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Study Ties Level Of Alcohol Use To Combat-Induced PTSD And Severity Of Its Symptoms

Apr 8, 2021 1:43:49 PM

For many American soldiers, the after-effects of post traumatic stress disorder (PTSD) can linger on throughout their lifetime, but it’s worse for some than others. How much worse? That, in part, can be determined by how much alcohol they consume in order to cope, according to a recent Veterans Affairs study.

Combat Veterans More Likely To Use Alcohol As PTSD Coping Mechanism

Published in the March 2021 online issue of the Journal of Dual Diagnosis, the report confirms the long-acknowledged correlation between PTSD and increased alcohol use. But it goes a step further by concluding that alcohol use as a coping mechanism increases among veterans who engage in combat vs. those who do not.

Even these results, however, are nuanced.

see why insync healthcare solutions is highly ratedIs it possible for veterans to get PTSD without the experience of war, you may ask? Yes. It's true that PTSD is commonly associated with life-threatening combat experiences such as coming under fire, witnessing friends and fellow soldiers die, or seeing lifeless bodies on the field of battle. But there are other non-combat causes of PTSD, too.

For example, military training alone can be a brutal, PTSD-inducing event. Is it as severe as the experiences of combat situations? Not if accompanying alcohol consumption is any indication, according to the study.

Statistically speaking, the study found that men with combat experience are almost three times more likely as those without combat experience – 6.46% vs. 2.37% in a weighted analysis – to depend on alcohol consumption as a coping mechanism for PTSD.

These numbers are based on an observational study of 11,474 men – 1,386 with combat experience and 10,088 without – who reported experiencing at least one lifetime traumatic event. That is, soldiers whose trauma experiences are associated with anxiety, depression, and PTSD.

The title of the study is Drinking to Cope with Posttraumatic Stress: A Nationally Representative Study of Men with and without Military Combat Experience. Results of the study were drawn from a National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a face-to-face interview study that recruited a nationally representative sample of adults living in the U.S. between 2004-2005.

PTSD Symptoms A Bigger Factor Than Combat Experience In Determining Alcohol ABUse

The diversity of traumatic experiences, the severity of PTSD, and diagnoses of alcohol abuse or dependency were significantly tied to drinking to cope with PTSD.
However, combat experience was not strongly linked to drinking to cope when the researchers adjusted for a person's total number of PTSD symptoms.

Those symptoms might include:

  • Nightmares and sleeplessness

  • Reliving combat events (flashbacks)

  • Severe anxiety and panic attacks

  • Eating disorders

  • Avoiding situations (sights, sounds, smells) that serve as reminders of traumatic events

  • Easily startled or frightened

  • Irritability, aggression and angry outbursts

  • Emotional numbness

  • Loss of interest in activities

And finally, there's self-destructive behavior, such as drinking too much, which is at the heart of the study. 

"Our findings suggest that although men with combat experience may be more prone to use alcohol to cope with PTSD symptoms and associated distress than trauma-exposed men without military combat experience, this may be partially due to greater overall posttraumatic stress severity among men who experienced military combat," the researchers wrote.

Their interpretation, they said, is supported by the following:

  • Higher rates of PTSD among men with combat experience versus those without in in their study

  • Higher number of PTSD-symptoms among men with combat experience versus those without

  • Prior research linking PTSD severity to both combat exposure and hazardous alcohol use.

"Alcohol use may be perceived by military combat veterans as an effective, socially acceptable strategy for coping with PTSD symptoms and associated distress, perhaps due to certain personality factors, masculinity-related gender norms, or general attitudes toward alcohol common in the military," the researchers said.

Increased Alcohol Use Among Vets Makes PTSD Symptoms Worse, Not Better

Dr. Shannon Blakey, who led the study, said she was especially surprised by two findings in particular:

"First, the association between combat experience and drinking to cope was statistically significant when adjusting for the presence versus absence of a PTSD diagnosis, but not when adjusting for the number of PTSD symptoms. This suggests that drinking to cope among trauma-exposed men is more strongly associated with PTSD severity than the mere presence of PTSD."

- Shannon Blakey, postdoctoral fellow at the Mid-Atlantic Mental Illness, Research, Education and Clinical Center at the Durham VA Health Care System in North Carolina

"Second, our analyses showed that trauma-exposed men without combat experience were more likely than men with combat experience to report an alcohol-use disorder," Blakey said. "That's not entirely consistent with previous research, and highlights the complexity of associations between trauma exposure, posttraumatic experiences, drinking to cope, and drinking severity among trauma survivors."

The findings highlight the importance of assessing and targeting PTSD symptom-related alcohol use, even in the absence of alcohol abuse/dependency. But they also raise questions that might be explored in future studies.

"Is there something unique about combat trauma, relative to other types of trauma, that increases the chances men will use substances like alcohol to ease their PTSD symptoms?” asks Blakey. “Are men who experience combat more likely than men without combat experience to hold positive sociocultural beliefs about the acceptability and helpfulness of alcohol to cope with PTSD symptoms? Are men who assume combat roles at greater risk of drinking to cope due to some other pre-existing risk factor?"

Although viewed as a coping mechanism, alcohol consumption actually exacerbates many of the symptoms associated with PTSD, including increased feelings of numbness, anger, anxiety, irritability, depression, distraction, a general lack of emotion, and detachment from others, according to the U.S. Department of Veterans Affairs.

Understanding the complicated nature of PTSD continues to be one of the VA's most pressing challenges, and with good reason. Large percentages of veterans who fought in Vietnam (about 30%), the Gulf War (about 12%), and Iraq and Afghanistan (about 11-20%) have experienced PTSD sometime in their lives.

Despite working from a large sample size, Blakey's research had noticeable limitations that included the absence of women, who are more than twice as likely as men to experience PTSD - mostly because they experience a far greater percentage of sexual assaults than men. 

"Future research can hopefully compare PTSD-related alcohol-use risk factors and outcomes among combat veterans, non-combat veterans, and non-veterans," Blakey said. "It would also be important for future studies to recruit enough women veterans to examine the potential influence of sex and gender on these relationships."

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As with this VA study, there is always room to learn and improve. At InSync Healthcare Solutions, we're always tailoring our EHR software to meet the evolving needs of our clients while also developing the most advanced behavioral health technology available. 

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For a closer look at how our specialized features and functionalities can improve clinical and administrative efficiencies in your behavioral health practice, schedule a demo now with one of our experts. As a respected leader in behavioral health EHR software, we're always happy to answer your questions and explain how our technology can streamline workflows in your practice. 


Journal of Dual Diagnostics:


U.S. Department of Veterans Affairs:



Mayo Clinic:



Andy Smith

Written by Andy Smith

Andy brings his passion for writing and editing, along with decades of experience, to research and compose stories that keep healthcare InSync. His articles take a deep dive into the trending and relevant issues of mental health, interoperability, physical therapy, speech therapy, substance abuse treatment, and CCBHC's - bringing clarity to the effects of emerging technology and Electronic Health Records on today's top healthcare stories.