Examining the Temporal Relation between Posttraumatic Stress Symptoms and Heavy Drinking among Veterans Receiving Mental Health Treatment in Primary Care

Abstract

Objective

Evidence for the use of integrated treatments targeting co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorders is steadily growing. However, limited work has evaluated the temporal association between posttraumatic stress symptoms (PTSS) and alcohol misuse over the course of integrated treatment, with no studies examining such interventions in primary care (PC). The current study examined temporal changes in PTSS and heavy drinking among individuals who received a brief treatment for co-occurring PTSD and alcohol misuse in PC (Primary Care Treatment Integrating Motivation and Exposure; PC-TIME) compared with those who received PC treatment as usual (PC-TAU).

Method

A total of 63 veterans (33 randomized to PC-TIME and 30 randomized to PC-TAU) presenting to PC with co-occurring PTSD and alcohol misuse were included in this study. PTSS and heavy drinking were examined at each treatment session for those in PC-TIME. Veterans in both conditions provided reports of PTSS and heavy drinking at baseline, 8-weeks (post-treatment), 14-weeks, and 20-week follow-ups.

Results

Session-by-session findings for PC-TIME demonstrated that PTSS at Session 1 predicted a greater decrease in heavy drinking from Session 1 to Session 2. Moreover, heavy drinking at baseline predicted greater decreases in PTSS at 8-weeks for those in PC-TIME, whereas the reverse association was found for those randomized to PC-TAU. Additionally, heavy drinking at 8-weeks predicted decreased PTSS at 14-weeks for those randomized to PC-TAU.

Conclusions

The current study evidenced mixed support for the temporal precedence of PTSS and alcohol misuse. Relations between PTSS and heavy drinking appeared to be linked to treatment targets within PC-TIME and varied between treatment condition (PC-TIME versus PC-TAU). Notably, those with greater than average heavy drinking at the initiation of integrated treatment appeared to have greater reductions in PTSS at post-treatment. Results suggest a mutual maintenance model may best characterize the association between co-occurring PTSS and heavy drinking among treatment-seeking individuals.

Keywords:

• Alcohol use
• alcohol misuse
• heavy drinking
• posttraumatic stress
• veterans
• primary care intervention
• temporal associations

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Institute for Alcoholism and Alcohol Abuse (NIAAA) grant awarded to Nadine Mastroleo and Kyle Possemato [1R34AA026745] and the National Institute of Health (NIH). The NIAAA and NIH did not have involvement in the study design, data collection, analysis, interpretation, report writing, or publication submission decision. This article is the result of work supported with resources and the use of facilities at the Syracuse VA Medical Center and VA Western NY Healthcare System. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.