1. PTSD, Combat, and Impulsivity: Predictors of Alcohol Use in a Military Sample
Lauren R. Khazem, B.A., Keyne C. Law, B.A, Bradley A. Green, Ph.D., & Michael D. Anestis,
Ph.D.
The University of Southern Mississippi
Presented at the Annual Meeting of the Association of Behavioral and Cognitive Therapies, Philadelphia, Pennsylvania. (November, 2014).
INTRODUCTION
Table 1
DATA ANALYSIS
Results of Model Examining Relationship Between Variables and Alcohol Use
Impulsivity and combat experiences have been linked to PTSD.
(Bryan Cukrowicz, West, & Morrow, 2010; Weiss, Tull, Anestis, & Gratz, 2013)
Examinations of the relationship between PTSD symptom clusters and alcohol abuse have produced mixed results, with only some symptoms associated with alcohol use or no association being observed.
(Maguen, Stalnaker, McCaslin, & Litz, 2009; McFall, Mackay, & Donovan, 1992; Shipherd, Stafford, & Tanner, 2005)
Individuals with PTSD have been observed as having higher levels
of Negative Urgency (engaging in impulsive behavior while under the influence of negative affect) and sensation seeking (having the propensity for involvement in risky behaviors).
(Weiss, Tull, Anestis, & Gratz, 2013)
The possibility that specific PTSD symptom clusters, different facets of impulsivity, and combat use may all contribute to alcohol use in military members has yet to be examined.
Test whether certain PTSD symptom clusters predicted alcohol use
Assess whether, after the inclusion of combat experience, and facets of impulsivity, certain PTSD symptom clusters would predict alcohol use in a military sample when included in the same model
Hierarchical Multiple Regression Analyses were conducted to examine the relationships between the independent variables (PTSD symptoms clusters, combat experiences, Negative Urgency, Premeditation, Sensation Seeking, and Positive Urgency) and alcohol use.
All Analyses:
Step 1: Covariates (Age, race, sex, SES, marital status, living situation, education, employment status, depression,)
Step 2: Combat experiences, PTSD symptom clusters and Negative Urgency
Step 3: Premeditation, Perseverance, Sensation Seeking, Positive Urgency
Alcohol
Use R2
ΔR2 β p
Step 2
.23
.12**
<.001
Combat Experiences
.05
.41
PTSD Hyperarousal
.33**
PTSD Intrusive
-.08
.35
PTSD Avoidance
-.01
.92
PTSD Numbing
.27*
.002
Negative Urgency
.28**
Step 3
.30
.03*
.04
.51
..32**
-.11
.20
.02
.79
.26*
.01
(Lack of) Premeditation
.06
.38
(Lack of) Perseverance
.36
Sensation Seeking
.17*
Positive Urgency
-.06
RESULTS
PTSD Numbing and Hyperarousal symptom clusters are
most salient.
Negative Urgency and Sensation Seeking are the most salient
aspects of impulsivity in alcohol use
Combat experiences are not associated with alcohol use.
OBJECTIVES
The current study aimed to:
DISCUSSION
Examining potential contributors to alcohol use and abuse in
military personnel is important for future prevention efforts for
alcohol abuse.
This research expands upon mixed results of previous findings indicating different relationships between PTSD symptom clusters and alcohol use.
Military personnel may engage in alcohol use when upset (further research needed).
Future longitudinal research should examine this potential relationship in other military samples and examine whether different relationships between variables exists
Future alcohol abuse prevention efforts for military members benefit from focusing on targeting individuals’ PTSD symptoms, propensities for risky behaviors and tendencies to engage in impulsive behaviors when upset
METHODS
Participants
903 Participants (Mage = 27.06, SD = 8.11) recruited from a military base in the southern US.
82.1% male,
59.1% White, 25.1% African American
86.9% US National Guard, 4.1% Army
35.8% most recently deployed less than one month prior to participation.
Measures
Deliberate Self-Harm Inventory
Combat Experiences Scale (Vogt, et al., 2008)
Alcohol Use Disorders Identification Test (Saunders et al., 1993)
Covariate: Patient Health Questionnaire-Depression Subscale (PHQ-9;
Spitzer, Kroenke, & Williams, 1999
Covariate: Post-traumatic Stress Disorder Checklist- Military Version (PCL-M; Weathers, et al., 1993)
UPPS-P Impulsive Behavior Scale
Covariates: Age, race, sex, SES, marital status, living situation, employment status, education
*= Significant at p<.05
**= Significant at p<.001
REFRENCES
CONTACT INFORMATION AND COPIES OF THIS RESEARCH
Bryan, CJ, Cukrowicz, KC, Wet, CL, & Morrow, (2010). Combat experiences and the acquired capability for suicide. Journal of Clinical Psychology, 66,
doi: / jclp.207-3
Joiner, TE. Why People Die by Suicide. Cambridge, MA: Harvard University Press; 2005.
Maguen, S, Stalnaker, M, McCaslin, S, & Litz, BT (2009). Military Medicine, 174,
McFall, ME, Mackay, PW, & Donovan, DM (1992). Combat-related posttraumatic stress disorder and severity of substance abuse in Vietnam Veterans. Journal of Studies on Alcohol, 53, 357−363
Saunders, J, Aasland, O, Barbor, T, de la Fuente, J, & Grant, M (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption—II. Addiction, 88, 791–804.≥
Shipherd, JC, Stafford, J, & Tanner, LR (2005). Predicting alcohol and drug abuse in Persian Gulf War veterans: what role do PTSD symptoms play? Addictive behaviors, 30, doi: /j.addbeh
Spitzer, RL, Kroenke, K, Williams, JB (1999). Patient Health Questionnaire Primary Care Study GroupValidation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA, 282, 1737– 44. doi: .1001/jama
Van Orden, KA, Cukrowicz, KC, Witte, TK, & Joiner TE (2012). Thwarted belongingness and perceived burdensomeness: Construct validity and psychometric properties of the Interpersonal Needs Questionnaire. Psychological Assessment, 24,
Van Orden, KA, Witte, TK, Cukrowicz, KC, Braithwaite, SR, Selby, EA, & Joiner, TE (2010). The interpersonal Theory of Suicide, Psychological Review, 117: doi: /a
Vogt DS, Proctor SP, King DW, King LA, & Vasterling JJ (2006). Validation of scales from the Deployment Risk and Resilience Inventory in a sample of Operation Iraqi Freedom veterans. Assessment,
Weathers, FW, Litz, BT, Herman, DS, Huska, JA, & Keane, TM. The PTSD Checklist (PCL): Reliability, validity and diagnostic utility (1993(. Paper presented at the Ninth Annual Meeting of the International Society for Traumatic Stress Studies, San Antonio, TX.
Weiss, NH, Tull, MT, Anestis, MD, & Gratz, KL (2013). The relative and unique contributions of emotion dysregulation and impulsivity to posttraumatic stress disorder among substance dependent inpatients. Drug and Alcohol Dependence, 128, doi: /j.drugalcdep
This work was in part supported by the Military Suicide Research Consortium (MSRC), an effort supported by the Office of the Assistant Secretary of Defense for Health Affairs under Award No. (W81XWH ). Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the MSRC or the Department of Defense
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