Reducing obstacles to affiliation with alcoholics anonymous among veterans with PTSD and alcoholism.

Alcohol use is prevalent among Vietnam veterans who suffer from chronic combat-related posttraumatic stress disorder (PTSD). Although Alcoholics Anonymous (AA) is the mainstay of ambulatory alcoholism treatment, adherence to particular components of the AA philosophy may prove especially challenging for alcoholic Vietnam veterans with PTSD. The authors describe elements of AA's philosophy, such as "surrendering" to a "higher power," making amends to persons one has harmed, and sharing one's story publicly, that may be difficult for the Vietnam veteran with PTSD. The authors suggest that an important factor in the successful affiliation of these patients with AA is their capacity to separate their alcohol-related problems and treatment from their PTSD symptoms and treatment and to accommodate dual identities as both an alcoholic and a traumatized soldier. Preparing such patients for AA by reframing some of the 12 steps is recommended.