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Am J Psychiatry 1996; 153:369-375
Copyright © 1996 by American Psychiatric Association
Chronic PTSD in Vietnam combat veterans: course of illness and substance abuse
JD Bremner, SM Southwick, A Darnell and DS Charney
National Center for Posttraumatic Stress Disorder, West Haven VA Medical Center, CT 06516, USA.
OBJECTIVE: The purpose of this study was to measure the longitudinal course
of specific symptoms of posttraumatic stress disorder (PTSD) and related
symptoms of alcohol and substance abuse and the effects of alcohol and
substances on the symptoms of PTSD. METHOD: A structured interview for the
assessment of PTSD and alcohol and substance abuse, as well as other
factors such as life stressors and treatment, was administered to 61
Vietnam combat veterans with PTSD. RESULTS: Onset of symptoms typically
occurred at the time of exposure to combat trauma in Vietnam and increased
rapidly during the first few years after the war. Symptoms plateaued within
a few years after the war, following which the disorder became chronic and
unremitting. Hyperarousal symptoms such as feeling on guard and feeling
easily startled developed first, followed by avoidant symptoms and finally
by symptoms from the intrusive cluster. The onset of alcohol and substance
abuse typically was associated with the onset of symptoms of PTSD, and the
increase in use paralleled the increase of symptoms. Patients reported a
tendency for alcohol, marijuana, heroin, and benzodiazepines to make PTSD
symptoms better, while cocaine made symptoms in the hyperarousal category
worse. There was no relationship between treatment interventions and the
natural course of PTSD. CONCLUSIONS: These findings suggest that symptoms
of PTSD begin soon after exposure to trauma, that hyperarousal symptoms are
the first symptoms to occur, that the natural course of alcohol and
substance abuse parallels that of PTSD, and that specific substances have
specific effects on PTSD symptoms.
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PTSD, Alcoholism, and Drug Abuse
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