Probable Posttraumatic Stress Disorder and Alcohol Use Among Enrollees in The World Trade Center Health Registry

Welch, Alice E

BACKGROUND: The World Trade Center (WTC) Health Registry (Registry) is a cohort study of survivors of the 9/11 terrorist attacks and includes exposed lower Manhattan residents, area workers, passers-by and rescue/recovery/clean-up workers. Results from this study (2006-07) show a high prevalence of probable posttraumatic stress disorder (PTSD) and alcohol use. This study investigates the association between PTSD and alcohol use among Registry enrollees and whether this association varies with age and race/ethnicity.

METHODS: We evaluated 39,823 enrollees aged 18 or older at Wave 1 of data collection (2003-04) without a pre-9/11 PTSD diagnosis, who completed Wave 2 (2006-07) and had no missing data on key variables. Alcohol use 30 days prior was categorized as: no drinking, problem drinking [any binge drinking (5+ drinks for men and 4+ drinks for women on a single occasion) and/or heavy drinking (average daily alcohol consumption of >2 drinks for men and >1 drink for women)], or moderate drinking (alcohol use other than binge or heavy drinking). PTSD was defined as a score >44 on the PTSD Checklist. We used multinomial regression to assess the strength of the association between PTSD and alcohol use before and after adjusting for sociodemographic characteristics, social support, mental health care utilization and 9/11-related exposures. Interaction terms between age and PTSD and race/ethnicity and PSTD were tested in the final model.

RESULTS: The overall prevalence of problem drinking was 28.6%. The proportion of problem drinkers was greater among those with PTSD (36.8%) compared to those without (26.7%). Adjusting for sociodemographics, social support, mental health care utilization and 9/11-related exposures, PTSD was associated with both moderate and problem drinking in opposite directions. Among enrollees with PTSD, the odds of problem drinking was greater (adjusted OR (aOR): 1.08; 95% CI: 1.00-1.17) and the odds of moderate drinking was lower (aOR: 0.68; 95% CI: 0.63-0.73) compared to those without. Problem drinking was greater only for adults aged 45-64 (aOR: 1.13; 95% CI: 1.01-1.26). Problem drinking among enrollees with PTSD was greater among Asians (aOR: 1.85; 95% CI: 1.26-2.72), blacks (aOR: 1.42; 95% CI: 1.09-1.85) and Hispanics (aOR: 1.29; 95% CI: 1.05-1.58) than their counterparts without.

CONCLUSIONS: Problem drinking was associated with PTSD several years post-9/11, highlighting the need for assessing alcohol use in post-disaster evaluations. We recommend the use of screening instruments which measure alcohol consumption to identify and follow-up with those at risk for or who already have an alcohol use disorder.