What is PTSD?
Post-traumatic stress disorder (PTSD) is a mental health condition in which an individual experiences periods of sustained and abnormally-elevated psychological distress following exposure to a traumatic or stressful event.1,15 Many people with PTSD also have other co-occurring disorders, such as substance use disorders like alcoholism or depression and anxiety, which can also worsen PTSD symptoms and make it more difficult to manage.
Anyone who has experienced trauma at any age can develop PTSD, though the condition develops prevalently among adults whose vocation—for example, military service members, police, firefighters, and emergency medical personnel—increases their risk of traumatic exposure .2,15 According to the National Center for PTSD, an estimated 7 to 8 people out of every 100 will develop the disorder in their lifetimes.1
Symptoms of PTSD usually emerge within 3 months of witnessing or experiencing trauma, but they can also develop much later.1 To receive a PTSD diagnosis, symptoms must last for longer than a month and significantly impair your ability to function normally.1
Characteristic symptoms of PTSD include: 2
- Re-experiencing the trauma through flashbacks, distressing thoughts, dreams, or nightmares.
- Avoiding people, places, or thoughts that remind you of the event.
- Being unable to remember important details regarding the traumatic event.
- Persistent self-blame or negative beliefs about yourself, others, and the world.
- Ongoing feelings of fear, horror, anger, guilt, or shame.
- A reduced interest in activities you once enjoyed.
- An inability to feel positive emotions.
- Irritability or aggressiveness.
- Having hyperarousal symptoms, such as being easily startled by sounds.
- Problems concentrating.
- Problems falling or staying asleep.
- Clinically significant distress or inability to function in areas of your life (such as your job or home life), which is not the result of another condition, such as brain injury.
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Who Develops PTSD?
Although anyone can develop PTSD after experiencing trauma, women are more likely to develop the disorder than men and is commonly associated with veterans of war.1 Much research has focused on this population because they have a high likelihood of developing the disorder due to the nature of their work.3
However, other victims of trauma, including people who have witnessed or experienced a sexual or physical assault, accident, disaster, terror attack, or other traumatic events, can develop PTSD. In addition, people can develop PTSD even if they have not directly experienced the event but have heard that a friend or family member has undergone trauma.1
Certain risk factors can increase the likelihood of developing PTSD following a traumatic event. Some of these factors may be present before the event while others may influence its development afterward. These factors can include:1
- Feelings of helplessness or fear.
- Exposure to traumatic events.
- Childhood trauma.
- Physical injury or witnessing death.
- A lack of social support following an event.
- Having increased stress after the trauma due to external factors (such as loss of a loved one, divorce, etc.).
- A personal or family history of mental health or substance abuse.
While these factors can increase the likelihood of PTSD, there are also resilience factors that can reduce the chances that a person will develop the disorder. These factors include:1
- Asking for and receiving support from family, friends, and loved ones.
- Acceptance of your actions and feelings following a traumatic event.
- Having good coping skills.
- Feeling that you can handle distressing events when they occur despite feeling afraid.
The Link Between Alcohol Abuse and PTSD
There is a strong bidirectional association between alcohol abuse and PTSD. PTSD can increase the risk of alcohol abuse, and alcohol abuse can increase the likelihood of becoming involved in events that can lead to trauma as well as worsen symptoms in people who already have PTSD.4
According to the VA’s National Center for PTSD, as many as 75% of people who are survivors of abuse or violent traumatic events reported drinking problems.4 Additionally, women with PTSD are 2.5 times more likely to develop an alcohol problem than women with no PTSD, and men with PTSD are 2 times more likely to have alcohol problems than men with no PTSD.4
However, the relationship between PTSD and substance abuse disorders is complex. When the initial problem is with alcohol or other substances, people may then have a higher risk of developing PTSD because they continuously place themselves in dangerous situations that can lead to trauma (such as driving while intoxicated or drinking while operating machinery or while swimming).5
Yet, people with a primary diagnosis of PTSD can also have a higher risk of developing substance use disorders because they use drugs or alcohol in an attempt to improve certain PTSD symptoms.5 In fact, people with PTSD report that using central nervous system depressants, such as alcohol, opioids, or benzodiazepines, helps to acutely relieve their PTSD symptoms, which can reinforce this “self-medication” approach and perpetuate a cycle of continued substance abuse.5
For some people with PTSD, alcohol use may increase to essentially counter the biochemical consequences of the “fight or flight” response, or increased arousal that is stimulated following exposure to or even reminders of a previously-experienced trauma.6
Normally, when you experience trauma, endorphin activity increases as a way to help numb your body to the pain of the event.6 However, repeated exposure to “uncontrollable trauma” (such as through flashbacks or the continuous mental reliving of the event) and the resulting chronic stimulation of the stress response can diminish the normal compensatory effects of our endorphin system, essentially resulting in a physiological phenomenon analogous to endorphin withdrawal.6 pg 259
Drinking alcohol may compensate for this endorphin withdrawal, or serve as a substitute for the lack of endorphin activity to help you feel better, at least temporarily, which, for many people, is preferable to feeling the pain of the event over and over again.6
What is Alcohol Use Disorder?
