Veterans of Iraq and Afghanistan are at greater risk of hazardous drinking and alcohol-related consequences compared to the general population (Calhoun et al., 2008, Lan et al., 2016, Wagner et al., 2007). Hazardous drinking is more frequent and severe among veterans with trauma exposure and posttraumatic stress disorder (PTSD; Fuehrlein et al., 2016), and trauma-exposed Iraq and Afghanistan veterans have reported trauma-related motives to continue versus change their drinking (Schreiner et al., 2021). Unfortunately, less is currently known regarding Iraq and Afghanistan veterans’ motives for changing or sustaining alcohol use, including the direction and degree to which motives relate to one another and the relative importance of these motives. Knowledge of this kind could facilitate streamlined therapeutic dialogue and tailored treatment to enhance engagement, which is important given the clear and critical need to promote treatment retention and recovery among veterans.

The motivational model of alcohol use (Cox and Klinger, 1990, Cooper et al., 1995) indicates that multiple pathways lead to alcohol use as evidenced by distinctive functions underlying reasons for drinking. Examples of common motives to drink include enhancement (e.g., increase enjoyment of everyday activities), coping with distress, socializing, and conforming to societal expectations (Cooper, 1994, Grant et al., 2007). On the other hand, motives for reducing or abstaining from drinking as reported in the non-veteran literature include improving health, relationships, and finances, and taking on new or successfully managing current responsibilities (Cunningham et al., 2002, 2004, 2005). It is possible that many individuals have more than one reason motivating them to drink or not (Cooper et al., 1995). Individuals who are motivated to continue drinking might report coping with distressing emotions while also agreeing that alcohol serves to buffer discomfort when socializing. Conversely, people who are motivated to cut back or stop drinking may be motivated to reduce alcohol-related health consequences, whereas another person is motivated by improving their occupational functioning. In addition to the unique motives of a person, knowledge of their relative importance could help anchor interventions to the primary motivational factors to better match treatment with patients’ intrinsic motivation.

Although knowledge about motives for changing versus not changing drinking among veterans remains limited, there is some evidence that these motives differ among veterans and in ways consistent with higher levels of trauma exposure. Among Iraq and Afghanistan veterans reporting heavy drinking, those who met diagnostic criteria for PTSD were significantly more likely to endorse drinking to cope with anxiety or depression relative to those without PTSD (McDevitt -Murphy et al., 2015), and drinking to cope was specifically related to re-experiencing and avoidance symptoms (McDevitt-Murphy et al., 2017). A recent analysis of 1,295 Iraq and Afghanistan veterans from a longitudinal cohort study revealed that PTSD avoidance symptoms were prospectively associated with higher alcohol use 1-2 years later and trauma-related reckless and self-destructive behavior was associated with future binge-drinking frequency (Livingston et al., 2021). These findings implicate PTSD symptoms as sharing functional associations with alcohol use and perhaps also motives for or against reducing alcohol use following a traumatic event. In related research, Schreiner and colleagues (2021) directly evaluated self-generated motives for and against reducing or abstaining from drinking among Iraq and Afghanistan veterans following use of a web-based intervention for hazardous drinking and PTSD. They observed that motives for changing (e.g., health, finances) and motives against changing were consistent with prior literature (e.g., tension reduction) but also potentially unique to trauma-exposed veterans (e.g., cope with nightmares, suppress combat memories). The preliminary evidence identifying differential motivations underscores the need for additional research to inform clinical intervention. The current study aims are three-fold: 1) reduce the dimensionality and increase interpretability of the qualitatively coded categories of motives for and against changing alcohol use, 2) investigate potential clustering of these motives by evaluating the strength and direction of their associations, and 3) explore whether certain motives may be more strongly associated with higher or lower overall motivation for or against change.