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

Background: 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. Methods: 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. Results: 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. Conclusions: 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.