of the need for targeted screening and intervention among AIAN communities. Finally, two studies in this virtual issue focus on military personnel and veterans. The first study by Stein and colleagues (2017) reports on alcohol misuse and AUD prior to enlistment in the Army, and highlights the strong association between prior AUD and subsequent development of PTSD among newly enlisted soldiers. The second study is a laboratory study (Ralevski et al., 2016) among military veterans with AUD and PTSD. It is among the first studies to examine the effects of trauma cues and stress (non-trauma) cues on alcohol craving, mood, physiological and neuroendocrine responses, and demonstrates the powerful effects of trauma cues on alcohol craving and consumption. Together, the six papers included in this virtual issue raise important considerations for future research and may help to inform best practices in the treatment of comorbid AUD and PTSD.