Smoking as a Marker of Comorbid Vulnerability Among Persons with Probable Posttraumatic Stress Disorder Who Engage in Hazardous Drinking

<i>Background:</i> Persons with posttraumatic stress disorder (PTSD) compared to those without evince high rates of hazardous drinking, or patterns of alcohol consumption that increase the risk for harmful consequences. One potential marker of vulnerability for PTSD-hazardous drinking comorbidity may be smoking behavior. Individuals with PTSD have a higher prevalence of smoking and smoke at higher rates. Smokers, compared to nonsmokers, are more apt to engage in hazardous alcohol use. Notably, there is a need to expand research on smoking in the context of PTSD and hazardous drinking to inform treatment of these morbidities. <i>Objective:</i> The present cross-sectional investigation sought to examine smoking status as a marker of risk among persons with probable PTSD who engage in hazardous drinking (<i>N</i> = 647; <i>M</i>_age = 38.90 years, SD = 10.71; 51.2% female). <i>Results:</i> Results indicated that trauma-exposed smokers, compared to non-smokers, evinced greater severity of PTSD symptoms, depression, emotion regulation difficulties, hazardous drinking, and substance use problems, with small effect sizes. No statistically significant group differences were found for anxiety symptom severity. Secondary analyses among only smokers supported an interrelation between cigarette dependence and each of the criterion variables that demonstrated statistically significant group differences. Specifically, cigarette dependence was statistically significantly and incrementally related to PTSD symptom severity, depression, emotion regulation difficulties, more severe hazardous drinking, and a greater degree of substance use problems. <i>Conclusions:</i> Overall, the current investigation found that smoking status among persons with probable PTSD who engaged in hazardous drinking was associated with numerous indicators of mental health and substance use vulnerability.