The relationship between DSM‐5 PTSD symptom clusters and alcohol misuse among military veterans

Walton, John N.; Raines, Amanda M.; Cuccurullo, Lisa-Ann J.; Vidaurri, Desirae N.; Villarosa‐Hurlocker, Margo C.; Franklin, C. Laurel

doi:10.1111/ajad.12658

Cited by 39 publications

(37 citation statements)

References 41 publications

(53 reference statements)

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“…In fact, as can be seen in Table 2 and Figure 2, approximately 15.0% more participants in the alcohol and marijuana group met provisional diagnostic criteria for PTSD Criterion D (negative cognitions; two or more symptoms in the cluster) and 7.9% more participants in the alcohol and marijuana group met provisional diagnostic criteria for PTSD Criterion E (hyperarousal; two or more symptoms); further, participants in the alcohol and marijuana group evidenced 30.8% greater overall negative cognition symptom severity and 26.4% greater overall hyperarousal symptom severity compared to participants in the alcoholonly group. These results are generally consistent with extant work from separate literatures indicating strong associations between PTSD negative cognition and hyperarousal symptom and both alcohol (e.g., Jacobson et al, 2001;Lehavot et al, 2014;Walton et al, 2018) and marijuana use (e.g., Turna et al, 2017;Roitman et al, 2014). Consistent with the second hypothesis, results also indicated that use of marijuana, in addition to alcohol, did not increase odds of PTSD intrusion or avoidance symptom endorsement, nor were there significant differences between the substance use groups regarding PTSD intrusion or avoidance symptom severity.…”

Section: Discussionsupporting

confidence: 90%

“…More specifically, the current study will examine PTSD symptom profiles between individuals that are currently only using alcohol and individuals that are currently only using alcohol and marijuana (i.e., excluding individuals that are currently abstaining or currently using other substances). Given extant work examining PTSDalcohol use (Jacobson et al, 2001;Lehavot, Stappenbeck, Luterek, Kaysen, & Simpson, 2014;Walton et al, 2018) and PTSD-marijuana use in isolation (Turna, Patterson, & Ameringen, 2017;Roitman, Mechoulam, Cooper-Kazaz, & Shalev, 2014) -both denoting strong associations between both PTSD negative cognitions and hyperarousal symptom and substance use -it was hypothesized that individuals who reported using both alcohol and marijuana in the past month would be more likely to (1) endorse PTSD negative cognition and hyperarousal symptoms at a clinical level and (2) report greater severity of PTSD negative cognition and hyperarousal symptoms than individuals who only reported using alcohol in the past month. Conversely, given mixed -largely null -results in the literature (see Debell et al, 2014;Yarnell, 2015 for overviews), it was hypothesized that there would be no differences between the alcohol only and alcohol and marijuana groups on PTSD intrusion and avoidance symptoms.…”

Section: Current Studymentioning

confidence: 99%

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Alcohol and Marijuana Polysubstance Use: Comparison of PTSD Symptom Endorsement and Severity Patterns

Kearns¹,

Cloutier²,

Carey³

et al. 2019

Cannabis

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A growing body of work links posttraumatic stress disorder (PTSD) symptoms and substance use. Unfortunately, much of the literature has examined associations in isolation (e.g., alcohol only). Failure to account for simultaneous or concurrent substance use may limit conclusions that can be drawn from existing research, including the extent to which specific substances contribute differentially to PTSD symptom patterns. The current study examined differences in PTSD symptom profiles between individuals using one or both of the most commonly co-administered psychoactive substances-alcohol and marijuana. Trauma-exposed participants (N = 533; Mage = 21.15) comprised two mutually-exclusive groups: past-month alcohol-only use (n = 334) or past-month alcohol and marijuana use (n = 199). Clusterlevel and symptom-level profile analyses evaluated mean differences and shape (parallelism) of PTSD symptom severity profiles between the groups. Follow-up analyses examined symptom-specific difference in PTSD symptom endorsement and severity. Overall, individuals using marijuana and alcohol evidenced greater PTSD negative cognition (30.8% greater) and hyperarousal (26.4% greater) symptom severity. Alcohol and marijuana users were more likely to endorse, and report greater severity of, mood-related PTSD negative cognition symptoms (e.g., anhedonia, negative affect) and externalizing hyperarousal symptom (e.g., irritability/aggression, risky behaviors) than alcohol-only users. Findings highlight important PTSD differences between individuals that are often lumped into homogenous categories of isolated substance users. Findings provide preliminary support for an 'additive' self-medication model between PTSD and polysubstance use. Lastly, findings indicate that mood-related negative cognition symptoms and externalizing hyperarousal symptoms may be important targets for PTSD-polysubstance use intervention.

