Dynamic changes in marines’ reports of PTSD symptoms and problem alcohol use across the deployment cycle.

Abstract

Posttraumatic stress disorder (PTSD) and alcohol misuse are commonly co-occurring problems in active-duty service members (SMs) and veterans. Unfortunately, relatively little is known about the temporal associations between these problems in the acute period following exposure to combat stressors. Discerning the temporal associations between these problems across the deployment cycle could inform prevention and treatment efforts. In this study, we examined the association between PTSD symptom severity and problem alcohol use in a large cohort of United States Marines (n = 758) evaluated prior to deployment and approximately 1, 5, and 8 months postdeployment. Results indicate that problem alcohol use was associated with a subsequent exacerbation of PTSD symptoms between the 1st and 2nd and 2nd and 3rd postdeployment assessments. PTSD symptom severity was associated with increased problem alcohol use between the 1st and 2nd postdeployment assessments. These findings suggest that problem drinking may lead to new onset or worsening of PTSD symptoms over time and that SMs with greater PTSD symptom severity upon returning from deployment may increase alcohol use in the weeks immediately following homecoming.

Military Combat, Posttraumatic Stress Disorder, and the Course of Alcohol Use Disorders in a Cohort of Australian Vietnam War Veterans

“…This suggests that ongoing PTSD rather than combat exposure is the major risk factor for ongoing AUDs. Several explanations have been advanced for the association between PTSD and AUDs (discussed elegantly by Simpson et al, 2014, andBerke et al, 2018). These encompass a "mutual maintenance" model, whereby PTSD symptoms lead to increased alcohol use, which, in turn, exacerbates or maintains PTSD symptoms; a "self-medication" model, whereby alcohol is used to ameliorate the symptoms of PTSD; and a "common factors" model, whereby risk factors for PTSD and AUDs are shared.…”

“…There is a distinct lack of follow‐up studies, with most reports presenting findings from samples of recent returnees who are often assessed with self‐administered group surveys, giving a short‐term perspective on alcohol use and PTSD. Studies of recent returnees that have commenced before and immediately following deployment (e.g., Berke et al., 2018) do not provide longer‐term information on aging veterans, particularly on cohorts from earlier service eras who did not receive focused early attention to intervention programs. The factors that increase the risks of long‐term AUDs over time (i.e., the perpetuating factors), are unclear; in addition, the role of the DSM‐III and DSM‐IV PTSD symptom clusters of intrusion, numbing and avoidance, and hyperarousal in long‐term alcohol misuse is also in question.…”

“…The findings from a study of 8 years of consecutive new treatment‐seekers ( N = 456,502) in the U.S. Veterans Affairs (VA) network (Seal et al., 2010) demonstrated that alcohol and other drug use disorders were 3–4.5 times more likely in veterans with compared to without PTSD or depression. In a cohort study of 871 U.S. Marines (Berke et al., 2018) who were assessed predeployment and at assessment points 1, 5, and 8 months after return from duty in Helmand Province, Afghanistan, PTSD severity was found to be related to significant alcohol use as assessed using the Alcohol Use Disorder Identification Test (AUDIT; K. Bush et al., 1998), and “problem alcohol use” was significantly related to increased PTSD severity.…”

A Randomized Clinical Trial to Assess the Efficacy of Online-Treatment with Trial-Based Cognitive Therapy, Mindfulness-Based Health Promotion and Positive Psychotherapy for Post-Traumatic Stress Disorder during the COVID-19 Pandemic: A Study Protocol

“…A review of the literature of 55 studies of PTSD patients found non-response rates as high as 50% and dropout rates ranging widely and depending on the nature of the study population [ 20 ]. In a meta-analysis assessing war trauma [ 21 ], dropout rates ranged from 5% to 78%, and in a recent review of data from three clinical trials of evidence-based PTSD treatments in military service members, the dropout rate was 31% [ 22 ]. These findings suggest new and innovative strategies are needed to improve treatment retention, especially in a new and complex situation such as the COVID-19 pandemic.…”

A randomized clinical trial to assess the efficacy of trial-based cognitive therapy compared to prolonged exposure for post-traumatic stress disorder: preliminary findings

“…Another meta-analysis 26 that assessed dropout rates in war trauma ranged from 5% to 78%, suggesting new and innovative strategies to improve treatment retention. More recently, Berke et al 27 reviewed data from three clinical trials of evidence-based PTSD treatment (namely CPT, present-centered therapy, and PE) in military service members and reported a 31% dropout rate. They suggested that dropout from PTSD treatment is significantly associated with treatment outcome, and that new strategies are needed to reduce dropout rates, especially in group and trauma-focused therapies.…”