Alcohol Use Disorder in Veterans and Active-Duty Military

A Comprehensive Clinical and Systems Overview

Overview

Alcohol use disorder (AUD) is one of the most pressing health challenges facing veterans and active-duty service members in the United States. It is more common in this population than in the general civilian population, and it rarely travels alone — it arrives alongside post-traumatic stress disorder (PTSD), depression, traumatic brain injury (TBI), chronic pain, and elevated suicide risk. Understanding AUD in this context means understanding the full weight of military service: the culture, the trauma, the transition, and the systems built to help.

The Veterans Health Administration (VA) has made real progress in identifying AUD among veterans. Screening infrastructure has expanded substantially, and integrated care models are growing. But identification is not the same as treatment, and treatment is not the same as recovery. A striking gap exists between the system's ability to find the problem and its ability to reliably solve it. That gap — and the people living inside it — is what this article addresses.

This article draws on a multi-expert panel discussion grounded in verified research. Where the evidence is strong, it is stated plainly. Where it is limited or absent, that is stated too.

Prevalence

The numbers are striking. In a nationally representative sample of 4,069 U.S. veterans, lifetime DSM-5 AUD prevalence was 40.8% (95% CI: 39.2–42.3%) and past-year AUD was 10.5% (95% CI: 9.6–11.5%) ^[1]. These figures are not marginal — they represent a population-level crisis.

Among active-duty service members, 8% met criteria for co-occurring alcohol and mental health problems, with an additional 26.89% reporting alcohol problems alone ^[2]. In VA inpatient settings, AUD-related diagnoses appeared in 14.3% of all admissions ^[3].

Longitudinal data from the National Health and Resilience in Veterans Study (NHRVS) reveal important heterogeneity in how veterans drink over time. Over a four-year follow-up, most veterans fell into "rare drinker" (65.3%) or "moderate drinker" (30.2%) categories. A meaningful but smaller subset followed "excessive drinking" (2.6%) or "recovering" (1.9%) trajectories ^[4]. That recovering class — just under 2% of the sample — is small, and understanding what predicts membership in it is clinically essential (see What Predicts Recovery below).

Racial disparities in diagnosis are documented and troubling. Black and Hispanic veterans face 23–109% greater odds of receiving an AUD diagnosis than White veterans at similar consumption levels ^[5] (Note: this specific figure could not be independently verified against the source abstract — the underlying study supports the general finding but the exact number should be confirmed before publication). This suggests that diagnostic practices may reflect racial bias rather than true differences in disorder prevalence — a finding that demands attention in both clinical training and research design.

Combat Exposure and Deployment

Military service involves exposures that have no civilian equivalent: combat, witnessing atrocity, moral injury, and the cumulative stress of multiple deployments. These experiences are not simply stressors — they reshape how people relate to themselves, to others, and to substances.

Among active-duty personnel with PTSD diagnoses, 26.9% carried a comorbid AUD diagnosis, and 83.3% of those with PTSD had at least one comorbid mental health disorder ^[6]. The relationship between PTSD and AUD is not incidental — it is mechanistic. Research examining PTSD symptom clusters found that dysphoric arousal (explaining 20.7% of relative variance) and externalizing behaviors (19.0% relative variance explained) were the symptom clusters most strongly associated with AUD ^[7]. This specificity matters: not all PTSD symptoms drive alcohol use equally, and treatment targeting should reflect that.

Coping style is a long-term risk factor. A 16-year longitudinal study of Canadian Armed Forces members found that self-medication coping predicted AUD across the entire follow-up period (AOR 1.26; 95% CI: 1.02–1.57), while problem-focused coping was protective (AOR 0.84–0.87) ^[8]. These are modifiable targets — coping skills training is not psychotherapy filler. It is a direct intervention on a documented 16-year risk trajectory.

Transition Stress

The period immediately following separation from military service is a high-risk window for AUD onset or escalation. This is not simply about losing a job. Military service provides structure, identity, purpose, and community — a unit of people who share a common mission and a common language. Separation strips all of that away simultaneously.

Veterans navigating this transition face identity disruption, loss of social structure, employment uncertainty, and often a profound sense of purposelessness. For those who used alcohol as a coping mechanism during service, the transition period removes the external structure that may have kept use in check. For those who did not drink heavily during service, the loss of belonging and routine can become a trigger.

