Posttraumatic stress disorder and alcohol misuse: Effects of partner violence and ethnic minority stressors

Aims: The aims of this study were to examine the effect of posttraumatic stress disorder (PTSD) on alcohol use outcomes (binge and frequent heavy drinking, alcohol abuse, and alcohol dependence) and the moderating effect of traumatic physical intimate partner violence (IPV) and ethnic minority stressors (discrimination and acculturation) among non-Hispanic white, non-Hispanic black, and Hispanic U.S. women. Methods: The study sample was drawn from two waves of the National Epidemiologic Surveys of Alcohol and Related Conditions, employing time-dependent data to conduct multiple extended Cox regression. Results: PTSD predicted frequent heavy drinking among Hispanic women with low acculturation (adjusted Hazard Ratio [aHR] 4.59; 95% Confidence Interval [CI] 1.21, 17.41) and alcohol abuse among Hispanic women overall (aHR 3.04; CI 1.35, 6.85). Discrimination moderated the latter relationship; PTSD predicted alcohol abuse only among those without reported discrimination (aHR 6.39; CI 2.63, 15.51). In the total sample, women with PTSD were 40% (aHR 1.41; CI 1.03, 1.92) more likely to develop alcohol dependence; in stratified analyses, PTSD predicted alcohol dependence only among those without IPV (aHR 1.63; CI 1.14, 2.32). PTSD also predicted alcohol dependence among Hispanic women with low acculturation (aHR 6.36; CI 1.62, 24.94). IPV independently predicted poor alcohol outcomes in most analyses, particularly among white and black women. In addition, discrimination was positively associated with most outcomes among black and Hispanic women. Conclusions: PTSD may influence the development of hazardous drinking, especially among Hispanic women. The influence of PTSD on alcohol outcomes is most apparent when other stressors are not in play.