Abstract
Purpose
This systematic review aimed to assess (1) the level of comorbidity of post-traumatic stress disorder (PTSD) and alcohol misuse reported in research studies since 2007 and (2) any associations found between specific PTSD symptom clusters and alcohol misuse.
Methods
A literature search was carried out to capture any papers published from 2007 to the end of July 2012. Six hundred and twenty abstracts were identified and reviewed, and 42 papers were included in the final review after applying inclusion and exclusion criteria.
Results
The prevalence of comorbid alcohol misuse in those with PTSD ranged from 9.8 to 61.3 %. The prevalence of comorbid PTSD in those with alcohol misuse ranged from 2.0 to 63.0 %, and the majority of prevalence rates were over 10.0 %. Almost all of the odds ratios representing the strength of association between the conditions across a variety of populations were significant, and those ranged from 1.1 to 4.87. Of the different PTSD symptom clusters, this review found most evidence for associations between alcohol misuse and both avoidance/numbing symptoms and hyperarousal symptoms.
Conclusions
Given that comorbidity appears to be common, the evidence from this systematic review supports the use of routine screening for comorbidity in populations who are known to have PTSD or alcohol misuse.
Similar content being viewed by others
References
McManus S, Meltzer H, Brugha T, Bebbington P, Jenkins R (eds) (2009) Adult psychiatric morbidity in England, 2007: results of a household survey. The NHS Information Centre for Health and Social Care, Leeds
Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC (1997) Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry 54:313–321. doi:10.1001/archpsyc.1997.01830160031005
Forman-Hoffman VL, Carney CP, Sampson TR, Peloso PM, Woolson RF, Black DW, Doebbeling BN (2005) Mental health comorbidity patterns and impact on quality of life among veterans serving during the first Gulf War. Qual Life Res 14:2303–2314. doi:10.1007/s11136-005-6540-2
Watson HJ, Swan A, Nathan PR (2011) Psychiatric diagnosis and quality of life: the additional burden of psychiatric comorbidity. Compr Psychiatry 52:265–272. doi:10.1016/j.comppsych.2010.07.006
McFarlane AC (1998) Epidemiological evidence about the relationship between PTSD and alcohol abuse: the nature of the association. Addict Behav 23:813–825. doi:10.1016/S0306-4603(98)00098-7
McCarthy E, Petrakis I (2010) Epidemiology and management of alcohol dependence in individuals with post-traumatic stress disorder. CNS Drugs 24:997–1007. doi:10.2165/11539710-000000000-00000
Brewin CR, Andrews B, Hejdenberg J (2012) Recognition and treatment of psychological disorders during military service in the UK armed forces: a study of war pensioners. Soc Psychiatry Psychiatr Epidemiol 47:1891–1897. doi:10.1007/s00127-012-0505-x
Scott JC, Pietrzak RH, Mattocks K, Southwick SM, Brandt C, Haskell S (2013) Gender differences in the correlates of hazardous drinking among Iraq and Afghanistan veterans. Drug Alcohol Depend 127:15–22. doi:10.1016/j.drugalcdep.2012.06.003
Scherrer JF, Xian H, Lyons MJ, Goldberg J, Eisen SA, True WR, Tsuang M, Bucholz KK, Koenen KC (2008) Posttraumatic stress disorder; combat exposure; and nicotine dependence, alcohol dependence, and major depression in male twins. Compr Psychiatry 49:297–304. doi:10.1016/j.comppsych.2007.11.001
Sullivan TP, Holt LJ (2008) PTSD symptom clusters are differentially related to substance use among community women exposed to intimate partner violence. J Trauma Stress 21:173–180. doi:10.1002/jts.20318
StataCorp (2009) Stata statistical software: release 11. Stata Corporation, College Station
Ajetunmobi O (2002) Making sense of critical appraisal. Arnold, London
Blume AW, Resor MR, Villanueva MR, Braddy LD (2009) Alcohol use and comorbid anxiety, traumatic stress, and hopelessness among Hispanics. Addict Behav 34:709–713. doi:10.1016/j.addbeh.2009.03.039
