Alcohol Use Disorder Amplifies Suicidal Ideation Severity in Military Personnel with PTSD

Heavy alcohol use may be a key factor contributing to suicide among military personnel with untreated post-traumatic stress disorder. A study of active military personnel found that heavy drinking amplifies the relationship between PTSD symptoms and the severity of suicidal thoughts. The authors of the study, which is published in Alcohol: Clinical and Experimental Research, recommend that the military health system consider requiring screening for suicidal ideation and alcohol use in service members who may have post-traumatic stress disorder and further develop integrated treatment programs that simultaneously treat alcohol use disorder and PTSD.

The study is one of only a few to examine the relationship between alcohol use disorder, PTSD, and suicidality among active-duty military personnel. PTSD and heavy drinking are each areas of concern within the U.S. military. When combined, they pose a significant risk of suicide among military personnel.

The study authors examined data collected from 160 active duty service members in the Army, Navy, and Air Force who met diagnostic criteria but were not engaged in treatment for post-traumatic stress disorder. Participants were experiencing PTSD as a result of various types of traumatic exposures – 40 percent was due to combat trauma, 20 percent due to military sexual trauma, 10 percent due to non-combat violent death such as the loss of a close friend or family member to suicide, 10 percent due to accidents, and 20 due to non-military assaults or other traumas. Most participants had experienced multiple other traumatic events in addition to the event most closely linked to their current PTSD symptoms.

While service members in the study who had symptoms of alcohol use disorder were not more likely to have thoughts of suicide, in those who did have thoughts of suicide, having alcohol use disorder amplified the severity of their suicidal ideation. In service members with PTSD who had low or no symptoms of alcohol use disorder, no significant association was found between PTSD symptoms and the severity of suicidal ideation. However, when alcohol use disorder symptoms were of average or high severity, PTSD symptoms were significantly associated with increased severity of suicidal ideation. Drinking greater quantities of alcohol and drinking more frequently were the symptoms of alcohol use disorder most associated with increased severity of suicidal ideation.

The study specifically looked at the effects of alcohol use disorder on suicidality in military personnel with clinically diagnosed PTSD; thus, it is not yet generalizable to the general population. Further, the study found associations, not causation, between alcohol use disorder symptoms and suicidality. Although the study included service members from three branches of the military, 80 percent of participants were in the Army. Seventy percent were classified as active-duty, and 30 percent were on active-duty status as members of the National Guard or Army Reserve.

The prevalence of suicide among U.S. military personnel is at its highest level since before World War II. PTSD and alcohol use disorder have each been shown to contribute to suicidality. Other studies have shown that up to 10 percent of military personnel have PTSD, and up to 50 percent have alcohol use disorder. The current study highlights the importance of assessing for alcohol use disorder in PTSD when conducting suicide risk evaluations. The study authors urge continued research on both risk and resilience to prevent suicide in the military population. Alcohol use disorder as a moderator in the relationship between PTSD and suicidality among military personnel.

T. Walton, S. Graupensperger, D. Walker, D. Kaysen.

ACER-23-5809.R1