# Longitudinal associations between PTSD symptom clusters and domains of hazardous drinking among a cohort of United States Army Reserve and National Guard soldiers

## TL;DR

This study finds that specific PTSD symptoms, like hyperarousal and avoidance, are linked to increased hazardous drinking behaviors in U.S. Army Reserve and National Guard soldiers over time.

## Contribution

The study provides new longitudinal evidence linking specific PTSD symptom clusters to alcohol-related problems, particularly among male soldiers.

## Key findings

- Avoidance and negative mood PTSD symptoms are associated with increased alcohol-related problems over time.
- Hyperarousal symptoms are linked to higher alcohol consumption and problems, especially in male soldiers.
- No PTSD symptom clusters were associated with dependence on alcohol.

## Abstract

Posttraumatic stress disorder (PTSD) and hazardous drinking remain significant problems in military‐connected populations. Prior research suggests that specific PTSD symptom clusters may relate differently to hazardous drinking behaviors, but longitudinal data are limited, especially among reservists.

Using a subset of data (N = 485 US Army Reserve/National Guard soldiers) from the Operation: SAFETY study, we examined the longitudinal associations between PTSD symptom clusters (re‐experiencing, avoidance, negative cognitions and mood, hyperarousal) and domains of hazardous drinking (consumption, dependence, alcohol‐related problems) measured by the AUDIT. We used generalized estimating equation models adjusting for anxiety and depression, and interactions with biological sex were tested.

Controlling for the effects of time and anxiety and depression symptomatology, re‐experiencing symptoms were not associated with any domains of hazardous drinking (ps >0.05). Greater avoidance symptoms (p < 0.001) and negative cognitions and mood (p < 0.05) were both associated with greater alcohol‐related problems over time. Greater symptoms of hyperarousal were associated with greater consumption (p < 0.05) and alcohol‐related problems (p < 0.01). No symptom clusters were associated with dependence (ps >0.05). There was a significant interaction between symptoms of hyperarousal and sex on alcohol‐related problems (p < 0.01), such that greater symptoms of hyperarousal were associated with greater alcohol‐related problems over time among male soldiers, but not female soldiers.

Findings suggest that specific PTSD symptom clusters, rather than overall severity, may influence hazardous drinking. These effects primarily manifest in consumption behaviors and alcohol‐related problems, with greater risk observed among male soldiers experiencing hyperarousal features of PTSD.

Among Army Reserve and National Guard soldiers, PTSD symptom clusters, particularly hyperarousal, avoidance, and negative cognitions and mood, were linked to hazardous drinking over time. Findings reveal symptom‐specific pathways between trauma and alcohol use that inform prevention and conceptual models of comorbidity in military populations.