Qualitative interviews with veterans facing co-occurring anxiety, PTSD, and unhealthy alcohol use found that recovery hinged on learning coping and communication skills, engaging in therapy, and — critically — building community with other veterans ^[9]. This finding aligns with trajectory data showing that secure attachment style and greater social support predicted membership in the recovering drinker class ^[4]. The transition window is not just a risk period — it is an intervention opportunity, if the right supports are in place.

PTSD-AUD Comorbidity

PTSD and AUD are so frequently intertwined in this population that treating one without addressing the other is clinically inadequate — and potentially dangerous. Among active-duty service members with PTSD, more than one in four carries a comorbid AUD diagnosis ^[6]. VA estimates suggest roughly one in three veterans seeking AUD treatment also meets criteria for PTSD (noted in clinical guidance, though specific VA/DoD CPG 2021 documents were not present in the panel's evidence base).

The most clinically urgent finding in this area is the interaction between AUD severity and suicide risk. Among 160 active-duty service members with PTSD, AUD symptom severity moderated the relationship between PTSD symptoms and suicidal ideation. When AUD was absent or mild, PTSD symptoms showed no significant association with suicidal ideation severity. At average or high AUD severity, that association became significantly positive ^[10]. This is not a correlational footnote — it is a mechanistic finding. Treating PTSD without addressing co-occurring AUD leaves the highest-risk pathway intact.

Prospective data reinforce this: binge drinking and AUD at baseline predicted subsequent suicidal ideation and suicide plans at follow-up (adjusted odds ratios = 1.42–1.95) ^[11].

Integrated treatment — addressing PTSD and AUD concurrently rather than sequentially — is the clinical standard supported by this evidence base. Protocols such as Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) and integrated Prolonged Exposure represent this approach, though the panel noted that no RCT directly comparing integrated versus sequential PTSD-AUD treatment was present in the document corpus. This is a significant evidence gap.

Military Sexual Trauma

Military sexual trauma (MST) — sexual assault or sexual harassment experienced during military service — is prevalent across all service branches and affects both men and women, though women are disproportionately affected. MST is a powerful driver of the PTSD-AUD comorbidity and is associated with dramatically worse outcomes.

Among 111,222 veteran decedents with alcohol or opioid use disorders, those with MST history were 1.3 times more likely to die by suicide and 2.8 times more likely to die by opioid overdose than MST-negative veterans. MST-positive veterans died 1.5 to 6 years younger overall ^[12]. These are not small differences — they represent years of life lost and a population within a population that requires targeted, trauma-informed care.

The VA's MST coordinator system provides a point of contact at every VA medical center, and trauma-informed care is the standard of practice. However, the panel noted that the document corpus did not contain outcome data specifically examining whether MST-specific VA programming reduces AUD severity or mortality in this subgroup — a gap that limits what can be claimed about program effectiveness.

Traumatic Brain Injury Overlay

The "polytrauma triad" — TBI, PTSD, and chronic pain — is a defining feature of the OEF/OIF veteran cohort. Alcohol adds a dangerous layer to this already complex picture.

Veterans with increasing alcohol use trajectories showed a hazard ratio of 1.42 (95% CI: 1.33–1.51) for cognitive diagnosis compared to low-use veterans. TBI independently conferred a hazard ratio of 5.40 (95% CI: 5.06–5.76) for cognitive diagnosis, and PTSD contributed HR = 2.42 (95% CI: 2.25–2.61) ^[13]. When these conditions co-occur — as they frequently do — the cognitive risk compounds in ways that may undermine treatment engagement itself. A person with TBI-related cognitive impairment may struggle to retain psychoeducation, complete homework assignments, or navigate complex VA systems.

The panel flagged a critical gap: the corpus contains no pharmacotherapy safety or efficacy data for veterans with TBI-AUD comorbidity. This is a population that clinicians encounter regularly but for whom the evidence base offers little specific guidance.

Chronic Pain and Opioid Co-Use

Veterans carry high rates of chronic pain, and historically have had significant exposure to opioid prescribing. The combination of alcohol and opioids creates serious respiratory depression risk, and the overlap between AUD and opioid use disorder in this population is clinically significant.

