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. 2021 Nov:122:107031.
doi: 10.1016/j.addbeh.2021.107031. Epub 2021 Jun 29.

Associations between symptoms of posttraumatic stress disorder, pain, and alcohol use disorder among OEF/OIF/OND veterans

Shaddy K Saba  1 , Jordan P Davis  2 , John J Prindle  3 , Carl Andrew Castro  4 , Eric R Pedersen  5
Affiliations

Associations between symptoms of posttraumatic stress disorder, pain, and alcohol use disorder among OEF/OIF/OND veterans

Shaddy K Saba et al. Addict Behav. 2021 Nov.

Abstract

Background: Alcohol use disorder (AUD) is prevalent among Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) veterans. Pain and posttraumatic stress disorder (PTSD) are highly comorbid and increase risk of AUD. Prior studies linking pain or PTSD to AUD have not explored interactions between pain and PTSD symptoms.

Methods: OEF/OIF/OND veterans (N = 1230) were recruited from social media websites for a cross-sectional study of health behavior. Pain was assessed using the Pain Outcomes Questionnaire. PTSD symptoms and PTSD symptom clusters were assessed using the Posttraumatic Stress Disorder Checklist for DSM-5. AUD symptoms were assessed with the AUD Identification Test. Linear regression models were used to test for main and interaction effects in the full sample and separately by sex.

Results: Both pain and PTSD symptoms were associated with increased AUD symptomology, though the relationship between pain and AUD was heighted at relatively low PTSD symptoms. With respect to PTSD symptom clusters, re-experiencing and negative cognitions and mood were associated with increased AUD symptomology. Interactions between pain and re-experiencing as well as pain and avoidance were revealed. Results for men mirrored the full sample, while an interaction between pain and negative cognitions and mood was associated with AUD in women.

Conclusions: Results highlight associations between AUD, PTSD symptoms, and pain among veterans. While the relationship between pain and AUD appeared stronger in the context of low PTSD symptoms, both pain and PTSD symptoms were associated with increased AUD. Clinicians treating veterans with AUD should address the range of potential comorbidities.

Keywords: Alcohol use disorder; Comorbidity; Pain; Posttraumatic stress disorder; Veterans.

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Conflict of interest statement

Declarations of Interest: None

Conflict of Interest No conflict declared

Figures

Figure 1.
Figure 1.
Interaction between PTSD symptoms and pain predicting AUDIT scores with 95% confidence intervals, full sample. PTSD symptoms were measured with the PCL-5, and pain was measured with the POQ. POQ scores plotted to +/− 1 standard deviations (SD) above and below the mean.
Figure 2a.
Figure 2a.
Interaction between re-experiencing and pain predicting AUDIT scores with 95% confidence intervals, full sample. Re-experiencing was measured with the PCL-5, and pain was measured with the POQ. POQ scores plotted to +/− 1 standard deviations (SD) above and below the mean.
Figure 2b.
Figure 2b.
Interaction between avoidance and pain predicting AUDIT scores with 95% confidence intervals, full sample. avoidance was measured with the PCL-5, and pain was measured with the POQ. POQ scores plotted to +/− 1 standard deviations (SD) above and below the mean.
Figure 3a.
Figure 3a.
Interaction between PTSD symptoms and pain predicting AUDIT scores with 95% confidence intervals, men-only sample. PTSD symptoms were measured with the PCL-5, and pain was measured with the POQ. POQ scores plotted to +/− 1 standard deviations (SD) above and below the mean.
Figure 3b.
Figure 3b.
Interaction between PTSD symptoms and pain predicting AUDIT scores with 95% confidence intervals, women-only sample. PTSD symptoms were measured with the PCL-5, and pain was measured with the POQ. POQ scores plotted to +/− 1 standard deviations (SD) above and below the mean.
Figure 4a.
Figure 4a.
Interaction between re-experiencing and pain predicting AUDIT scores with 95% confidence intervals, men-only sample. Re-experiencing was measured with the PCL-5, and pain was measured with the POQ. POQ scores plotted to +/− 1 standard deviations (SD) above and below the mean.
Figure 4b.
Figure 4b.
Interaction between avoidance and pain predicting AUDIT scores with 95% confidence intervals, men-only sample. Avoidance was measured with the PCL-5, and pain was measured with the POQ. POQ scores plotted to +/− 1 standard deviations (SD) above and below the mean.
Figure 4c.
Figure 4c.
Interaction between negative cognitions and mood and pain predicting AUDIT scores with 95% confidence intervals, women-only sample. Negative cognitions and mood was measured with the PCL-5, and pain was measured with the POQ. POQ scores plotted to +/− 1 standard deviations (SD) above and below the mean.
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