with other comorbid mental disorders (Brady et al., 2000; Keane and Wolfe, 1990). For example, approximately 80 percent of individuals with PTSD have a comorbid psychiatric disorder at some time in their lives (Foa, 2009). Studies of psychiatric inpatients have found that more than 75 percent of PTSD patients have other psychiatric or medical diagnoses, including depression, suicidal ideation and attempts, alcohol and other drug abuse, anxiety, conduct disorder, chronic pain, and metabolic syndrome (Campbell et al., 2007; Floen and Elklit, 2007; Jakovljevic et al., 2006). A study of service members previously deployed to Iraq and Afghanistan (Tanielian et al., 2008) found that 14 percent screened positive for probable PTSD; 14 percent screened positive for probable major depression; 19 percent reported symptoms of probable traumatic brain injury (TBI) during deployment; and about one-third met criteria for PTSD, major depression, or TBI, with 5 percent meeting criteria for all three. Adams et al. (2012) found an association between TBI and past month reported binge drinking by military personnel after controlling for PTSD and combat exposure.

Comparing veterans of the Vietnam era with those of the Iraq and Afghanistan wars, Fontana and Rosenheck (2008) found that, because of the emphasis on PTSD, the latter veterans were less often diagnosed and treated for substance abuse disorders. Regarding this finding, the Army notes that “current treatment of Iraq and Afghanistan veterans should take into consideration the potential for manifestations of substance abuse and violent behavior as well as the potential for recurrence or late onset of PTSD” (U.S. Army, 2012, p. 23).

Alcohol-Related Diagnoses

The Armed Forces Health Surveillance Center (2011, 2012b) examined trends and demographic characteristics for acute, chronic, and “recurrent” alcohol-related diagnoses over a 10-year period from January 1, 2001, through December 31, 2010, for the active duty component of the military. Records of health care encounters, including hospitalizations and ambulatory care, in the Defense Medical Surveillance System were searched to identify those encounters that were associated with ICD-9 diagnostic codes encompassing both alcohol abuse and dependence indicators and were classified as acute or chronic cases. Acute cases were defined by four codes: (1) alcohol abuse/drunk, (2) toxic effect of alcohol, (3) excessive blood alcohol content, and (4) alcohol poisoning. Chronic cases were defined by eight codes: (1) acute intoxication in the presence of alcohol dependence, (2) alcohol-induced mental disorders, (3) other and unspecified alcohol dependence (chronic alcoholism), (4) alcoholic liver disease, (5) alcoholic cardiomyopathy, (6) alcoholic gastritis, (7) alcoholic polyneuropathy, and (8) personal history of alcoholism.

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