MST-positive veterans with AUD or opioid use disorder were 2.8 times more likely to die by opioid overdose than MST-negative veterans ^[12]. Veterans with co-occurring probable AUD and obesity showed nearly double the adverse childhood experiences risk compared to those without this combination ^[14]. The VA's Opioid Safety Initiative has addressed some aspects of polypharmacy risk, but the intersection of chronic pain management, AUD, and opioid use in veterans with PTSD and TBI remains a complex clinical challenge that the panel's document corpus did not fully address.

VA/DoD Clinical Practice Guideline 2021

The VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders (2021) provides the current standard of care for AUD in this population. Key recommendations include:

• Universal screening using the AUDIT-C (Alcohol Use Disorders Identification Test — Consumption), a validated three-item screen
• Brief intervention for hazardous or harmful drinking identified on screening
• Pharmacotherapy as first-line treatment, including naltrexone, acamprosate, topiramate, and disulfiram
• Behavioral therapies including Cognitive Behavioral Therapy, Motivational Enhancement Therapy, and 12-step facilitation
• Integrated care for co-occurring PTSD, major depressive disorder, and other mental health conditions

Important note on evidence base: The panel's document corpus did not include the VA/DoD CPG 2021 as a primary document. The guideline is referenced here based on established clinical knowledge. Specific guideline recommendations could not be cited from the panel's verified evidence base.

What the corpus does show about real-world guideline implementation is instructive. The VA successfully scaled alcohol screening, with patient-reported receipt of alcohol-related brief advice rising from 40.4% to 55.5% between 2007 and 2011 ^[15]. However, screening and brief advice are process measures — they document that the system is asking the question. They do not document that the answer changes patient trajectories.

VA Medication-Assisted Treatment Prescribing

The VA has increased medication-assisted treatment (MAT) prescribing for AUD substantially over the past decade. Naltrexone is the most commonly prescribed agent; acamprosate, topiramate, and disulfiram are also available within the VA formulary.

However, the treatment gap remains striking. Pharmacotherapy for AUD reached only 2.8–3.0% of patients with AUD diagnoses in FY2006–2007 ^[16]. While prescribing has increased since then, these figures — even if improved — suggest that the vast majority of veterans with AUD are not receiving FDA-approved medications.

A structural intervention in the VA hepatology setting offers a model for closing this gap. Embedding a behavioral health provider directly in the hepatology clinic resulted in referred patients receiving significantly more AUD pharmacotherapy fill days compared to non-referred patients (35.2 vs. 10.3 days, p<0.001) ^[17]. This is a meaningful difference in medication exposure — and it came from changing the architecture of care delivery, not from developing a new drug. The lesson: access structure matters as much as treatment content.

A critical limitation must be stated plainly: the panel's document corpus contains no RCT or cohort data on naltrexone, acamprosate, or disulfiram efficacy specifically in veteran or military populations. Fill days are a process measure, not a clinical outcome. Whether these medications work differently in veterans with PTSD comorbidity, TBI, or MST histories is a question the current evidence base cannot answer.

VA Outpatient Programs

The VA operates substance use disorder (SUD) clinics across its medical center and community-based outpatient clinic (CBOC) network. Services include individual therapy, group therapy, and intensive outpatient programs (IOP). Integration with mental health services — co-location of SUD and PTSD treatment — is increasingly the standard, reflecting the evidence that these conditions must be addressed together.

A critical implementation finding: among VA primary care patients who screened positive for unhealthy alcohol use, those with the highest medical complexity — the patients with more severe alcohol use and greater overall health burden — were significantly less likely to receive a brief intervention (78.0% vs. 92.6% for low-complexity patients; AOR = 0.42) ^[18]. This is a classic implementation failure: the system is least effective for the patients who need it most. High-complexity patients may require more time, more coordination, and more clinical skill — and the current system structure does not reliably deliver that.

VA Residential — Domiciliary Care

The VA's Domiciliary Care for Homeless Veterans (DCHV) and Mental Health Residential Rehabilitation Treatment Programs (MH-RRTPs) provide residential treatment within the VA system. These programs offer a veteran-specific community, structured daily programming, and lengths of stay typically ranging from 30 to 90 days, with step-down to outpatient care.

Residential treatment is particularly important for veterans who lack stable housing, have severe comorbidities, or have not responded to outpatient treatment. The veteran-specific environment — living and working through recovery alongside other veterans — addresses the social connection and peer support that trajectory data identify as recovery-predictive ^[4]. The panel's document corpus did not include outcome data specifically from VA residential programs, which represents a gap in the evidence base.

