PTSD-related drinking to cope and changes in drinking risk levels in a nationally representative sample

Posttraumatic stress disorder (PTSD) is associated with high-risk drinking that may be sustained through drinking to cope with PTSD symptoms. This study sought to determine whether PTSD-related drinking to cope was associated with changes in World Health Organization risk drinking levels (WHO RDL) over 3 years among those with PTSD symptoms, using data from the National Epidemiologic Survey of Alcohol and Related Conditions. The sample included individuals who reported past-year alcohol use and PTSD symptoms at Wave 1 (baseline). Mean drinks per drinking day were used to define WHO RDL (low, moderate, high, and very high risk) at each wave and change in WHO RDL from baseline to a 3-year follow-up. Separate multinomial logistic models regressed drinking to cope on change in WHO RDL in two groups determined by baseline WHO RDL: (1) low and (2) higher (≥moderate) risk drinkers. Among low-risk drinkers at baseline, drinking to cope with PTSD symptoms was associated with greater odds of increasing WHO RDL at 3-year follow-up (OR = 2.62, p < .001). Among moderate-to-very high-risk drinkers at baseline, drinking to cope was associated with lower odds of reducing WHO RDL at 3 years (1-level reduction OR = 0.39, p = .007; 2-level reduction OR = 0.41, p = .032). Individuals with PTSD symptoms who drink to cope with their symptoms are at greater risk for escalation and maintenance of problematic alcohol use. Results highlight the importance of interventions that directly target PTSD-related drinking to cope.