{"id":{"repo_id":"buffalo","oai_identifier":"oai:ubir.buffalo.edu:10477/78594"},"canonical_url":"https://search.dev.ndltd.org/etd/buffalo/oai:ubir.buffalo.edu:10477/78594","repository":{"repo_id":"buffalo","name":"Buffalo","base_url":"https://ubir.buffalo.edu/oai/request"},"display":{"title":"Comorbid posttraumatic stress symptoms and substance use in veterans: Latent class analysis and path analysis considering the effects of pre-service variables","abstract":"Ph.D.","abstract_html":"Ph.D.","abstract_has_math":false,"creators":["Linn, Braden; 0000-0002-8068-1795"],"institution":"State University of New York at Buffalo","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":["Nochajski, Thomas","Social Work"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2018,"date_issued":"2018-10-26T02:56:11Z","date_published":"2018-10-26T02:56:11Z","updated_at":"2026-07-27T19:05:12Z","subjects":["social work"],"languages":["eng"],"rights":["Users of works found in University at Buffalo Institutional Repository (UBIR) are responsible for identifying and contacting the copyright owner for permission to reuse. University at Buffalo Libraries do not manage rights for copyright-protected works and cannot assist with permissions.","Copyright retained by author."],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"http://hdl.handle.net/10477/78594","outbound_label":"Handle","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Nochajski, Thomas","Social Work"]},{"key":"dc:creator","label":"Author","values":["Linn, Braden; 0000-0002-8068-1795"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2018-10-26T02:56:11Z","2018","2018-08-10 14:54:02"]},{"key":"dc:publisher","label":"Institution","values":["State University of New York at Buffalo"]},{"key":"dc:type","label":"Dc Type","values":["Text","Dissertation"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["social work"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["eng"]},{"key":"dc:rights","label":"Dc Rights","values":["Users of works found in University at Buffalo Institutional Repository (UBIR) are responsible for identifying and contacting the copyright owner for permission to reuse. University at Buffalo Libraries do not manage rights for copyright-protected works and cannot assist with permissions.","Copyright retained by author."]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["http://hdl.handle.net/10477/78594"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["Ph.D.","Posttraumatic stress disorder (PTSD) occurs in approximately 16% of Operation Iraqi Freedom/Operation Enduring Freedom veterans. In addition to severe psychopathology, veterans with PTSD often have additional comorbid conditions, such as alcohol abuse, depression, anxiety, and psychosocial problems. Comorbid conditions increase the severity of symptoms and complicate treatment with alcohol abuse, in particular, increasing the severity of PTSD symptoms and increasing risk of dropout. To increase understanding of comorbid PTSD and alcohol and, ultimately, to improve treatment outcomes, recent research has been concerned with understanding the functional relationship between PTSD and alcohol abuse. Two common explanations for this functional relationship are the self-medication hypothesis, which states that alcohol is used to alleviate symptoms of distress, and the shared vulnerability hypothesis, which states that PTSD and alcohol abuse are both outcomes of traumatic stress. At the same time, questions about problems associated with subsyndromal PTSD have also been raised. To begin to fill the gaps in the literature, this dissertation had three aims. The first aim asked if veterans are heterogeneous with respect to exposure to traumatic stress, PTSD and depression symptoms, and alcohol use. The second aim asked if veterans with subsyndromal symptoms have alcohol use problems and other psychosocial complications. The third aim asked if the self-medication and shared vulnerability hypotheses could operate at the same time. The third aim also asked if comorbid PTSD and alcohol use problems were affected by premilitary variables and if they were connected to psychosocial distress and suicidality. In response to these aims, a convenience sample of 396 veterans completed measures on demographics, military service history, traumatic stress exposure, combat experiences, PTSD symptoms, depression symptoms, alcohol abuse, alcohol expectancies, life distress, suicidality, service usage, family history of mental health and substance abuse problems, and premilitary service history of mental health and substance use problems. Latent class analysis in aim 1 found three profiles to be the best fit to the data. One class had high levels of traumatic stress exposure but low symptoms and alcohol use. A second class had high PTSD and depression symptoms and moderate alcohol use. A third class had modest PTSD and depression symptoms and problematic levels of alcohol abuse. Analysis of auxiliary variables, primarily distress tolerance and alcohol expectancies, suggests that the third class may be self-medicating. Aim 2 performed a latent class analysis on clusters B, C, D, and E