This application is submitted in response to PA-08-167, Secondary Analysis of Existing Alcohol Epidemiology Data (R01). The prevalence of alcohol use disorders (AUD) is substantially greater among women with posttraumatic stress disorder (PTSD), and the prevalence of PTSD among women who have experienced intimate partner violence (IPV) exceeds that of women in the general population. Substantial unanswered questions remain, however, regarding the effect of PTSD on the course of hazardous alcohol use and alcohol treatment utilization and the role IPV may play in that relationship. Further, even less is known about how racial and ethnic health disparities might moderate these complex relationships. Nationally representative longitudinal epidemiologic studies are essential to clarify these questions, particularly those related to disparities, given the dearth of longitudinal studies and the biases associated with clinical studies. A prospective cohort study will be conducted using two waves of the longitudinal National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). This study will draw on both retrospective and prospective data covering alcohol and other drug use, psychiatric disorders, traumatic experiences, and the social context in which these events occur. The use of these rich data provides a unique and cost-effective opportunity to address the Specific Aims of this study: 1) To examine the overall effect of PTSD on subsequent alcohol use (i.e. binge drinking, frequent heavy drinking, and AUD) among non-Hispanic White, Hispanic/Latina, and Black/African American women with a traumatic history of IPV victimization relative to women without such a history, and whether recency of IPV among women with a traumatic history of IPV increases the effect of PTSD on alcohol outcomes;2) To examine racial/ethnic disparities in the effect of PTSD on alcohol use outcomes among women with a traumatic history of IPV victimization relative to women without such a history, and whether U.S. nativity or acculturation and discrimination increase the risk of poor alcohol outcomes associated with PTSD;and 3) To examine the role of ethnicity, IPV and PTSD in alcohol treatment utilization and perceived unmet need for alcohol treatment. The findings derived from this study have the potential to: 1) inform the development of secondary prevention and intervention efforts targeting IPV and PTSD-affected women as well as tertiary prevention efforts, including those aimed at improving access to alcohol treatment for trauma-affected women;2) inform the development of effective and culturally relevant alcohol prevention and treatment programs for ethnic minorities;3) alert health care providers and treatment programs to the socio-cultural factors that may affect ethnic minority clients, resulting in more culturally sensitive and specific care, increased treatment completion, and satisfaction with treatment;and 4) reduce the social costs related to alcohol use and service utilization.
The findings derived from this study have the potential to inform secondary and tertiary prevention strategies to reduce the risk of alcohol use disorders among women and limit the severity and progression of those disorders. The results of this study also may serve to illustrate ethnic-specific pathways to AUD and alcohol treatment, and thus inform the development of culturally relevant alcohol prevention, intervention, and treatment programs. Finally, the implications of these findings may be particularly relevant for abused women, given the potential to improve outcomes through trauma-informed services.