Chiu S, Niles JK, Webber MP, Zeig-Owens R, Gustave J, Lee R, Rizzotto L, Kelly KJ, Cohen HW, Prezant DJ (2011) Evaluating risk factors and possible mediation effects in posttraumatic depression and posttraumatic stress disorder comorbidity. Public Health Rep 126:201–209
Coffey SF, Schumacher JA, Brady KT, Cotton BD (2007) Changes in PTSD symptomatology during acute and protracted alcohol and cocaine abstinence. Drug Alcohol Depend 87:241–248. doi:10.1016/j.drugalcdep.2006.08.025
Drapkin ML, Yusko D, Yasinski C, Oslin D, Hembree EA, Foa EB (2011) Baseline functioning among individuals with posttraumatic stress disorder and alcohol dependence. J Subst Abuse Treat 41:186–192. doi:10.1016/j.jsat.2011.02.012
Durai UN, Chopra MP, Coakley E, Llorente MD, Kirchner JE, Cook JM, Levkoff SE (2011) Exposure to trauma and posttraumatic stress disorder symptoms in older veterans attending primary care: comorbid conditions and self-rated health status. J Am Geriatr Soc 59:1087–1092. doi:10.1111/j.1532-5415.2011.03407.x
Farris SG, Epstein EE, McCrady BS, Hunter-Reel D (2012) Do co-morbid anxiety disorders predict drinking outcomes in women with alcohol use disorders? Alcohol Alcohol 47:143–148. doi:10.1093/alcalc/agr155
Gahm GA, Lucenko BA (2008) Screening soldiers in outpatient care for mental health concerns. Mil Med 173:17–24
Hien DA, Campbell ANC, Ruglass LM, Hu MC, Killeen T (2010) The role of alcohol misuse in PTSD outcomes for women in community treatment: a secondary analysis of NIDA’s Women and Trauma Study. Drug Alcohol Depend 111:114–119. doi:10.1016/j.drugalcdep.2010.04.011
Hofmann SG, Richey JA, Kashdan TB, McKnight PE (2009) Anxiety disorders moderate the association between externalizing problems and substance use disorders: data from the National Comorbidity Survey-Revised. J Anxiety Disord 23:529–534. doi:10.1016/j.janxdis.2008.10.011
Hruska B, Fallon W, Spoonster E, Sledjeski EM, Delahanty DL (2011) Alcohol use disorder history moderates the relationship between avoidance coping and posttraumatic stress symptoms. Psychol Addict Behav 25:405–414. doi:10.1037/a0022439
Jakupcak M, Tull MT, McDermott MJ, Kaysen D (2010) PTSD symptom clusters in relationship to alcohol misuse among Iraq and Afghanistan war veterans seeking post-deployment VA health care. Addict Behav 35:840–843. doi:10.1016/j.addbeh.2010.03.023
Johnson SD, Cottler LB, Callaghan O’Leary C, Ben Abdallah A (2010) The association of trauma and PTSD with the substance use profiles of alcohol- and cocaine-dependent out-of-treatment women. Am J Addict 19:490–495. doi:10.1111/j.1521-0391.2010.00075.x
Khoury L, Tang YL, Bradley B, Cubells JF, Ressler KJ (2010) Substance use, childhood traumatic experience, and posttraumatic stress disorder in an urban civilian population. Depress Anxiety 27:1077–1086. doi:10.1002/da.20751
Liebschutz J, Saltz R, Brower V, Keane TM, Lloyd-Travaglini C, Averbuch T, Samet JH (2007) PTSD in urban primary care: high prevalence and low physician recognition. J Gen Intern Med 22:719–726. doi:10.1007/s11606-007-0161-0
Maguen S, Cohen B, Cohen G, Madden E, Bertenthal D, Seal K (2012) Gender differences in health service utilization among Iraq and Afghanistan veterans with posttraumatic stress disorder. J Womens Health (Larchmt) 21:666–673. doi:10.1089/jwh.2011.3113
McDevitt-Murphy ME, Murphy JG, Monahan CJ, Flood AM, Weathers FW (2010) Unique patterns of substance misuse associated with PTSD, depression, and social phobia. J Dual Diagn 6:94–110. doi:10.1080/15504261003701445
McDevitt-Murphy ME, Williams JL, Bracken KL, Fields JA, Monahan CJ, Murphy JG (2010) PTSD symptoms, hazardous drinking, and health functioning among U.S. OEF and OIF veterans presenting to primary care. J Trauma Stress 23:108–111. doi:10.1002/jts.20482
Miller MW, Fogler JM, Wolf EJ, Kaloupek DG, Keane TM (2008) The internalizing and externalizing structure of psychiatric comorbidity in combat veterans. J Trauma Stress 21:58–65. doi:10.1002/jts.20303
Norman SB, Inaba RK, Smith TL, Brown SA (2008) Development of the PTSD-Alcohol Expectancy Questionnaire. Addict Behav 33:841–847. doi:10.1016/j.addbeh.2008.01.003
