Determinants of new-onset alcohol use disorder in US military veterans: Results from the National Health and Resilience in Veterans Study

Background: Although veterans are at increased risk of alcohol use disorder (AUD) relative to civilians, few longitudinal studies have examined both risk and protective factors that influence the development of AUD. This study aimed to identify risk and protective factors that contribute to incident AUD. Methods: Data were analyzed from the National Health and Resilience in Veterans Study (NHRVS), a nationally representative, prospective cohort study of U.S. veterans. The sample included 1,770 veterans who did not meet criteria for lifetime AUD at Wave 1 and completed at least one follow-up assessment over a 7-year period. Veterans completed self-report measures to assess for risk and protective factors. A multivariable binary logistic regression analysis was conducted to examine baseline factors associated with incident AUD. Results: A total of 5.9% of veterans without AUD at Wave 1 developed AUD in the 7-year follow-up period. Adult sexual trauma, greater severity of anxious arousal symptoms of PTSD, lifetime history of drug and nicotine use disorders, and higher alcohol consumption at Wave 1 were independently associated with incident AUD. Lifetime drug use disorder (75.9%) and higher alcohol consumption (22.1%) explained the most variance in incident AUD. Conclusion: Approximately 6% of veterans without AUD at Wave 1 developed AUD over a 7-year period. Lifetime drug use disorder and greater alcohol consumption at baseline, as well as trauma-related characteristics (i.e., adult sexual trauma, anxious arousal symptoms), were associated with increased risk of developing AUD. Future research should examine whether treatment of drug use disorder and PTSD symptoms in at-risk veterans may help mitigate risk of developing AUD in this population.