Veterans With Recent Substance Use and Aggression: PTSD, Substance Use, and Social Network Behaviors

Objective: Violence is a salient concern among veterans, yet relationships between psychiatric comorbidity, social networks, and aggression are poorly understood. We examined associations between biopsychosocial factors (substance use, posttraumatic stress disorder [PTSD], and social network behaviors) with aggression. Method: We recruited veterans endorsing past-year aggression and substance use (N = 180) from Department of Veterans Affairs outpatient treatment clinics. Main and interaction effects between probable PTSD, substance use, social network violence and substance use, and veteran violence were examined with negative binomial regressions-specifically, physical aggression toward a relationship partner (PA-P), physical injury of a partner (PI-P), physical aggression toward nonpartners (PA-NP), and physical injury of nonpartners (PI-NP). Results: Alcohol use yielded consistent main effects. PTSD and social network violence demonstrated main effects for PA-NP and PI-NP. PTSD and social network violence interacted to predict PA-P such that social network violence appeared salient only in the context of PTSD. PTSD was associated with PI-P, PA-NP, and PI-NP in social network substance use models. In the PA-P model including social network substance use, veterans with PTSD reported greater PA-P in the context of greater social network substance use, whereas veterans without PTSD endorsed PA-P concurrent with greater alcohol frequency. For PI-P, PTSD interacted with alcohol to predict a greater likelihood of partner injury in the context of social network substance use. Conclusions: Investigated variables demonstrated unique associations within the context of specific relationships and the severity of behaviors. Overall, the findings underscore the importance of biopsychosocial models for understanding veteran violence.