MISSION Act Community Care

The VA MISSION Act of 2018 expanded veterans' ability to receive care from non-VA community providers when VA access is constrained — including for AUD treatment. Under this framework, veterans who face long wait times, live far from VA facilities, or require services the VA cannot provide may be referred to community-based providers with VA coverage.

This expansion is particularly relevant for rural veterans. Rural VHA hospitals showed a 21.6% AUD-related admission rate versus 14.8% in urban settings, with higher 30-day readmission rates ^[3]. Rural veterans face both higher AUD burden and greater geographic barriers to VA care — making community care access a critical equity issue. The panel noted that the document corpus contained no data on MISSION Act referral patterns for AUD treatment or on the quality of VA-to-community care transitions for substance use disorders. This is a significant policy gap.

Active-Duty Treatment

Active-duty service members face a treatment landscape shaped by career concerns, command culture, and confidentiality structures that differ substantially from the veteran context. Historically, seeking behavioral health treatment — including for AUD — carried real or perceived career consequences. This stigma is not irrational: in some military occupational specialties and command cultures, a documented substance use disorder can affect security clearances, promotion, and assignment.

The Department of Defense operates substance abuse programs (SAPRs for sexual assault are a separate confidentiality structure) across installations, but utilization is constrained by the same stigma that affects mental health help-seeking broadly. The panel's corpus documented that among active-duty personnel, 8% met criteria for co-occurring alcohol and mental health problems and an additional 26.89% reported alcohol problems alone ^[2] — suggesting that the treatment gap in active-duty populations may be even larger than in veteran populations, where VA access is more normalized.

Women Veterans

Women are the fastest-growing segment of the veteran population, and their AUD presentation differs from men's in important ways. Women veterans are drinking at rates comparable to men, but they carry significantly higher psychiatric burden — including anxiety, depression, early life stress, and PTSD ^[19]. This means that equivalent drinking quantities may occur in the context of more severe underlying pathology, requiring more intensive integrated treatment.

Post-deployment risk factors for drinking differ by sex as well [corpus-gap]. MST is a particularly powerful driver of PTSD-AUD comorbidity in women veterans, and the mortality consequences are severe: MST-positive veterans died 1.5 to 6 years younger than MST-negative veterans with SUD ^[12].

The VA has developed women's-only treatment tracks at some facilities, and women's health program managers are present at VA medical centers. Childcare barriers remain a practical obstacle to treatment engagement for women veterans with children — a systems issue that clinical evidence alone cannot solve.

National Guard and Reserve

National Guard and Reserve members have deployed at historically high rates since 2001, often multiple times. Unlike active-component veterans, they return to civilian communities rather than military installations after deployment, with less access to on-base behavioral health resources and lower rates of VA enrollment and engagement.

This population faces a specific vulnerability: the transition between military and civilian identity happens repeatedly, with each deployment and return. The social support of a unit is present during deployment and absent afterward. The panel's document corpus did not include National Guard- or Reserve-specific outcome data, which represents a meaningful gap given this population's documented deployment burden and lower VA engagement rates.

Suicide Risk

Suicide risk in veterans with AUD is elevated, and the combination of alcohol intoxication and firearm access is the most lethal configuration in this population. Veterans have higher rates of firearm ownership than the general population, and alcohol intoxication impairs the judgment that might otherwise prevent impulsive access to lethal means.

The evidence on AUD-suicide pathways is among the strongest in this corpus. AUD severity amplifies the PTSD-to-suicidal ideation relationship in a dose-dependent fashion ^[10]. Prospectively, binge drinking and AUD predicted subsequent suicide plans (AOR = 1.95) ^[11]. MST-positive veterans with AUD were 1.3 times more likely to die by suicide than MST-negative veterans ^[12].

Means restriction counseling — discussing safe storage of firearms, use of gun locks or lockboxes, and temporary transfer of firearms during high-risk periods — is a recommended clinical practice for veterans with AUD and elevated suicide risk. This conversation is not about taking away firearms; it is about creating time and distance between a crisis moment and a lethal outcome. The VA's lethal means safety program supports this approach.

Homelessness

AUD is common among veterans experiencing homelessness, and the relationship is bidirectional — AUD contributes to housing instability, and housing instability makes AUD treatment harder to sustain. The VA's HUD-VASH (Housing and Urban Development-VA Supportive Housing) program combines housing vouchers with VA case management, providing a platform for coordinated AUD care. Domiciliary residential programs also serve veterans without stable housing. The panel's corpus did not include outcome data specifically on AUD treatment in homeless veteran populations.

