Associations between PTSD symptoms and heavy drinking and aggression among treatment-seeking veterans

Aggression is common among military veterans with posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) and is associated with psychosocial impairment. This study examined the associations between within-person changes in PTSD and heavy drinking over the course of treatment and reports of psychological and physical aggression in a sample of treatment-seeking veterans.

This is a secondary analysis of 141 veterans with co-occurring PTSD and AUD enrolled in a 12-week randomized controlled trial examining doxazosin.

Examination of time-varying covariation suggests that the interaction between PTSD symptom severity and the presence of heavy drinking across a 12-week treatment and follow-up period was positively associated with psychological aggression at each timepoint, but not physical aggression.

Results indicate that although aggression decreases across treatment for veterans with co-occurring PTSD and AUD, within-person changes in PTSD and heavy drinking can influence this trajectory. Specifically, at a given timepoint, when participants reported one or more heavy drinking day, the association between PTSD symptoms and psychological aggression strengthened; however, when participants reported no heavy drinking days, the association between PTSD symptoms and psychological aggression was nonsignificant. This suggests that the combined effect of heavy drinking and PTSD is associated with a greater risk for psychological aggression. Findings suggest that targeting changes in PTSD and heavy drinking behavior may reduce psychological aggression incidentally; however, there remains a critical need to further investigate underlying mechanisms and therapeutic options to reduce physical aggression behavior among veterans with co-occurring PTSD and AUD. (PsycInfo Database Record (c) 2026 APA, all rights reserved).