How Do Suicidal Thoughts and Behaviors Affect Recovery From Alcohol Use Disorder and PTSD?
Veterans living with posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) face a higher risk for suicidal thoughts and behaviors (STB). Despite this overlap, many research studies and treatment programs exclude people who experience suicide risk, often out of concern that suicidal thoughts may interfere with recovery. These exclusions can unintentionally limit access to care and participation in research for individuals already managing trauma and substance use challenges.
A newly published study examined whether suicidal thoughts and behaviors actually slow recovery from PTSD and AUD during treatment. Notably, co-author Dr. Sudie Back is a close collaborator with CAS and serves as a Project Harmony co-investigator, and co-authors Dr. Margaret Baer and Dr. Krithika Prakash are early career investigators with Project Harmony’s Consortium on Addictions, Stress, and Trauma. Using data from 141 treatment-seeking Veterans enrolled in a randomized controlled trial, researchers tracked changes in PTSD symptoms and alcohol use over a 12-week period. Participants regularly reported their drinking patterns and PTSD symptoms, allowing the research team to compare how symptoms changed over time among Veterans with current STB, a history of STB, and no STB.
The findings offer important clarification. Veterans who reported current suicidal thoughts experienced higher overall PTSD symptom severity during treatment. However, neither current nor lifetime STB meaningfully altered the pace of recovery. Veterans with current STB showed reductions in both PTSD symptoms and alcohol use over time at rates comparable to Veterans without STB. In this study, suicidal thoughts and behaviors were associated with greater symptom burden, but not with poorer response to treatment.
These results have implications for communities, clinicians, and researchers alike. For Veterans and their loved ones, the findings challenge the idea that suicidal thoughts automatically mean treatment will not work. The study suggests that STB does not need to be fully resolved before individuals can engage in, and benefit from, treatment for PTSD and AUD. Clinicians can continue providing evidence-based care for trauma and alcohol use while also conducting routine suicide-risk assessments, safety planning, and timely transitions to higher levels of support when needed. For researchers, the study raises important questions about suicide-related exclusion criteria, which remain common in clinical trials.
More inclusive research practices may help ensure that study samples better reflect the real-world populations most affected by PTSD, AUD, and suicide risk, strengthening the relevance and applicability of research findings for prevention, treatment, and recovery efforts.
Reference
Baer, M. M., Prakash, K., Forkus, S. R., Back, S. E., Litz, B. T., Roache, J. D., Young-McCaughan, S., Keane, T. M., Peterson, A. L., & Flanagan, J. C. (2026). Suicidal thoughts and behaviors do not influence Veterans’ alcohol use disorder or posttraumatic stress disorder recovery trajectories in a randomized controlled trial. Journal of Studies on Alcohol and Drugs. https://doi.org/10.15288/jsad.25-00113
Prepared by Emmanuel D. Thomas, PhD, Postdoctoral Research Fellow, Rutgers Center of Alcohol & Substance Use Studies