PTSD Avoidance Symptoms Associated With Alcohol Craving in Treatment-Seeking Veteran Population

Abstract

Objective: Posttraumatic stress disorder (PTSD) is one of the most frequently treated behavioral health conditions within the Department of Veterans Affairs and often co-occurs with alcohol or substance use. Past research suggests that alcohol and/or substance use may be used to cope with PTSD symptoms but there are inconsistent findings in how specific PTSD symptom clusters are associated with alcohol use disorder (AUD) or substance use disorder (SUD). Evaluating the relationship between PTSD symptom clusters and craving for individual drug of dependence may help explain these ambiguous results. Methods: Veterans (N = 167) recently engaged in mental health residential treatment were recruited to participate in a semi-structured diagnostic interview (Structured Clinical Interview for the DSM-5, Research Version [SCID-5-RV]) to assess for past 12-month history of AUD/SUD. Participants also completed the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) to assess PTSD symptoms. Results: Covarying for severity of alcohol use, avoidance symptoms were significantly associated with alcohol craving for veterans with alcohol as their drug of dependence. Covarying for severity of stimulant use, no PTSD symptom clusters were associated with stimulant craving for veterans with stimulants as their drug of dependence. Conclusions: Veterans with high levels of PTSD avoidance symptoms may experience alcohol craving symptoms because they believe that alcohol use will eliminate or alleviate thoughts, feelings, or external reminders of the trauma. These results have important clinical implications in the treatment of co-occurring PTSD and AUD.

Keywords:

• Posttraumatic stress disorder
• dual diagnosis
• self-medication hypothesis
• PTSD symptom clusters
• avoidance

Acknowledgements

We would like to acknowledge Margaret Kucia for her contributions to this study as a diagnostic interviewer and valued team member.

Disclosure statement

The authors report no conflicts of interest. The contents of this report do not represent the views of the Department of Veterans Affairs or the United States Government.

Notes

1 Twenty participants missed one item, six participants missed two items, two participants missed three items, one participant missed four items.

Additional information

Funding

This work was supported by the Pennsylvania Department of Health, under award number: SAP #400077079.