Articlehybrid2016

Posttraumatic stress disorder and alcohol dependence: Epidemiology and order of onset.

Erin C. Berenz · Roxann Roberson‐Nay · Shawn J. Latendresse · Briana R. Mezuk · Charles O. Gardner · Ananda B. Amstadter +1 more

57 citations0/0 files storedPsychological Trauma Theory Research Practice and Policy

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Posttraumatic Stress Disorder Research Substance Abuse Treatment and Outcomes Child Abuse and Trauma

Abstract

OBJECTIVE: Posttraumatic stress disorder (PTSD) and alcohol dependence (AD) frequently co-occur; however, epidemiologic studies of temporal associations between PTSD and AD are limited. The aims of this study were (a) to investigate the bidirectional associations between PTSD and AD and (b) to examine demographic and clinical correlates of order-of-onset among individuals with PTSD and AD. METHOD: Participants were 11,103 adults (60.6% women; Mage = 48.7 years, SD = 15.9) from the National Epidemiologic Survey on Alcohol and Related Conditions who endorsed lifetime alcohol consumption and DSM-IV PTSD Criterion A trauma exposure (American Psychiatric Association, 2000). Cox proportional hazards models with time-dependent covariates were used to evaluate bidirectional associations between PTSD and AD. Sex differences were assessed using stratified analyses. RESULTS: After adjusting for demographic, trauma, and alcohol characteristics, PTSD was associated with greater likelihood of subsequent AD (hazard ratio [HR] = 1.359, 95% CI = 1.357-1.362), and AD was associated with greater likelihood of subsequent PTSD (HR = 1.274, 95% CI = 1.271-1.277). Bidirectional associations between PTSD and AD were stronger for women compared with men. Among individuals with PTSD and AD, initial onset of PTSD was associated with younger age of first potentially traumatic event. Initial onset of AD was associated with earlier initiation of alcohol use, earlier onset of heavy alcohol use, family history of alcohol problems, and history of generalized anxiety disorder and social anxiety disorder for women but not men. Initial AD was associated with lifetime panic disorder for men and women. CONCLUSIONS: Etiology of PTSD and AD is heterogeneous, and order of onset may reflect differing risk pathways. (PsycINFO Database Record

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2013Diagnostic and Statistical Manual of Mental Disorders 1995Posttraumatic Stress Disorder in the National Comorbidity Survey 2005Reinterpreting Comorbidity: A Model-Based Approach to Understanding and Classifying Psychopathology 1999Psychiatric Disorders Among Survivors of the Oklahoma City Bombing 1997A 2-year longitudinal analysis of the relationships between violent assault and substance use in women.1993A Twin Study of Genetic and Environmental Contributions to Liability for Posttraumatic Stress Symptoms 2002Genetic and Environmental Influences on Trauma Exposure and Posttraumatic Stress Disorder Symptoms: A Twin Study 1998Posttraumatic stress disorder and drug disorders: testing causal pathways.

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