Beyond drinking: Psychosocial complexity and dropout from Department of Veterans Affairs posttraumatic stress disorder (PTSD) residential treatment.
Source: PubMed, NCBI / U.S. National Library of Medicine
Posttraumatic stress disorder (PTSD) commonly co-occurs with substance use disorders, including alcohol use disorder (AUD), among U.S. veterans and contributes to impaired functioning and reduced quality of life. Department of Veterans Affairs residential rehabilitation treatment programs offer a safe and structured environment for veterans who are unable to manage PTSD treatment in outpatient settings; however, dropout remains a significant barrier. This study aimed to identify predictors of residential treatment dropout among veterans with PTSD and complex comorbidities. Veterans (= 3,117) enrolled in 40 different Department of Veterans Affairs PTSD residential rehabilitation treatment programs throughout the United States between October 1, 2017, and September 30, 2020, were examined. Analyses compared demographic and clinical characteristics, including AUD diagnosis, recent drinking behaviors, illicit substance use, and psychiatric symptom severity (e.g., PTSD, depression, anxiety) at admission, between completers and noncompleters. Logistic regression assessed predictors of treatment completion, controlling for age, race/ethnicity, employment, and housing status. Forty-four percent met criteria for AUD; 43.9% reported past 30-day alcohol use. Noncompleters were younger, more often unemployed or disabled, and unstably housed and had used substances prior to admission. Baseline psychiatric symptom severity did not differ between completers and noncompleters. AUD (β =
Abstract
Posttraumatic stress disorder (PTSD) commonly co-occurs with substance use disorders, including alcohol use disorder (AUD), among U.S. veterans and contributes to impaired functioning and reduced quality of life. Department of Veterans Affairs residential rehabilitation treatment programs offer a safe and structured environment for veterans who are unable to manage PTSD treatment in outpatient settings; however, dropout remains a significant barrier. This study aimed to identify predictors of residential treatment dropout among veterans with PTSD and complex comorbidities. Veterans (= 3,117) enrolled in 40 different Department of Veterans Affairs PTSD residential rehabilitation treatment programs throughout the United States between October 1, 2017, and September 30, 2020, were examined. Analyses compared demographic and clinical characteristics, including AUD diagnosis, recent drinking behaviors, illicit substance use, and psychiatric symptom severity (e.g., PTSD, depression, anxiety) at admission, between completers and noncompleters. Logistic regression assessed predictors of treatment completion, controlling for age, race/ethnicity, employment, and housing status. Forty-four percent met criteria for AUD; 43.9% reported past 30-day alcohol use. Noncompleters were younger, more often unemployed or disabled, and unstably housed and had used substances prior to admission. Baseline psychiatric symptom severity did not differ between completers and noncompleters. AUD (β = 0.21,= .03) and past 30-day substance use (β = 0.14,< .0001) significantly predicted an increased likelihood of noncompletion, whereas number of drinking days or binge drinking days and psychiatric symptom severity did not. Findings highlight the need for tailored interventions that address underlying psychosocial barriers to improve retention and outcomes among veterans with PTSD and complex comorbidities. (PsycInfo Database Record (c) 2026 APA, all rights reserved).