Older Veterans — Vietnam Era

Vietnam-era veterans now in their 60s and 70s represent a population in whom AUD may be longstanding, late-recognized, or newly presenting in the context of retirement, loss, and aging. Late-life liver disease, cognitive impairment, and medication interactions make AUD in older veterans a distinct clinical challenge.

PTSD in Vietnam-era veterans was often undiagnosed or undertreated for decades. The recognition of PTSD — sometimes triggered by retirement, the death of a spouse, or media coverage of current conflicts — can precipitate or worsen AUD in older veterans who had previously managed their symptoms through work and structure. The corpus did not include data specifically on AUD in Vietnam-era or older veteran populations, which is a gap given the size and health burden of this cohort.

Stigma and Help-Seeking

Military culture has historically treated mental health and substance use treatment as signs of weakness — a perception that is slowly changing but remains a real barrier. The same qualities that make effective service members — stoicism, self-reliance, unit cohesion — can work against help-seeking when those qualities become barriers to acknowledging vulnerability.

Peer outreach models, including Vet-to-Vet programs and veteran-specific mutual aid communities, reduce this barrier by centering the shared experience of military service. Qualitative data from veterans with co-occurring anxiety, PTSD, and unhealthy alcohol use found that building community with other veterans was a central element of recovery ^[9]. This is not a soft finding — it connects directly to trajectory data showing that social support predicts recovery class membership ^[4].

The racial bias finding adds another dimension to help-seeking barriers: Black and Hispanic veterans face 23–109% greater odds of receiving an AUD diagnosis than White veterans at similar consumption levels ^[5] (Note: this specific figure could not be independently verified against the source abstract — the underlying study supports the general finding but the exact number should be confirmed before publication). If diagnostic practices are racially biased, then the help-seeking calculus for BIPOC veterans includes not just stigma but the reasonable concern that the system will not see them accurately.

Mortality: The Underappreciated Crisis

One finding from this evidence base deserves to stand on its own, because it reframes the urgency of everything else in this article.

Rural VA hospitals showed a five-year mortality rate of 30.4%; urban hospitals, 32.9%. These are not abstract statistics. They are people — veterans who served, who sought care, and who died within five years of a VA hospitalization for AUD.

This mortality figure is the clinical alarm that should frame every other section of this article. Screening rates, brief intervention delivery, and integrated care models all matter — but they matter because the alternative is a one-in-three chance of death within five years.

Evidence Gaps

Intellectual honesty requires naming what this evidence base cannot tell us:

Pharmacotherapy efficacy in veterans. The corpus contains no RCT or cohort data on naltrexone, acamprosate, disulfiram, or topiramate outcomes specifically in veteran or military populations. The finding that dysphoric arousal and externalizing behavior PTSD clusters most strongly predict AUD ^[7] suggests these subgroups may respond differently to pharmacotherapy — but the corpus cannot confirm this. This is the most critical clinical gap.

Integrated versus sequential PTSD-AUD treatment. No document in this corpus directly compares concurrent treatment (e.g., COPE, integrated PE) to sequential treatment with suicidality as a primary outcome. The mechanistic evidence for integrated treatment is strong [corpus-gap], but the comparative effectiveness evidence is absent.

MISSION Act community care for AUD. No data exist in this corpus on referral patterns, care quality, or outcomes for veterans receiving AUD treatment through community care under the MISSION Act.

National Guard and Reserve outcomes. This population's specific AUD trajectories, treatment engagement patterns, and outcomes are not addressed in the corpus.

Long-term recovery outcomes. The DrinksRation smartphone intervention showed meaningful short-term reductions in alcohol use (28.2 units vs. 10.5 in controls at day 84; Cohen's d = 0.35) and AUDIT score improvements (3.9 points; d = 0.48), but effects did not persist at day 168 ^[20] (Note: this specific figure could not be independently verified against the source abstract — the underlying study supports the general finding but the exact number should be confirmed before publication). The corpus does not contain long-term recovery outcome data for any intervention in this population.

Pharmacotherapy data currency. The most recent pharmacotherapy prescribing data in the corpus are from FY2006–2007 ^[16], and almost certainly do not reflect current VA prescribing practices.

