CHRONIC PTSD IN VIETNAM COMBAT VETERANS - COURSE OF ILLNESS AND SUBSTANCE-ABUSE

Objective: The purpose of this study was to measure the longitudinal c ourse of specific symptoms of posttraumatic stress disorder (PTSD) and related symptoms of alcohol and substance abuse and the effects of al cohol and substances on the symptoms of PTSD. Method: A structured int erview for the assessment of PTSD and alcohol and substance abuse, as well as other factors such as life stressors and treatment, was admini stered to 61 Vietnam combat veterans with PTSD. Results: Onset of symp toms typically occurred at the time of exposure to combat trauma in Vi etnam and increased rapidly during the first few years after the war. Symptoms plateaued within a few years after the tear, following which the disorder became chronic and unremitting. Hyperarousal symptoms suc h as feeling on guard and feeling easily startled developed first, fol lowed by avoidant symptoms and finally by symptoms from the intrusive cluster. The onset of alcohol and substance abuse typically was associ ated with the onset of symptoms of PTSD, and the increase in use paral leled the increase of symptoms. Patients reported a tendency for alcoh ol, marijuana, heroin, and benzodiazepines to make PTSD symptoms bette r, while cocaine made symptoms in the hyperarousal category worse. The re 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 a re 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.