Intensity of Posttraumatic Stress Disorder Symptoms in Relation to Alcohol Use in War Veterans - Experiences from Bosnia-Herzegovina
Sakusic, Avdo, Zoricic, Zoran, Avdibegovic, Esmina, Pavlovic, Slobodan, Gaspar, Vladimir, Ilic, Spomenko, Torre, Robert, Alcoholism
Summary -The aim of this study was to determine the connection between alcohol consumption levels and the intensity of Posttraumatic stress disorder (PTSD) symptoms, stress levels and the number of traumatic events in war veterans with clinically diagnosed PTSD and veterans without clinically diagnosed PTSD. We analyzed a group of 200 war veterans aged between 30 and 50, of whom 100 had a clinically diagnosed PTSD while 100 were without it. For our study we used the medical documentation from the Department of Psychiatry in Tuzla, Harvard trauma questionnaire - Bosnia-Herzegovina version, Trauma questionnaire: identification of traumatic experience and PTSD symptoms used for measuring the intensity of PTSD symptoms and the level of stress, Semi-structured diagnostic interview for alcohol abuse and dependence (SCID-I), and a socio-demographic questionnaire designed for this study. In the total sample of war veterans the mean age was (mean ± SD; 42.84 ± 3.94 years). A significantly higher number of war veterans with clinically diagnosed PTSD consumed alcoholic drinks (P<0.001). A significant difference in the number of traumatic events, the level of stress, intensity of symptoms of avoidance and arousal was determined among veterans with alcohol use and veterans without alcohol use (P<0.01). We found a significant correlation between alcohol consumption and stress levels, as well as alcohol consumption and the intensity of PTSD symptoms (P<0.001). The results of this study suggest that high levels of stress and higher severity of PTSD symptoms can be predictors of alcohol consumption in war veterans.
Keywords: alcohol consumption; posttraumatic stress disorder; war veterans
Posttraumatic stress disorder and disorders related to alcohol use and other psychoactive substances often appear in comorbidity. Exposure to combat is linked with a higher risk of psychiatric disorders and alcohol related disorders in veterans.1·2 The connection between PTSD and disorders related with the use of alcohol and other psychoactive substances is complex. Disorders related to alcohol use and other psychoactive substances and PTSD are especially prevalent in war veterans who experienced fierce combat. Research also points to other possible variables such as family history, individual stress response, use of alcohol and psychoactive substances prior to and after exposure to combat.3 The beginning of alcoholism and psychoactive substance dependence is correlated with the beginning of PTSD symptoms while the increase in use is parallel to the intensification of symptoms.4 Breslau, Davis and Schultz5 found that the risk for the development of nicotine, psychoactive substance and alcohol dependence is increased in individuals exposed to trauma and who developed PTSD, while a significantly lover risk of dependence was found in those who were exposed to trauma but who have not developed PTSD. They also found that exposure to trauma itself, with or without PTSD, was not a predictor for the development of dependence. Other authors report that war veterans consume alcohol more frequently because of fear and anxiety, which is a result of exposure to frequent stressful situations.6 Stewart et al.7 found a significant and strong correlation between symptoms of re-experiencing and high arousal, and alcohol use in volunteers with PTSD who worked on relief after a plane crash. Contrary to this finding, den Velde et al.8 did not find any correlation between PTSD symptoms and alcohol consumption in a study on Holocaust victims and World War ? veterans with chronic PTSD. We set the goal ofthe paper in line with the mentioned studies on the association of alcohol intake and symptoms of PTSD: examining the correlation between the level of stress, number of traumatic events, intensity of PTSD symptoms and the use of alcohol in the group of war veterans with clinically diagnosed PTSD and the group of soldiers-war veterans who were not clinically diagnosed with PTSD during the period of research. …