Alcohol Addiction in War Veterans Treated in a In-patient Psychiatric Facility: Incidence, Comorbidity with PTSD Symptoms, Association with Combat Stressors

BACKGROUND: The dearth of and inconsistency in the data on the prevalence, risks of occurrence, comorbidity, and causation of stress-related disorders and alcohol use disorders in Russian veterans of local wars constituted the background for this study. AIM: To study the psychopathological structure, clinical changes, and the reasons for the mental disorders su ﬀ ered by Russian veterans of local wars; in particular, to study the prevalence, pathogenic factors, comorbidity of alcohol addiction and alcohol abuse, together with symptoms of stress disorders, in Russian veterans undergoing inpatient treatment. METHODS: Our observational case-control study included 685 patients who were undergoing treatment in the psychiatric department of a military hospital: the Main group (veterans) consisted of 264 veterans of armed con ﬂ icts who had undergone inpatient treatment from 1992 to 2010; the Control group, 1 , 296 patients, all servicemen and military pensioners who had undergone inpatient treatment during a calendar year and had never taken part in combat operations in the past; Control group 2 , 125 military personnel (regular and reserve) who had not taken part in combat operations and corresponded to the patients of the main group in terms of the mean age and age distribution curve. We performed a clinical and psychopathological analysis of the symptoms identi ﬁ ed in patients from the compared samples and, RESULTS: We uncovered no di ﬀ erence in the prevalence of symptoms of alcohol addiction and alcohol abuse among veterans and other servicemen and military pensioners who had not taken part in combat operations. However, there was a tendency to underdiagnose alcohol addiction in veterans in general and those with symptoms of PTSD, in particular. That is, alcohol addiction was not diagnosed in most cases when the veterans displayed symptoms of stress or other mental disorders, in addition to the signs of alcohol addiction. In most such cases, a stress-related mental disorder or another mental disorder with identi ﬁ ed signs was diagnosed and alcohol abuse was described as a concomitant disorder or a complication. There was no signi ﬁ cant association between any form of alcohol addiction or abuse and the presence of stress disorder symptoms in our sample of veterans; on the contrary, symptoms of re-experience of trauma were more often observed in veterans who were not prone to frequent drinking. The incidence of combat stressors traced in the medical history did not di ﬀ er in veterans with any form of alcohol abuse and veterans who were not prone to frequent drinking. However, the main group subjects with alcohol addiction more often displayed cases of addictive behavior during combat operations. Therefore, alcohol abuse during combat operations requires additional research to better establish its prognostic signi ﬁ cance. CONCLUSION: This Study found no di ﬀ erence in the incidence of alcohol dependence and alcohol abuse among veterans and other o ﬃ cers. In the sample of veterans, there was no signi ﬁ cant association between alcoholism and the presence of PTSD symptoms or a history of combat stressors. It is possible that the same risk of alcohol addiction in di ﬀ erent categories of military o ﬃ cers is due to a compact of social stressors that equally had a more signi ﬁ cant adverse e ﬀ ect on the entire population of Russian military personnel in the 90s of the last century and the ﬁ rst years of this century, as well as the massive abuse of alcohol, which could also equalize the risks of developing alcohol dependence in all groups of militaries.