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Peer-reviewedCC BY 4.0The American Journal on Addictions

How common is alcohol use disorder in posttraumatic stress disorder? A systematic review, meta‐analysis, and moderator analysis

  • Maria Olivia Pozzolo Pedro1
  • Manoela Pozzolo Pedro2
  • Gabriella Zimmer Monteiro3
  • Valquíria Custodio Klaumann4
  • Priscila Dib Gonçalves5
  • Silvia S. Martins6
  • João Maurício Castaldelli‐Maia1,7
7 affiliations
  1. 1Department and Institute of Psychiatry University of São Paulo São Paulo Brazil
  2. 2Institute of Psychiatry Federal University of Rio de Janeiro Rio de Janeiro Brazil
  3. 3Heidelberg Hospital Curitiba Brazil
  4. 4Secretary of Health of Paraná Curitiba Brazil
  5. 5Department of Psychiatry Columbia University Irving Medical Center New York New York USA
  6. 6Department of Epidemiology Mailman School of Public Health, Columbia University New York New York USA
  7. 7Perdizes Institute (IPER) University of São Paulo São Paulo Brazil
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Abstract

Background and Objectives: Comorbidity between posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) complicates care, yet reported prevalence varies widely across settings and methods. We estimated AUD prevalence among adults with PTSD and identified sources of variability.

Methods: We searched PubMed, Google Scholar, the Virtual Health Library, and SciELO through June 2025, without language restrictions. All included studies were published in English. Observational studies reporting current or lifetime AUD in adults with PTSD were included (20 studies; 185,432 participants). Two reviewers independently appraised quality. Multilevel random‐effects meta‐analysis, trim‐and‐fill, sensitivity analyses, and meta‐regressions were conducted.

Results: After excluding studies that relied solely on screening instruments, current AUD studies were insufficient for meta‐analysis (k = 3); results are restricted to lifetime prevalence. Pooled lifetime AUD prevalence was 35.58% (95% confidence interval [CI]: 24.48%–48.48%), with high heterogeneity (I 2 = 99.37%). Trim‐and‐fill identified no missing studies. Meta‐regression indicated that clinical sample source (vs. community), inpatient care setting (vs. outpatient), and veteran status (vs. non‐veteran) were associated with higher lifetime AUD prevalence; a higher proportion of female participants was associated with lower prevalence, and a current versus lifetime PTSD assessment with higher prevalence.

Discussion and Conclusions: This review identifies sample characteristics that moderate AUD burden within PTSD populations: clinical settings, inpatient care, and veteran status predict higher prevalence, whereas greater female representation predicts lower rates. These findings support population‐specific screening and integrated, trauma‐informed care.

Scientific Significance: This is the first meta‐analysis quantifying clinical and demographic moderators of AUD in PTSD samples, informing risk‐stratified screening and population‐tailored treatment allocation.

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Cite

BibTeXRIS
BibTeX
@article{pedro2026common,
  title = {{How common is alcohol use disorder in posttraumatic stress disorder? A systematic review, meta‐analysis, and moderator analysis}},
  author = {Maria Olivia Pozzolo Pedro and Manoela Pozzolo Pedro and Gabriella Zimmer Monteiro and Valquíria Custodio Klaumann and Priscila Dib Gonçalves and Silvia S. Martins and João Maurício Castaldelli‐Maia},
  journal = {The American Journal on Addictions},
  year = {2026},
  month = sep,
  doi = {10.1111/ajad.70200},
  url = {https://doi.org/10.1111/ajad.70200},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - How common is alcohol use disorder in posttraumatic stress disorder? A systematic review, meta‐analysis, and moderator analysis
AU  - Maria Olivia Pozzolo Pedro
AU  - Manoela Pozzolo Pedro
AU  - Gabriella Zimmer Monteiro
AU  - Valquíria Custodio Klaumann
AU  - Priscila Dib Gonçalves
AU  - Silvia S. Martins
AU  - João Maurício Castaldelli‐Maia
PY  - 2026
DA  - 2026/09/16
JO  - The American Journal on Addictions
DO  - 10.1111/ajad.70200
UR  - https://doi.org/10.1111/ajad.70200
AB  - Background and Objectives: Comorbidity between posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) complicates care, yet reported prevalence varies widely across settings and methods. We estimated AUD prevalence among adults with PTSD and identified sources of variability.  Methods: We searched PubMed, Google Scholar, the Virtual Health Library, and SciELO through June 2025, without language restrictions. All included studies were published in English. Observational studies reporting current or lifetime AUD in adults with PTSD were included (20 studies; 185,432 participants). Two reviewers independently appraised quality. Multilevel random‐effects meta‐analysis, trim‐and‐fill, sensitivity analyses, and meta‐regressions were conducted.  Results: After excluding studies that relied solely on screening instruments, current AUD studies were insufficient for meta‐analysis (k = 3); results are restricted to lifetime prevalence. Pooled lifetime AUD prevalence was 35.58% (95% confidence interval [CI]: 24.48%–48.48%), with high heterogeneity (I 2 = 99.37%). Trim‐and‐fill identified no missing studies. Meta‐regression indicated that clinical sample source (vs. community), inpatient care setting (vs. outpatient), and veteran status (vs. non‐veteran) were associated with higher lifetime AUD prevalence; a higher proportion of female participants was associated with lower prevalence, and a current versus lifetime PTSD assessment with higher prevalence.  Discussion and Conclusions: This review identifies sample characteristics that moderate AUD burden within PTSD populations: clinical settings, inpatient care, and veteran status predict higher prevalence, whereas greater female representation predicts lower rates. These findings support population‐specific screening and integrated, trauma‐informed care.  Scientific Significance: This is the first meta‐analysis quantifying clinical and demographic moderators of AUD in PTSD samples, informing risk‐stratified screening and population‐tailored treatment allocation.
SN  - 1055-0496
SN  - 1521-0391
ER  -