A Case Study of Meditation to Reduce Alcohol Use Disorder Symptomology in Veteran PTSD Comorbidity

Within today's military setting post-traumatic stress disorder (PTSD) is becoming an ever-increasing issue, with the problem affecting individuals regardless of socioeconomic background, gender or culture (2, 3). Coupled with the rise of drug and alcohol related issues plaguing Australia there is a potential for the two major health concerns to have a detrimental effect on the health of military veterans (3, 4).

When PTSD is diagnosed in military veterans it can include a variety of symptoms including, but not limited to, substance abuse, anxiety, nightmares and depression (1, 5). Alcohol use disorder (AUD) that is comorbid with PTSD has been indicated as a main factor of concern, with 28% of United States veterans reporting substance abuse and PTSD (1). Additionally, a study of 14,805 Australian civilians aimed to ascertain prevalence and comorbidity rates found that PTSD was prevalent in 4.4% of the population, AUD was prevalent in 4.3% of the population and that comorbidity was prevalent in 0.5% of the population (4).

The current National Health and Medical Research Council (NHMRC) advice to reduce risk from alcohol related disease or injury is that the average individual not consume more than two standard drinks per day (6). People who consume alcohol for the purpose of self-medication, such as those diagnosed with PTSD, are drinking in an attempt to quickly alleviate and ‘avoid’ the symptoms such as flashbacks and anxiety attacks (2). This highlights the potential psychological difficulties individuals face when confronting AUDs especially when linked with mental health disorders.

Meditation has been shown to reduce some of the negative psychological side effects associated with PTSD and AUD (7, 8) such as stress and anxiety (7), which impact on quality of life and social functioning (8). Meditation requires an individual to focus their attention on a single point of reference (7), directing attention on the current moment and not on disturbing thoughts. Additionally, mantram, an important element of meditation, is utilised to calm the body, occupy and calm the mind and improve awareness through the daily practice of word repetition to oneself (8). This is useful when other forms of meditation are not possible, and research has shown that mantram is an effective way of dealing with symptoms of military-related PTSD (9, 10). Meditation, including mantram, may be an effective intervention to help overcome alcohol misuse in individuals with PTSD (9, 10). Mantram can be performed in any location and at any time, providing flexibility to use this as an alternative to alcohol at the time it is most needed by the individual.

Given the importance of reducing alcohol consumption in veterans, this case study explored how the implementation of meditation and mantram may reduce alcohol comorbidity in a veteran with PTSD. It was hypothesised that with the implementation of meditation as a behavioural intervention in combination with aspects of Skinner’s theory of positive reinforcement (13), alcohol consumption would decline.

At baseline, mean alcohol consumption was 6.26 (SD=4.38) standard drinks per day (Figure 1). During the intervention, the participant recorded an average of 30min meditation per day over and above the minimum required (Table 1). The behaviour diary and interview revealed the circumstances around alcohol consumption; namely the consumption of alcohol whilst alone to avoid intrusive thoughts and as a coping strategy when surrounded by peers due to issues with social companionship. Mean consumption of alcoholic beverages was lower during intervention (M=3.53; SD=3.44 standard drinks per day) compared to baseline, however, day-to-day variability should be noted (Figure 1).

Figure 1.

Following implementation of a meditation intervention for one week, alcohol consumption was reduced compared to the baseline week. The maximum number of standard drinks consumed in one day during the intervention phase (10 beverages) was lower than the baseline (14 beverages). The outcome of this intervention indicates that meditation can potentially lead to reductions in PTSD symptomology and therefore reduce the need for drinking alcohol as a coping mechanism.

The intervention has shown that meditation can reduce alcohol consumption, however the mean number of drinks consumed during the intervention week was still above NHMRC guidelines (6). Holliday (5) conducted a study to specifically look at American veterans suffering from PTSD with AUD comorbidity and determine daily alcohol intake levels (M=4.21, range=1-21). The participant in the current study had a baseline alcohol consumption that was above the mean reported by Holliday (5), and this fell below the mean during the intervention period (5). This suggests that whilst the levels of alcohol consumption stayed above recommended daily intake levels (6), the implementation of meditation in the short term may help to reduce alcohol intake to levels below those reported by veterans with PTSD and AUD comorbidity in the literature (5, 6).

Psychoeducation has remained one of the most effective tools when treating individuals who have a mental illness (17). Meditation skills have been adapted into treatment programmes and have been shown to be beneficial in controlling urges for coping with substance misuse (18-20). Given that previous research has provided encouraging indications that meditation can lead to the improvement of health and quality of life in veterans suffering from PTSD (21, 22), it is possible that psychoeducation relating to meditation may be useful for PTSD and AUD symptoms; however further studies are needed to investigate this.

Implementing an education programme prior to the intervention focusing on the individual’s desire for behaviour change may be useful in future studies. Furthermore, studies could include an extended intervention phase thus allowing for periods where the individual can start to use an alternate reward instead of alcohol. Allowing for a longer intervention period also aides in establishing a routine (19). The level of detail required in the behavioural diary left room for subjective interpretation, with the possibility of the participant conforming to social desirability bias, i.e. guilt about documenting true feelings, which is a known issue with self-reports of alcohol consumption (23). Single Systems designs are reflexive in relationship as the intervention causes the participant to focus on the study rather than what is natural, and only allows recording of the specific details rather than the broader aspect (18). However, the implementation of a mixed method design would capture a much broader perspective of the issues surrounding PTSD and AUD comorbidity (24).

The results from this case study indicate that implementing a meditation intervention may reduce alcohol consumption in veterans with PTSD and AUD comorbidity. This study has led to short-term improvements in the participant veteran’s attitude and PTSD symptoms. Alcohol consumption is highly prevalent within Australia and the veteran community, thus it is expected that interventions that reduce alcohol intake will lead to substantial reductions in morbidity and mortality. Further research into meditation and alcohol consumption for veterans may improve mental health and quality of life beyond the results displayed in this study.