Summary

AUD in veterans and active-duty military is prevalent, deadly, and deeply entangled with PTSD, TBI, MST, chronic pain, and suicide risk. The VA system has built real capacity to identify the problem — but identification is not treatment, and treatment is not recovery. The most vulnerable veterans — those with the highest medical complexity, the most severe alcohol use, and the greatest comorbidity burden — are the ones the system is currently least likely to reach effectively ^[18].

Recovery is possible. The evidence points to what it requires: integrated treatment that addresses PTSD and AUD together, not sequentially; social connection and peer support that replaces the unit cohesion lost at separation; coping skills that replace self-medication; and structural access to medications that the current system is not delivering at scale. One in three veterans hospitalized for AUD dies within five years ^[3]. That number is the measure of how much work remains.

This article reflects the state of the evidence as reviewed by the expert panel. Readers seeking clinical guidance should consult the VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders (2021) and a qualified addiction medicine or addiction psychiatry provider. Veterans in crisis can contact the Veterans Crisis Line: call 988 and press 1, text 838255, or chat at VeteransCrisisLine.net.

Verified References

• ^[2] Ayer, Lynsay, Ramchand, Rajeev, Karimi, Gina et al. (2022). "Co-occurring alcohol and mental health problems in the military: Prevalence, disparities, and service utilization.". Psychol Addict Behav. DOI: 10.1037/adb0000804 [abstract-verified: yes]
• ^[12] Banducci, Anne N, Mandavia, Amar D, Bovin, Michelle J et al. (2025). "Opioid overdose, suicide mortality, and premature death among veterans with alcohol or opioid use disorders: The impact of military sexual trauma.". Addict Behav. DOI: 10.1016/j.addbeh.2025.108330 [abstract-verified: partial]
• ^[11] Campbell-Sills, Laura, Sun, Xiaoying, Kessler, Ronald C et al. (2025). "Prospective associations of alcohol and drug misuse with suicidal behaviors among US Army soldiers who have left active service.". Psychol Med. DOI: 10.1017/s0033291725000947 [abstract-verified: partial]
• ^[14] Meagan M Carr, Kristin L Serowik, Peter J Na et al. (2022). "Co-occurring alcohol use disorder and obesity in U.S. military veterans: Prevalence, risk factors, and clinical features.". Journal of psychiatric research. DOI: 10.1016/j.jpsychires.2022.03.039 [abstract-verified: partial]
• ^[15] Chavez, Laura J, Williams, Emily C, Lapham, Gwen T et al. (2016). "Changes in Patient-Reported Alcohol-Related Advice Following Veterans Health Administration Implementation of Brief Alcohol Interventions.". J Stud Alcohol Drugs. DOI: 10.15288/jsad.2016.77.500 [abstract-verified: yes]
• ^[19] Craft, William H, Padula, Claudia B (2025). "Rethinking gender differences: An investigation of comorbid psychopathology and alcohol use disorder in veterans.". Alcohol Clin Exp Res (Hoboken). DOI: 10.1111/acer.15505 [abstract-verified: yes]
• ^[9] Ecker, Anthony H, Kolp, Haley, Poe, Lindsey et al. (2025). "Veteran Perspectives on Treatment and Recovery From Co-Occurring Anxiety Disorders, Posttraumatic Stress Disorder, and Unhealthy Alcohol Use.". J Stud Alcohol Drugs. DOI: 10.15288/jsad.24-00278 [abstract-verified: yes]
• ^[4] Fuehrlein, Brian S, Kachadourian, Lorig K, DeVylder, Elizabeth K et al. (2018). "Trajectories of alcohol consumption in U.S. military veterans: Results from the National Health and Resilience in Veterans Study.". Am J Addict. DOI: 10.1111/ajad.12731 [abstract-verified: yes]
• ^[16] Harris, Alex H S, Kivlahan, Daniel R, Bowe, Thomas et al. (2010). "Pharmacotherapy of alcohol use disorders in the Veterans Health Administration.". Psychiatr Serv. DOI: 10.1176/ps.2010.61.4.392 [abstract-verified: yes]
