A systematic review of the comorbidity between PTSD and alcohol misuse
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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.
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.
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.
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.
KeywordsPost-traumatic stress disorder Alcohol misuse Alcohol use disorder Comorbidity
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.
- 1.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, LeedsGoogle Scholar
- 2.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 PubMedCrossRefGoogle Scholar
- 9.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 PubMedCrossRefPubMedCentralGoogle Scholar
- 11.StataCorp (2009) Stata statistical software: release 11. Stata Corporation, College StationGoogle Scholar
- 14.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 126:201–209PubMedPubMedCentralGoogle Scholar
- 17.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 PubMedCrossRefGoogle Scholar
- 20.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 PubMedCrossRefPubMedCentralGoogle Scholar
- 21.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 PubMedCrossRefGoogle Scholar
- 32.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 PubMedCrossRefGoogle Scholar
- 33.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 PubMedCrossRefPubMedCentralGoogle Scholar
- 34.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 PubMedCrossRefGoogle Scholar
- 36.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 PubMedCrossRefPubMedCentralGoogle Scholar
- 44.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 PubMedCrossRefGoogle Scholar
- 45.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 PubMedCrossRefGoogle Scholar
- 49.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 PubMedCrossRefGoogle Scholar
- 51.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 PubMedCrossRefGoogle Scholar
- 54.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)Google Scholar
- 55.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)]Google Scholar
- 56.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
- 58.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 PubMedCrossRefGoogle Scholar