Psychosocial Well-Being Among Veterans With Posttraumatic Stress Disorder and Substance Use Disorder

Clinical Impact Statement This study suggests that veterans who served on/after September 11, 2001 (i.e., post-9/11 veterans) with comorbid posttraumatic stress disorder and substance use disorder (PTSD/SUD) are at high risk for adverse experiences such as lifetime homelessness, violent behavior, and suicide. Moreover, post-9/11 veterans with comorbid PTSD/SUD appear to have worse psychosocial well-being in key aspects of their vocational, financial, and social lives relative to post-9/11 veterans with only one or neither of these disorders. Findings suggest that health care professionals, policymakers, and other stakeholders should assess, target, and monitor psychosocial well-being among veterans with posttraumatic stress disorder (PTSD) and/or substance use disorder (SUD). Objective: Concurrent posttraumatic stress disorder and substance use disorder (PTSD/SUD) in U.S. military veterans represents an urgent public health issue associated with significant clinical challenges. Although previous research has shown that veterans with PTSD/SUD endorse more psychosocial risk factors and fewer protective factors than veterans with neither or only one of these disorders, no study has applied a comprehensive framework to characterize the vocational, financial, and social well-being of veterans with PTSD/SUD. Furthermore, it is not fully known how well-being among veterans with PTSD/SUD compares to that of veterans with posttraumatic stress disorder (PTSD) only, substance use disorder (SUD) only, or neither disorder. Method: This cross-sectional observational study analyzed data from the National Post-Deployment Adjustment Survey, which recruited a random national sample of U.S. veterans who served on/after September 11, 2001. Participants (weighted N = 1,102) self-reported sociodemographic, clinical, and military background information in addition to aspects of their vocational, financial, and social well-being. Results: Veterans with PTSD/SUD were particularly likely to report lifetime experiences of homelessness, violent behavior, suicidal ideation, and suicide attempts. Veterans with PTSD/SUD reported worse social well-being than the PTSD-only, SUD-only, and neither-disorder groups. They also reported worse vocational and financial well-being than veterans with SUD only or with neither disorder but did not significantly differ from the PTSD-only group on vocational or financial well-being. Conclusions: The findings underscore the importance of assessing multiple aspects of well-being in veterans with PTSD and/or SUD. The findings also point to promising treatment targets to improve psychosocial functioning and overall quality of life among veterans with PTSD and/or SUD.