Pfefferbaum B, North CS, Pfefferbaum RL, Christiansen EH, Schorr JK, Vincent RD, Boudreaux AS (2008) Change in smoking and drinking after September 11, 2001, in a national sample of ever smokers and ever drinkers. J Nerv Ment Dis 196:113–121. doi:10.1097/NMD.0b013e318162aaae
Pietrzak RH, Goldstein RB, Southwick SM, Grant BF (2011) Prevalence and axis I comorbidity of full and partial posttraumatic stress disorder in the United States: results from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. J Anxiety Disord 25:456–465. doi:10.1016/j.janxdis.2010.11.010
Pietrzak RH, Schechter CB, Bromet EJ, Katz CL, Reissman DB, Ozbay F, Sharma V, Crane M, Harrison D, Herbert R, Levin SM, Luft BJ, Moline JM, Stellman JM, Udasin IG, Landrigan PJ, Southwick SM (2012) The burden of full and subsyndromal posttraumatic stress disorder among police involved in the World Trade Center rescue and recovery effort. J Psychiatr Res 46:835–842. doi:10.1016/j.jpsychires.2012.03.011
Read JP, Colder CR, Merrill JE, Ouimette P, White J, Swartout A (2012) Trauma and posttraumatic stress symptoms predict alcohol and other drug consequence trajectories in the first year of college. J Consult Clin Psychol 80:426–439. doi:10.1037/a0028210
Sartor CE, McCutcheon VV, Pommer NE, Nelson EC, Grant JD, Duncan AE, Waldron M, Bucholz KK, Madden PAF, Heath AC (2011) Common genetic and environmental contributions to post-traumatic stress disorder and alcohol dependence in young women. Psychol Med 41:1497–1505. doi:10.1017/S0033291710002072
Seal KH, Cohen G, Waldrop A, Cohen BE, Maguen S, Ren L (2011) Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001–2010: implications for screening, diagnosis and treatment. Drug Alcohol Depend 116:93–101. doi:10.1016/j.drugalcdep.2010.11.027
Taft CT, Kaloupek DG, Schumm JA, Marshall AD, Panuzio J, King DW, Keane TM (2007) Posttraumatic stress disorder symptoms, physiological reactivity, alcohol problems, and aggression among military veterans. J Abnorm Psychol 116:498–507. doi:10.1037/0021-843X.116.3.498
Rona RJ, Jones M, Fear NT, Hull L, Hotopf M, Wessely S (2010) Alcohol misuse and functional impairment in the UK armed forces: a population-based study. Drug Alcohol Depend 108:37–42. doi:10.1016/j.drugalcdep.2009.11.014
Arbanas G (2010) Patients with combat-related and war-related posttraumatic stress disorder 10 years after diagnosis. Croat Med J 51:209–214. doi:10.3325/cmj.2010.51.209
Caspi Y, Saroff O, Suleimani N, Klein E (2008) Trauma exposure and posttraumatic reactions in a community sample of Bedouin members of the Israel Defense Forces. Depress Anxiety 25:700–707. doi:10.1002/da.20449
Dom G, De Wilde B, Hulstijn W, Sabbe B (2007) Traumatic experiences and posttraumatic stress disorders: differences between treatment-seeking early- and late-onset alcoholic patients. Compr Psychiatry 48:178–185. doi:10.1016/j.comppsych.2006.08.004
Dragan M, Lis-Turlejska M (2007) Prevalence of posttraumatic stress disorder in alcohol dependent patients in Poland. Addict Behav 32:902–911. doi:10.1016/j.addbeh.2006.06.025
Driessen M, Schulte S, Luedecke C, Schaefer I, Sutmann F, Ohlmeier M, Kemper U, Koesters G, Chodzinski C, Schneider U, Broese T, Dette C, Havemann-Reinicke U, TRAUMAB-Study Group (2008) Trauma and PTSD in patients with alcohol, drug, or dual dependence: a multi-center study. Alcohol Clin Exp Res 32:481–488. doi:10.1111/j.1530-0277.2007.00591.x
Leray E, Camara A, Drapier D, Riou F, Bougeant N, Pelissolo A, Lloyd KR, Bellamy V, Roelandt JL, Millet B (2011) Prevalence, characteristics and comorbidities of anxiety disorders in France: results from the “Mental Health in General Population” Survey (MHGP). Eur Psychiatry 26:339–345. doi:10.1016/j.eurpsy.2009.12.001
Park S, Cho MJ, Hong JP, Sohn JH, Lee HW, Park JI (2012) Comparison of treated and untreated alcohol dependence in a nationwide sample of Korean adults. Addict Res Theory 20:125–132. doi:10.3109/16066359.2011.580066
