Are PTSD symptoms associated with engagement and response to alcohol care management for Veteran Affairs patients with high risk drinking?

Thesis (Master's)--University of Washington, 2017-06Introduction: Posttraumatic stress disorder (PTSD) may create important barriers to engagement in alcohol use disorder (AUD) care management. Among a sample of Veteran Affairs (VA) patients randomized to receive nurse care management for AUD, this study tested whether PTSD interfered with engagement in AUD care management and predicted more heavy drinking days at 12-month follow up than not having PTSD. Methods: VA patients from three primary care sites were enrolled in the Choosing Healthier Drinking Options In Primary Care (CHOICE) trial if they reported high-risk drinking (≥4 drinks/day for women; ≥5 for men, two times per week or once per week if any prior AUD treatment) and met eligibility criteria. This observational substudy was interested only in patients randomized to receive AUD care management and who completed baseline screening for PTSD (n=147). Adjusted generalized linear regression models with Poisson and binomial distributions were used to assess the relationship between baseline PTSD and the number of nurse care visits at 12 month follow up as well as the number of heavy drinking days in past 28 days at 12 month follow up, respectively. Results: Participants with and without PTSD did not differ significantly on baseline sociodemographic characteristics or baseline percent heavy drinking days. After adjusting for potential confounders, PTSD was not significantly associated with the number of visits with the CHOICE nurse. Participants with PTSD had significantly lower odds of having a heavy drinking day than patients without PTSD (OR=.77; 95% CI: .65, .92; p<.01). Conclusions: Findings suggest future interventions for AUD should not exclude patients with PTSD or dissuade providers from treating patients with high-risk drinking on the basis of having PTSD