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
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.
SUBJECTS AND METHODS
The study was conducted at the Department of Psychiatry ofthe University Clinical Center in Tuzla and among soldiers - war veterans in the barracks in Tuzla during 2004 and 2005. The inclusion criteria were age between 30 and 50 years and participation in combat during the war in Bosnia and Herzegovina from 1992 to 1995. The exclusion criterion for all subjects was the use of alcohol before the war, while for the soldiers - war veterans it was non-psychiatric treatment prior to the research period. The research included 130 war veterans diagnosed with PTSD at the Department of Psychiatry in the University Clinical Center in Tuzla and 120 soldiers - war veterans of the Army of the Federation of Bosnia-Herzegovina from the barracks in Tuzla. The soldiers were granted consent to participate in the research by the Ministry of Defense of the Federation of Bosnia and Herzegovina. A total of 250 war veterans were included in the research, out of which a stratified sample of 200 war veterans was formed. Data on hospital treated war veterans were obtained from the hospital admission protocol and anamnesis at the Department of Psychiatry in Tuzla. Of the total 1166 patients treated from January 2002 to January 2003, 130 (11.2%) were war veterans with PTSD. All 130 war veterans whose addresses were found in the hospital protocol were invited by letter to participate in the research. 1 13 out of 130 responded to the invitation to participate. Of the 1 13 war veterans who responded, 6 did not satisfy the inclusion criteria and during the research procedure 7 out of 107 war veterans gave up participating in further research. …