Richardson JD, Elhai JD, Sarreen J (2011) Predictors of treatment response in Canadian combat and peacekeeping veterans with military-related posttraumatic stress disorder. J Nerv Ment Dis 199:639–645. doi:10.1097/NMD.0b013e318229ce7b
Rodgers B, Parslow R, Degenhardt L (2007) Affective disorders, anxiety disorders and psychological distress in non-drinkers. J Affect Disord 99:165–172. doi:10.1016/j.jad.2006.09.006
Wang H, Jin H, Nunnink SE, Guo W, Sun J, Shi J, Zhao B, Bi Y, Yan T, Yu H, Wang G, Gao Z, Zhao H, Ou Y, Song Z, Chen F, Lohr JB, Baker DG (2011) Identification of post traumatic stress disorder and risk factors in military first responders 6 months after Wen Chuan earthquake in China. J Affect Disord 130:213–219. doi:10.1016/j.jad.2010.09.026
Zalihic A, Skobic H, Pejanovic-Skobic N (2008) Case-control study: posttraumatic stress disorder and habits of war veterans. Psychiatr Danub 20:75–79
Aaron LA, Bradley LA, Alarcón GS, Alexander RW, Triana-Alexander M, Martin MY, Alberts KR (1996) Psychiatric diagnoses in patients with fibromyalgia are related to health care-seeking behavior rather than to illness. Arthritis Rheum 39:436–445. doi:10.1002/art.1780390311
Koloski NA, Talley NJ, Boyce PM (2001) Predictors of health care seeking for irritable bowel syndrome and nonulcer dyspepsia: a critical review of the literature on symptom and psychosocial factors. Am J Gastroenterol 96:1340–1349. doi:10.1111/j.1572-0241.2001.03789.x
Breslau N, Davis GC, Schultz LR (2003) Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma. Arch Gen Psychiatry 60:289–294. doi:10.1001/archpsyc.60.3.289
National Institute for Health and Clinical Excellence (2005) Post-traumatic stress disorder (PTSD): the management of PTSD in adults and children in primary and secondary care (Clinical Guideline CG26)
National Institute for Health and Clinical Excellence (2011) Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence [National Clinical Practice Guideline 115 (full guideline)]
Department of Veterans Affairs (2009) Report of consensus conference: practice recommendations for treatment of veterans with comorbid substance use disorder and PTSD. http://www.ptsd.va.gov/professional/pages/handouts-pdf/SUD_PTSD_Practice_Recommend.pdf. Accessed 9 March 2013
Schindel-Allon I, Aderka IM, Shahar G, Stein M, Gilboa-Schechtman E (2010) Longitudinal associations between post-traumatic distress and depressive symptoms following a traumatic event: a test of three models. Psychol Med 40:1669–1678. doi:10.1017/S0033291709992248
Goodwin L, Jones M, Rona RJ, Sundin J, Wessely S, Fear NT (2012) Prevalence of delayed-onset posttraumatic stress disorder in military personnel: is there evidence for this disorder?: results of a prospective UK cohort study. J Nerv Ment Dis 200:429–437. doi:10.1097/NMD.0b013e31825322fe
Rytwinski NK, Scur MD, Feeny NC, Youngstrom EA (2013) The co-occurrence of major depressive disorder among individuals with posttraumatic stress disorder: a meta-analysis. J Trauma Stress 26:299–309. doi:10.1002/jts.21814
Boschloo L, van den Brink W, Penninx BWJH, Wall MM, Hasin DS (2012) Alcohol-use disorder severity predicts first-incidence of depressive disorders. Psychol Med 42:695–703. doi:10.1017/S0033291711001681
Acknowledgments
This research received no specific grant from any funding agency, commercial or not-for-profit sectors. Dr Laura Goodwin receives salary support from the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London.
Conflict of interest
Professor Simon Wessely is Honorary Civilian Consultant Advisor in Psychiatry to the British Army and a Trustee of Combat Stress, a UK charity that provides services and support for veterans with mental health problems.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Debell, F., Fear, N.T., Head, M. et al. A systematic review of the comorbidity between PTSD and alcohol misuse. Soc Psychiatry Psychiatr Epidemiol 49, 1401–1425 (2014). https://doi.org/10.1007/s00127-014-0855-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-014-0855-7