Alcohol Use and Craving among Veterans with Mental Health Disorders and Mild Traumatic Brain Injury

By Herrold, Amy A.; Jordan, Neil et al. | Journal of Rehabilitation Research & Development, September 2014 | Go to article overview

Alcohol Use and Craving among Veterans with Mental Health Disorders and Mild Traumatic Brain Injury


Herrold, Amy A., Jordan, Neil, High, Walter M., Babcock-Parziale, Judi, Chambers, R. Andrew, Smith, Bridget, Evans, Charlesnika T., Li, Xue, Mallinson, Trudy, Jenkins, Shonna, Pape, Theresa Louise-Bender, Journal of Rehabilitation Research & Development


INTRODUCTION

Hazardous alcohol use, indicative of alcohol use disorder (AUD), is endemic among U.S. Veterans deployed to Iraq and Afghanistan [1-3]. AUD rates are even higher for Veterans returning from deployment with co-occurring mental health disorders (MHDs) and mild traumatic brain injury (mTBI) [4-6]. In fact, occurrence of MHDs or mTBI is a known risk factor for AUD [7-8]. Increased risk for AUD is clinically important because alcohol misuse detracts from therapeutic efforts targeting MHDs and mTBI-related impairments [9-10].

Intuitively, it is plausible that the co-occurrence of MHDs and mTBI contributes to increased vulnerability to AUD due to craving. The interrelationship of these co-occurring conditions with alcohol craving has received little research attention. Alcohol craving is a well-established risk factor for AUD relapse [11-12]. There is some evidence suggesting that alcohol craving is more severe among individuals with MHDs (e.g., depression, anxiety, and posttraumatic stress disorder [PTSD]) [13-15], but no studies to date have examined alcohol craving among Veterans with co-occurring MHDs, mTBI, and AUD. Because the co-occurrence of MHDs, mTBI, and AUD is common among U.S. Veterans deployed to Iraq and Afghanistan and evidence suggests that alcohol craving may be exacerbated by these conditions, we sought to describe alcohol craving among a group of Veterans exposed to traumatic events during deployment who reported active MHD or mTBI symptoms at the time of enrollment into a larger parent study. The purpose of this article is to report our descriptive findings, which will enable future research that addresses the need to elucidate the relationships among MHDs, mTBI, AUD, and alcohol craving.

Prevalence of and Risk for Co-occurring Mild Traumatic Brain Injury, Mental Health Disorders, and Alcohol Use Disorder

Mild TBI is often referred to as the signature injury of the conflicts in Iraq and Afghanistan, in part, because mTBI prevalence rates, ranging from 16 to 20 percent, are higher than rates reported for other conditions among these same Veterans [16-17]. Among Veterans with mTBI, depression and anxiety disorders such as PTSD are the most commonly co-occurring MHDs. Prevalence rates for PTSD and depression, for example, have been reported to be as high as 44 and 23 percent, respectively [18-19].

Evidence indicates that people with mTBI are at increased risk for developing postinjury AUD [7] and that Veterans with PTSD or depression have 3.0 to 4.5 times greater risk of being diagnosed with AUD [2]. Furthermore, Veterans with mTBI and AUD have a higher incidence of mood disorders (60%) relative to Veterans with TBI but no AUD (37%) [10].

Relationship Between Alcohol Use Disorder and Alcohol Craving

Alcohol craving, the urge to drink, is associated with an increased risk of relapse among people with AUD [11-12,20-21]. More severe [13] and more frequent [14] alcohol craving is reported by people with PTSD and co-occurring AUD relative to people with AUD alone. Increased frequency and severity of alcohol craving are also linked with the incidence of depression [15,22] and more severe depressive symptoms [23].

Collectively, the evidence suggests that people with co-occurring mTBI, MHDs, and AUD conditions may be more susceptible to AUD relapse. Little is known, however, about the frequency and severity of alcohol craving among people with these co-occurring conditions. Since alcohol misuse detracts from rehabilitation efforts, a better understanding of the frequency and severity of alcohol craving among Veterans with co-occurring mTBI, MHDs, and AUD will inform clinical rehabilitation efforts.

To address the need for a better understanding of alcohol craving among Veterans deployed to Iraq and/or Afghanistan who present with co-occurring mTBI, MHDs, and AUD, we examined self-reported alcohol craving in a sample of Veterans with active MHD symptoms with and without mTBI symptoms. …

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