Vulnerability Reawakened: Increased Substance Use Among Aging Traumatized Veterans During COVID-19 Pandemic

Clinical Impact Statement This study suggests that individuals who had experienced severe traumatic events as young adults carry vulnerability that resurges upon exposure to unrelated stressors, 40 years later. This vulnerability, especially salient among those who developed long term posttraumatic stress disorder (PTSD) in response to previous traumatic experiences, may be manifested as risky substance use, in face of subsequent adversity in old age. At a time of a global threat, older traumatized individuals should be targeted as a high risk population, and specific support and interventions should be provided to them. Objective: This study prospectively assesses the implication of (a) exposure to distant trauma of war captivity, (b) stressful life events across the life span, and (c) posttraumatic stress disorder (PTSD) trajectories and current PTSD, on substance use during the COVID-19 pandemic. Method: One hundred and twenty Israeli ex-prisoners of war (ex-POWs) and 65 matched veterans of the 1973 Yom Kippur War filled out self-report questionnaires in 4 waves of assessment (T1-18, T2-30, T3-35, and T4-42 years after the war). A fifth wave of assessment (T5) was conducted in the midst of the COVID-19 pandemic, 47 years after the war. Results: Whereas in the earlier assessments (T1-T4) war captivity was not related to substance use, during the COVID-19 pandemic (T5) ex-POWs reported higher increase of use of alcohol, tranquilizers, cannabis, and sleep medications than comparable veterans. War-induced PTSD trajectories that were prospectively measured between T1-T4, and concurrent PTSD during the pandemic (T5) were related to increase in substance use during the pandemic (T5). Conclusions: The findings demonstrate the long-term effects of both earlier experience of severe traumatic stress in young adulthood and the resultant PTSD trajectories, as reflected in increased substance use among the elderly, in the face of subsequent calamity.