of the PCL 5 and found that three profiles were the best fit for the data. The first class had low levels of symptoms. The second class was symptomatic, but the total score on the PCL 5 was lower than the cut off score that is suggestive of PTSD. A third class was in excess of the cut off score, indicating likely PTSD. The subsyndromal class exhibited higher levels of alcohol problems than the symptomatic class. The subsyndromal class also exhibited levels of suicidality similar to that of the symptomatic class. Results of the aim indicate that subsyndromal PTSD can be associated with problems that are more severe than exhibited by those that meet the diagnostic threshold. A diagnosis of PTSD should not be required for services and providers should perform additional screenings for alcohol use and psychosocial problems in those with PTSD symptoms that are below what is required for diagnosis. Aim 3.1 found that PTSD symptoms and alcohol use are a functional of exposure to traumatic stress, which indicates empirical support for the shared vulnerability hypothesis. Aim 3 also found that alcohol expectancies moderate the relationship between PTSD symptoms and alcohol abuse such that those with higher alcohol expectancies (that alcohol can ease distress and improve mood) have more alcohol use problems as PTSD symptoms increase. Results provide initial empirical support for the simultaneous presence of the self-medication and shared vulnerability explanations for the functional relationship that exists between PTSD and alcohol use problems. Aim 3.2 found that premilitary substance use, family history of alcohol use and mental health problems, and Adverse Childhood Experiences all contribute to comorbid PTSD and alcohol use problems. Alcohol use problems contribute to psychosocial problems (i.e., relationship distress and employment problems) and suicidality. Suicidality is not related to psychosocial problems but is related to combat experiences and premilitary variables. Results suggest that PTSD and alcohol use problems are influenced by factors in addition to military service and expand the number of clinical targets. Results also contribute to the discussion of suicide in veterans by providing insight in to other variables that should be investigated. Chiefly among them are premilitary variables and combat experiences. Results of this study are tempered by the cross-sectional methodology and self-report bias. Aim 2 is also limited by low internal reliability of some symptom clusters on the PCL 5. Taken together, however, results of this study of veterans indicate that veterans have a heterogeneous presentation of PTSD, depression, and alcohol use problems and that self-medication may only operate in some veterans. The study also suggests that the functional relationship that exists between PTSD and alcohol use may be more complex than initially hypothesized and that comorbid PTSD and alcohol use are related to many other problems and experiences that occur across the life course. Finally, this study suggests that subsyndromal PTSD is associated with severe problems for veterans and that this population should not be ignored in clinical settings."]},{"key":"dc:format","label":"Dc Format","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["Comorbid posttraumatic stress symptoms and substance use in veterans: Latent class analysis and path analysis considering the effects of pre-service variables"]}]}],"canonical_facts":{"dc:contributor":["Nochajski, Thomas","Social Work"],"dc:creator":["Linn, Braden; 0000-0002-8068-1795"],"dc:date":["2018-10-26T02:56:11Z","2018","2018-08-10 14:54:02"],"dc:description":["Ph.D.","Posttraumatic stress disorder (PTSD) occurs in approximately 16% of Operation Iraqi Freedom/Operation Enduring Freedom veterans. In addition to severe psychopathology, veterans with PTSD often have additional comorbid conditions, such as alcohol abuse, depression, anxiety, and psychosocial problems. Comorbid conditions increase the severity of symptoms and complicate treatment with alcohol abuse, in particular, increasing the severity of PTSD symptoms and increasing risk of dropout. To increase understanding of comorbid PTSD and alcohol and, ultimately, to improve treatment outcomes, recent research has been concerned with understanding the functional relationship between PTSD and alcohol abuse. Two common explanations for this functional relationship are the self-medication hypothesis, which states that alcohol is used to alleviate symptoms of distress, and the shared vulnerability hypothesis, which states that PTSD and alcohol abuse are both outcomes of traumatic stress. At the same time, questions about problems associated with subsyndromal PTSD have also been raised. To begin to fill the gaps in the literature, this dissertation had three aims. The first aim asked if veterans are heterogeneous with respect to exposure to traumatic stress, PTSD and depression symptoms, and alcohol use. The second aim asked if veterans with subsyndromal symptoms have alcohol use problems and other psychosocial complications. The third aim asked if the self-medication and shared vulnerability