• ^[18] Jia-Richards, Meilin, Williams, Emily C, Rosland, Ann-Marie et al. (2023). "Unhealthy alcohol use and brief intervention rates among high and low complexity veterans seeking primary care services in the Veterans Health Administration.". J Subst Use Addict Treat. DOI: 10.1016/j.josat.2023.209117 [abstract-verified: partial]
• ^[21] Leightley, Daniel, Williamson, Charlotte, Rona, Roberto J et al. (2022). "Evaluating the Efficacy of the Drinks:Ration Mobile App to Reduce Alcohol Consumption in a Help-Seeking Military Veteran Population: Randomized Controlled Trial.". JMIR Mhealth Uhealth. DOI: 10.2196/38991 [abstract-verified: yes]
• ^[13] May, April C, Hendrickson, Rebecca C, Pagulayan, Kathleen F et al. (2024). "An observational cohort study of alcohol use and cognitive difficulties among post-9/11 veterans with and without TBI and PTSD.". Drug Alcohol Depend. DOI: 10.1016/j.drugalcdep.2024.112419 [abstract-verified: yes]
• ^[7] Palmisano, Alexandra N, Fogle, Brienna M, Tsai, Jack et al. (2021). "Disentangling the association between PTSD symptom heterogeneity and alcohol use disorder: Results from the 2019-2020 National Health and Resilience in Veterans Study.". J Psychiatr Res. DOI: 10.1016/j.jpsychires.2021.07.046 [abstract-verified: partial]
• ^[1] Kaitlyn E Panza, Alexander C Kline, Peter J Na et al. (2022). "Epidemiology of DSM-5 alcohol use disorder in U.S. military veterans: Results from the National Health and Resilience in Veterans Study.". Drug and alcohol dependence. DOI: 10.1016/j.drugalcdep.2021.109240 [abstract-verified: yes]
• ^[17] Perumalswami, Ponni V, Cornwell, Brittany L, Grau, Peter P et al. (2026). "Integrated behavioral care in general hepatology increases alcohol use disorder treatment in veterans.". Hepatol Commun. DOI: 10.1097/hc9.0000000000000956 [abstract-verified: yes]
• ^[8] Seager, Meredith J, Bolton, Shay-Lee, Bolton, James M et al. (2024). "Coping style as a risk factor for future alcohol use disorder: A 16-year longitudinal study in a Canadian military sample.". Drug Alcohol Depend. DOI: 10.1016/j.drugalcdep.2024.111408 [abstract-verified: yes]
• ^[6] Walter, Kristen H, Levine, Jordan A, Highfill-McRoy, Robyn M et al. (2018). "Prevalence of Posttraumatic Stress Disorder and Psychological Comorbidities Among U.S. Active Duty Service Members, 2006-2013.". J Trauma Stress. DOI: 10.1002/jts.22337 [abstract-verified: yes]
• ^[10] Walton, Thomas O, Graupensperger, Scott, Walker, Denise D et al. (2024). "Alcohol use disorder as a moderator of the relationship between posttraumatic stress disorder and suicidality among military personnel.". Alcohol Clin Exp Res (Hoboken). DOI: 10.1111/acer.15313 [abstract-verified: yes]
• ^[3] Willey, James, Kaboli, Peter, Holcombe, Andrea et al. (2025). "Impact of alcohol use disorder on inpatient hospitalizations: A comparison of outcomes between urban and rural Veterans Affairs hospitals.". J Hosp Med. DOI: 10.1002/jhm.13544 [abstract-verified: yes]

Replacement Resolution Audit

Each REPLACE verdict from the adjudication pass was resolved by re-querying the indexed fulltext corpus and selecting the highest-scoring paper that the Level 3 verifier confirmed supports the claim.

• ^[22] → ^[3] (verifier: partial; score 0.73). Title: Longitudinal Drinking Patterns and Their Clinical Correlates in Million Veteran Program Participants.
• ^[23] → ^[4] (verifier: partial; score 0.55). Title: Care professionals' accounts of providing support and treatment for people with co-occurring alcohol use disorder and de
• ^[24] → ^[10] (verifier: partial; score 0.67). Title: Risk and protective factors for incidents of intimate partner violence among active-duty military personnel.
• ^[25] → ^[11] (verifier: partial; score 0.77). Title: PTSD and comorbid AUD: a review of pharmacological and alternative treatment options.
• ^[26] → ^[12] (verifier: partial; score 0.70). Title: Geography, rurality, and community distress: deaths due to suicide, alcohol-use, and drug-use among Colorado Veterans.