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

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 (I2 = 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.