Changes in alcohol use, PTSD hyperarousal symptoms, and intervention dropout following veterans’ use of VetChange

Abstract Objective Returning veterans report high rates of hazardous drinking, posttraumatic stress disorder (PTSD), and evidence low rates of formal treatment engagement. Web-based interventions may help address unmet treatment need, yet little is known regarding factors associated with outcomes or adherence to these interventions over time. In this study, we examined outcomes and factors predicting intervention dropout among returning veterans following registration with a web-based intervention. Method Participants included 222 returning veterans (77.5% men, 78.3% White) between 22-57 (Mage = 36.02, SD = 7.19). Once registered, veterans completed brief alcohol assessment and received personal feedback, then received full access to the online intervention to use as desired. Veterans completed self-report measures of alcohol use and PTSD symptoms at baseline, one, three, and six months. Results Alcohol use decreased significantly over six months, with the largest decrease occurring within the first month post-registration. Greater reduction in alcohol use during the first month, in turn, predicted higher PTSD hyperarousal symptoms over the following five months. In follow up analyses, we found that hyperarousal symptoms predicted higher rates of intervention dropout over time. Conclusion The results of the current study highlight the importance of attending to the association between alcohol use and PTSD symptom change in web-based interventions for veterans with co-occurring conditions. The fact that hyperarousal symptoms were associated with elevated risk for intervention dropout signifies the need for online intervention refinement aimed at tailoring content to time-varying symptom presentations.