Smoking and non-alcohol substance use in veterans with PTSD and alcohol use disorder

Aims: To describe co-occurring non-alcohol substance use in veterans with PTSD and alcohol use disorder (AUD) entering controlled trials of topiramate. Methods: Baseline psychological, alcohol and non-alcohol substance use (NASU) measures are reported for 77 veterans with comorbid AUD and PTSD entering trials of topiramate treatment. PTSD, anxiety, anddepression, aswell as smoking, non-alcohol substance use (NASU) and NASU disorder diagnoses (NASUDs) were calculated. Subjects with andwithout smoking or NASUwere compared on alcohol use, PTSD, depression, and anxiety severity. Results: Mean age was 50.4±12.6, 93.5% were male. 41.6% were Vietnam era and 23.4% were Iraq/Afghanistan veterans. All met criteria for DSM-IV alcohol dependence and PTSD. 58.4% had combat-related PTSD. Mean Clinician Administered PTSD Scale (CAPS) score was 77.9±17.2; mean Beck Depression and Anxiety scores were 22.2±12.3 and 24.4±11.5 respectively. During the past 90 days prior to screening, participants had on average 5.4 drinking days per week, 4.5 heavy drinking days per week and consumed 63.7 drinks per week and 12.9 drinks per drinking day. 57.1% were smokers and 41.6% reported NASU in the past 30 days: 36.4% cannabis, 16.9% cocaine, 5.2% amphetamines, and 3.9% opioids. Urine drug screens were positive for cannabis in 23.4%, cocaine in 6.5%, amphetamines in 3.9%, and opiates in 7.6%. 28.6% met SCID NASUD criteria. Compared to nonsmokers, smokers had more drinks per week (72.7 vs. 51.4, p= .048) and more drinks per drinking day (15.7 vs. 9.4, p= .011) in the past 90 days. Smokers did not have higher mean CAPS, BDI, or BAI scores than nonsmokers. Patients with NASU also had more drinks per week (74.1 vs. 53.5, p= .05); but not higher CAPS, BDI or BAI scores than those negative for NASU. Conclusions: Smoking and other non-alcohol substance use were related with higher amounts of alcohol use but not greater PTSD, depression and anxiety severity in veterans with PTSD and AUD entering pharmacotherapy clinical trials. Financial support: W81XWH-05-2-0094, W81XWH-11-20245, and W81XWH-12-2-0137.