Posttraumatic stress and substance use among military veterans: Associations with distress intolerance and anxiety sensitivity

Addict Behav. 2022 Mar;126:107177. doi: 10.1016/j.addbeh.2021.107177. Epub 2021 Nov 9.


The co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is highly prevalent among military veterans and represents a difficult-to-treat comorbidity. Distress intolerance (DI; i.e., the perceived inability to tolerate negative emotional states) and anxiety sensitivity (AS, i.e., the fear of anxiety-related sensations) are two promising targetable mechanisms with potential to predict and improve treatment outcomes for veterans with PTSD/SUD. We hypothesized that PTSD symptom severity would be related to (a) alcohol use severity and (b) drug use severity through DI and AS, evaluated concurrently. Participants included 120 military veterans (98.3% male; Mage = 41.41, SD = 10.77) presenting for psychological services at a Veterans Affairs PTSD/SUD clinic. Results indicated that PTSD symptom severity was related to alcohol use severity through AS, but not DI; and PTSD symptom severity was related to drug use severity through DI, but not AS. Clinical and research implications are discussed.

Keywords: Alcohol; Anxiety sensitivity; Distress; Intolerance; PTSD; Substance use; Trauma; Veterans.

MeSH terms

  • Adult
  • Anxiety / epidemiology
  • Anxiety Disorders
  • Comorbidity
  • Female
  • Humans
  • Male
  • Stress Disorders, Post-Traumatic* / epidemiology
  • Substance-Related Disorders* / epidemiology
  • Veterans*