Alcohol use disorder (AUD) is a significant public health concern that accounts for three million deaths worldwide every year (World Health Organization, 2022). The prevalence of AUD is higher among US veterans than non-veterans (Williamson, Stevelink, Greenberg, & Greenberg, 2018). For example, in a nationally representative study of US veterans, the lifetime and past-year prevalence of AUD were 42.2% and 14.8%, respectively (Fuehrlein et al., 2016), whereas in the general US adult population it was 29.1% and 13.9%, respectively (Grant et al., 2015). Further, in a recent cross-sectional survey of 1,730 US veterans, 24.1% screened positive for hazardous alcohol consumption group (Adams et al., 2022). Further, in a study on 189 Israel Defense Forces male combat veterans, the prevalence of risky or hazardous or above level alcohol consumption group was 11.3% (Feingold and Zerach (2021)).

While there has been an abundance of research on the epidemiology of alcohol use, most studies have focused on AUD and have been cross-sectional; longitudinal studies of alcohol use are scarce. The lack of longitudinal data is particularly evident in studies of military veterans. To date, only three known studies have examined alcohol use trajectories in this population. Two studies were on approximately 300 Vietnam-era veterans (Jacob et al., 2010, Jacob et al., 2005); the other study was our previous longitudinal study that examined the 4-year trajectories of alcohol consumption in a nationally representative sample of veterans (Fuehrlein et al., 2018). In that study, we found that lifetime major depressive disorder (MDD) was a strong determinant for the excessive alcohol consumption group, whereas lower social support and fewer medical conditions were strong determinants for the at-risk alcohol consumption group (Fuehrlein et al., 2018). Further, we found that secure attachment style, greater social support and no history of MDD were strong determinants for the recovering vs. the excessive alcohol consumption group. Characterization of the nature and predictors of courses of alcohol consumption in longitudinal studies is important, as it provides population-based insight into characteristics of individuals who may be at heightened risk for persistent alcohol use, which can help inform prevention and early intervention efforts.

Toward this end, we sought to build upon our previous 4-year findings (Fuehrlein et al., 2018) and examine the nature and the risk and protective factors associated with 10-year alcohol consumption trajectories in a nationally representative sample of US veterans. We had two aims: (1) to identify common trajectories of alcohol consumption; and (2) to identify risk and protective factors associated with distinct trajectories of alcohol consumption. Based on our previous studies (Fuehrlein et al., 2018, Palmisano et al., 2022), we hypothesized that psychiatric conditions such as MDD and posttraumatic stress disorder (PTSD) would be strong determinants for the excessive alcohol consumption group, and that greater social support and secure attachment style would be strong determinants for the recovering trajectory.