Academic journal article Alcohol Research

Nature and Treatment of Comorbid Alcohol Problems and Post Traumatic Stress Disorder among American Military Personnel and Veterans

Academic journal article Alcohol Research

Nature and Treatment of Comorbid Alcohol Problems and Post Traumatic Stress Disorder among American Military Personnel and Veterans

Article excerpt

Many service members and veterans seeking treatment for alcohol problems have experienced the life-threatening stress of combat, many have post- traumatic stress disorder (PTSD), and many service members and veterans seeking treatment for PTSD have alcohol or other substance problems. Sensitivity to these issues can influence how a therapist relates to the patient and also has possible implications for developing a treatment strategy (U.S. Department of Veterans Affairs [DVA] 2010). Historically, clinicians have been concerned that patients need to reduce or resolve substance abuse before PTSD treatment can be successful. But research is showing that both disorders can be treated simultaneously. Here, we assess the scope of the problem and examine treatments that can be effective for treating each disorder individually as well as in tandem.

Alcohol Problems in Active-Duty Military Personnel and Veterans

For more than 30 years the Department of Defense (DoD) has conducted recurrent surveys to determine rates of excessive alcohol use among active-duty personnel. The most recent of these (DoD 2013) revealed wide prevalence of "binge" drinking, defined as consuming 5 or more drinks for males or 4 or more drinks for females on a single occasion. An analysis of this survey by Bray and colleagues (2013) found that across the U.S. Armed Services 33 percent of personnel reported binge drinking during the 30 days preceding the survey, with considerable variation in rates across military departments (Army, 34 percent; Navy, 38 percent; Marines, 49 percent; and Air Force, 24 percent). Twenty percent of male and female active-duty personnel engaged in heavy drinking, which was defined as binge drinking at least once a week during the past 30 days (Bray et al. 2013).

Less is known about alcohol use problems among veterans. One analysis examined results from the National Survey on Drug Use and Health from 2004 through 2010 (Golub et al. 2013). The study compared veterans ages 21 to 34 with non-veteran peers matched on age and gender. The two groups were quite similar in their rates of alcohol use disorder (AUD) in the past year (15 percent); "binge" drinking (44 percent), defined as consuming 5 or more drinks on at least one occasion during the past 30 days; and heavy drinking (14 percent), defined as binge drinking on 5 or more days during the past 30 days (Golub et al. 2013).

Combat Stress and Alcohol Misuse

As of September 30, 2013, 2.6 million service members had been deployed to Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn since 2001 (DVA 2013). Due to high rates of combat and blast exposure, healthcare providers within the DOD and the U.S. Departments of Veterans Affairs (VA) are offering services to increasing numbers of veterans and active-duty personnel returning with complex mental and physical health problems (Hoge et al. 2004, 2008).

PTSD is the most common mental health diagnosis for the nearly 1 million U.S. veterans who served in Iraq and Afghanistan between October 1, 2001, and September 30, 2013, and who accessed services through the Veterans Health Administration (VHA) (DVA 2013). Nineteen percent of those who have served in Iraq and Afghanistan develop PTSD within a year of their return to the United States (Tanielian and Jaycox 2008).

Symptom clusters for PTSD as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are illustrated in the accompanying textbox (American Psychiatric Associ-ation 2013). Based on the previous DSM-4 criteria (American Psychiatric Association 1994), rates of PTSD in returning service members vary somewhat as a function of the method for collecting data, with results from screening instruments suggesting a range of 10 to 20 percent (Milliken et al. 2007; Seal et al. 2007; Sundin et al. 2010). Structured clinical interviews yield a somewhat lower but still disconcerting PTSD rate of 7 to 10 percent (Erbes et al. …

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