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Posttraumatic stress disorder (PTSD) and unhealthy alcohol use are commonly associated conditions. It is unknown whether specific symptoms of PTSD are associated with subsequent initiation of unhealthy alcohol use.Data from the first 3 enrollment panels (n = 151,567) of the longitudinal Millennium Cohort Study of military personnel were analyzed (2001–2012). Complementary log-log models were fit to estimate whether specific PTSD symptoms and symptom clusters were associated with subsequent initiation of 2 domains of unhealthy alcohol use: risky and problem drinking (experience of 1 or more alcohol-related consequences). Models were adjusted for other PTSD symptoms and demographic, service, and health-related characteristics.Eligible study populations included those without risky (n = 31,026) and problem drinking (n = 67,087) at baseline. In adjusted analyses, only 1 PTSD symptom—irritability/anger—was associated with subsequent increased initiation of risky drinking (relative risk [RR] 1.05, 95% confidence interval [CI] 1.00–1.09) at least 3 years later. Two symptom clusters (dysphoric arousal [RR 1.17, 95% CI 1.11–1.23] and emotional numbing [RR 1.30, 95% CI 1.22–1.40]) and 5 symptoms (restricted affect [RR 1.13, 95% CI 1.08–1.19], sense of foreshortened future [RR 1.12, 95% CI 1.06–1.18], exaggerated startle response [RR 1.07, 95% CI 1.01–1.13], sleep disturbance [RR 1.11, 95% CI 1.07–1.15], and irritability/anger [RR 1.12, 95% CI 1.07–1.17]) were associated with subsequent initiation of problem drinking.Findings suggest that specific PTSD symptoms and symptom clusters are associated with subsequent initiation of unhealthy alcohol use.