Posttraumatic stress and substance use among military veterans: Associations with distress intolerance and anxiety sensitivity

•PTSD symptoms and substance use among veterans were examined.•Anxiety sensitivity (AS) and distress intolerance (DI) were evaluated as mediators.•PTSD severity was related to alcohol use severity through AS but not DI.•PTSD severity was related to drug use severity through DI but not AS.•PTSD is differentially linked to alcohol or substance use via AS and DI, respectively. The co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is highly prevalent among military veterans and represents a difficult-to-treat comorbidity. Distress intolerance (DI; i.e., the perceived inability to tolerate negative emotional states) and anxiety sensitivity (AS, i.e., the fear of anxiety-related sensations) are two promising targetable mechanisms with potential to predict and improve treatment outcomes for veterans with PTSD/SUD. We hypothesized that PTSD symptom severity would be related to (a) alcohol use severity and (b) drug use severity through DI and AS, evaluated concurrently. Participants included 120 military veterans (98.3% male; Mage = 41.41, SD = 10.77) presenting for psychological services at a Veterans Affairs PTSD/SUD clinic. Results indicated that PTSD symptom severity was related to alcohol use severity through AS, but not DI; and PTSD symptom severity was related to drug use severity through DI, but not AS. Clinical and research implications are discussed.