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Section: Discussionsupporting

confidence: 90%

Section: Current Studymentioning

confidence: 99%

Alcohol and Marijuana Polysubstance Use: Comparison of PTSD Symptom Endorsement and Severity Patterns

Kearns¹,

Cloutier²,

Carey³

et al. 2019

Cannabis

View full text Add to dashboard Cite

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“…The association found between PTSD and AUD severity is in line with previous studies [38][39][40][41]. The association between a more severe AUD and PTSD may be due to the amnestic, anxiolytic, and sedative properties of alcohol that may help these patients to cope with or avoid the intrusive PTSD symptoms (self-medication hypothesis) and is also supported by the fact that PTSD is more frequently present prior to an addictive disorder rather than the opposite [42].…”

Section: Discussion/conclusionsupporting

confidence: 89%

“…The association between a more severe AUD and PTSD may be due to the amnestic, anxiolytic, and sedative properties of alcohol that may help these patients to cope with or avoid the intrusive PTSD symptoms (self-medication hypothesis) and is also supported by the fact that PTSD is more frequently present prior to an addictive disorder rather than the opposite [42]. Prior studies conducted on military veterans also showed that AUD severity was correlated with increased PTSD severity and more severe psychopathology, including higher prevalence of suicide attempts [39][40][41]. In our study, PTSD was also a significant predictor of TUD, but only for "very high" tobacco dependence, and not for "low to very high" dependence.…”

Section: Discussion/conclusionmentioning

confidence: 97%

Posttraumatic Stress Disorder Is a Risk Factor for Multiple Addictions in Police Officers Hospitalized for Alcohol

Brunault

Lebigre

Idbrik³

et al. 2019

Eur Addict Res

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Background: In police officers, posttraumatic stress disorder (PTSD) is associated with alcohol use disorder (AUD), but we lack data on the association between PTSD and other substance-related and addictive disorders. Objectives: We assessed whether PTSD could be a risk factor for different substance-related and addictive disorders in police officers, including alcohol, tobacco, cannabis, and gambling. Method: This cross-sectional study included all police officers admitted consecutively for alcohol to an inpatient ward dedicated to police officers (Le Courbat rehabilitation center, France; n= 133). Each patient completed self-administered questionnaires that assessed lifetime exposure to potentially traumatic events (Life Event Checklist for DSM-5), PTSD severity and diagnosis (PTSD Checklist for DSM-5), AUD severity (Alcohol Use Disorder Identification Test [AUDIT]), tobacco dependence (Fagerström test for Nicotine Dependence), cannabis dependence (Cannabis Abuse Screening test), and gambling disorder (Canadian Problem Gambling Index). Results: Mean AUDIT score was 23.7 ± 8.0; 66.2% had an AUDIT score ≥20. Our sample comprised a high prevalence for PTSD (38.3%) and for substance-related and addictive disorders: tobacco dependence (68.4%), cannabis dependence (3.8%), and pathological gambling (3%). Patients with PTSD experienced higher lifetime exposure to traumatic experiences: physical assault, severe human suffering, sudden accidental death of another person, and other types of stressful events/experiences. In multiple linear regressions adjusted for age, sex, and marital status, PTSD was a significant predictor of the severity of AUD and tobacco use disorder, but not of the severity of cannabis use disorder nor gambling disorder. Conclusions: PTSD is common in police officers hospitalized for alcohol and associated with a higher severity of some addictive disorders (alcohol/tobacco). PTSD and its comorbid addictive disorders should be systematically screened and treated in this population.

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“…The research literature overwhelmingly supports a strong link between PTSD and substance use disorders (Bohnert et al, ; Brady et al, ; Debell et al, ; Walton et al, ). The most well‐supported theory, the self‐medication hypothesis, posits that substances are used as maladaptive coping strategies in response to PTSD symptoms.…”

Section: Introductionmentioning

confidence: 99%

Interactive effects of PTSD and substance use on suicidal ideation and behavior in military personnel: Increased risk from marijuana use

et al. 2019

Self Cite

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Background: The current study examines the unique and interactive effects of posttraumatic stress disorder (PTSD) symptoms and days using alcohol, opioids, and marijuana on PTSD symptoms, suicidal ideation, and suicidal behavior up to 1 year, later in a high-risk sample of military personnel not active in mental health treatment. Methods: Current and former military personnel at risk for suicide (N = 545; M age = 31.91 years, standard deviation = 7.27; 88.2% male) completed self-report measures of PTSD symptoms, past 30 days heavy alcohol use, opioid use, marijuana use, and current suicidal ideation via telephone at baseline and 1, 3, 6, and 12 months later. PTSD symptoms and the substance use variables (and relevant covariates) were entered as predictors of changes in PTSD symptoms, the likelihood of suicidal ideation, suicidal ideation severity, and the likelihood of suicidal behavior during the 11-month follow-up period. Results: PTSD symptoms predicted PTSD symptoms 1 month later. PTSD symptoms and marijuana use predicted the likelihood of suicidal ideation 1 month later and suicidal behavior during the 11-month follow-up period. The interaction between PTSD symptoms and marijuana use significantly predicted increased PTSD symptoms over time and suicidal behavior. At high, but not low levels of PTSD symptoms, more days using marijuana predicted increased PTSD symptoms over time and the likelihood of suicidal behavior. Conclusions: Results suggest marijuana, especially for military personnel experiencing elevated PTSD symptoms may negatively impact suicidal thoughts and behavior. These results are relevant to suggestions that medical marijuana could be used in treating or augmenting treatment for PTSD. K E Y W O R D S alcohol, cannabis, opioids, posttraumatic stress disorder, suicide

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The relationship between DSM‐5 PTSD symptom clusters and alcohol misuse among military veterans

Cited by 39 publications

References 41 publications

Alcohol and Marijuana Polysubstance Use: Comparison of PTSD Symptom Endorsement and Severity Patterns

Alcohol and Marijuana Polysubstance Use: Comparison of PTSD Symptom Endorsement and Severity Patterns

Posttraumatic Stress Disorder Is a Risk Factor for Multiple Addictions in Police Officers Hospitalized for Alcohol

Interactive effects of PTSD and substance use on suicidal ideation and behavior in military personnel: Increased risk from marijuana use

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