hypotheses could operate at the same time. The third aim also asked if comorbid PTSD and alcohol use problems were affected by premilitary variables and if they were connected to psychosocial distress and suicidality. In response to these aims, a convenience sample of 396 veterans completed measures on demographics, military service history, traumatic stress exposure, combat experiences, PTSD symptoms, depression symptoms, alcohol abuse, alcohol expectancies, life distress, suicidality, service usage, family history of mental health and substance abuse problems, and premilitary service history of mental health and substance use problems. Latent class analysis in aim 1 found three profiles to be the best fit to the data. One class had high levels of traumatic stress exposure but low symptoms and alcohol use. A second class had high PTSD and depression symptoms and moderate alcohol use. A third class had modest PTSD and depression symptoms and problematic levels of alcohol abuse. Analysis of auxiliary variables, primarily distress tolerance and alcohol expectancies, suggests that the third class may be self-medicating. Aim 2 performed a latent class analysis on clusters B, C, D, and E of the PCL 5 and found that three profiles were the best fit for the data. The first class had low levels of symptoms. The second class was symptomatic, but the total score on the PCL 5 was lower than the cut off score that is suggestive of PTSD. A third class was in excess of the cut off score, indicating likely PTSD. The subsyndromal class exhibited higher levels of alcohol problems than the symptomatic class. The subsyndromal class also exhibited levels of suicidality similar to that of the symptomatic class. Results of the aim indicate that subsyndromal PTSD can be associated with problems that are more severe than exhibited by those that meet the diagnostic threshold. A diagnosis of PTSD should not be required for services and providers should perform additional screenings for alcohol use and psychosocial problems in those with PTSD symptoms that are below what is required for diagnosis. Aim 3.1 found that PTSD symptoms and alcohol use are a functional of exposure to traumatic stress, which indicates empirical support for the shared vulnerability hypothesis. Aim 3 also found that alcohol expectancies moderate the relationship between PTSD symptoms and alcohol abuse such that those with higher alcohol expectancies (that alcohol can ease distress and improve mood) have more alcohol use problems as PTSD symptoms increase. Results provide initial empirical support for the simultaneous presence of the self-medication and shared vulnerability explanations for the functional relationship that exists between PTSD and alcohol use problems. Aim 3.2 found that premilitary substance use, family history of alcohol use and mental health problems, and Adverse Childhood Experiences all contribute to comorbid PTSD and alcohol use problems. Alcohol use problems contribute to psychosocial problems (i.e., relationship distress and employment problems) and suicidality. Suicidality is not related to psychosocial problems but is related to combat experiences and premilitary variables. Results suggest that PTSD and alcohol use problems are influenced by factors in addition to military service and expand the number of clinical targets. Results also contribute to the discussion of suicide in veterans by providing insight in to other variables that should be investigated. Chiefly among them are premilitary variables and combat experiences. Results of this study are tempered by the cross-sectional methodology and self-report bias. Aim 2 is also limited by low internal reliability of some symptom clusters on the PCL 5. Taken together, however, results of this study of veterans indicate that veterans have a heterogeneous presentation of PTSD, depression, and alcohol use problems and that self-medication may only operate in some veterans. The study also suggests that the functional relationship that exists between PTSD and alcohol use may be more complex than initially hypothesized and that comorbid PTSD and alcohol use are related to many other problems and experiences that occur across the life course. Finally, this study suggests that subsyndromal PTSD is associated with severe problems for veterans and that this population should not be ignored in clinical settings."],"dc:format":["application/pdf"],"dc:identifier":["http://hdl.handle.net/10477/78594"],"dc:language":["eng"],"dc:publisher":["State University of New York at Buffalo"],"dc:rights":["Users of works found in University at Buffalo Institutional Repository (UBIR) are responsible for identifying and contacting the copyright owner for permission to reuse. University at Buffalo Libraries do not manage rights for copyright-protected works and cannot assist with permissions.","Copyright retained by author."],"dc:subject":["social work"],"dc:title":["Comorbid posttraumatic stress symptoms and substance use in veterans: Latent class analysis and path analysis considering the effects of pre-service variables"],"dc:type":["Text","Dissertation"]},"updated_at":"2026-07-27T19:05:12Z"}