When problem drinking becomes severe enough, a person may have an alcohol use disorder (AUD). AUD is a clinical diagnosis that refers to alcohol addiction, which is a chronic, relapsing brain disease that is characterized by an inability to control alcohol use.7 People with AUD continue to drink despite the negative effects it has on their lives.7
The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) outlines several characteristic signs, symptoms, and behavioral changes used to diagnose AUD. To receive a diagnosis of AUD, a person must meet at least 2 of the outlined criteria within a 12-month period. Some of these criteria include:15
- Being unable to control or cut down your drinking, despite intentions to do so.
- Spending a lot of time drinking or recovering from the effects of alcohol (i.e. frequently calling in sick to work because of hangovers or staying in bed all day after a night of drinking).
- Experiencing social, occupational, or educational problems because of your alcohol use.
- Giving up or severely cutting down on the time you spend on activities you once enjoyed so you can drink.
- Drinking while in situations where it is physically dangerous to do so, such as while driving or operating machinery.
- Continuing to drink despite having a physical or psychological problem that is likely the result of your alcohol use.
Treating Co-Occurring PTSD and AUD
An estimated 15 million Americans have AUD, which includes 14.4 million adults aged 18 and older, and around 401,000 adolescents aged 12–17.7 Studies show that 85% of people with PTSD meet the criteria for an additional psychiatric disorder while inpatient substance abuse treatment centers have reported that 50% of their patients met the criteria for PTSD.8 Furthermore, one study showed that 42% of PTSD study participants also met the criteria for an AUD diagnosis.9 The National Center for PTSD reports that between 6 and 8 of every 10 Vietnam veterans seeking PTSD treatment have alcohol use problems.4
Treating comorbid PTSD and AUD requires an integrated approach, which means simultaneously managing both conditions with targeted therapies.10 The main types of treatment are psychotherapy, medication, or both.1
Research on medications that can effectively treat both PTSD and AUD has, to date, been somewhat limited. Studies have shown that topiramate (a medication sometimes used off-label to decrease drinking behavior in people with AUD) and prazosin (an antihypertensive medication used off-label to manage some of the symptoms of PTSD) may help to reduce symptoms of both disorders.11 Other medications that have been studied for treating PTSD mainly include antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs).1
The U.S. Department of Veterans Affairs lists four SSRI medications that have been recommended for PTSD: sertraline (Zoloft), paroxetine (Paxil), fluoxetine (Prozac), and venlafaxine (Effexor).12 There are three medications approved by the FDA to treat alcoholism by helping individuals stop or reduce their drinking and avoid relapse.11 Naltrexone, acamprosate and disulfiram are all non-addictive.11 While not everyone will respond to them, they have shown to be an important tool for managing AUD.11
Different psychotherapeutic techniques and therapies may be used to treat comorbid AUD and PTSD. Psychotherapy, also known as talk therapy, can help people identify their emotions and triggers for symptoms to help them develop better coping mechanisms. The type of treatment that is best for you can depend on the type of trauma you experienced.
For example, veterans of war may benefit from different treatments than victims of childhood abuse. One form of psychotherapy that may be particularly helpful for PTSD is known as cognitive behavioral therapy (CBT), which focuses on the identification of negative or unhelpful thoughts and behaviors and learning healthier coping skills.11,14
Two forms of CBT have been shown to help treat PTSD. Exposure therapy helps people overcome trauma by gradually re-exposing them to the context of the trauma in a safe, controlled situation so they learn to manage their fear; this may help reduce symptoms of distress.1,14 The other form of CBT is known as cognitive restructuring, which helps people understand and make sense of the trauma.1 It is designed to help people view their trauma in a different and perhaps healthier or more constructive way.1
In addition to CBT, other approaches to treating comorbid disorders may include dialectical behavior therapy (DBT), which is designed to reduce self-harming behaviors, and assertive community treatment, which is focused on helping people reintegrate into their communities.14
Studies have examined other treatments specifically geared toward PTSD and AUD, and while not all treatments have shown beneficial results, the best-studied method has been Seeking Safety, a treatment developed specifically to address this comorbidity.11 It includes an integrative approach to addressing cognitive, behavioral, interpersonal, and case management issues.11 Holistic approaches such as mindfulness, acupuncture, and yoga have also been shown to help reduce alcohol use and symptoms of PTSD.11
Get Help for Alcoholism and PTSD
If you’re struggling with alcoholism and PTSD, American Addiction Centers (AAC) can help you find treatment. Alcohol.org is a subsidiary of AAC, a nationwide provider of rehab centers.
AAC’s treatment team of doctors, therapists, and other treatment professionals, will address the comorbidity of PTSD and alcoholism and can tailor your mental health and recovery treatment plans to offer you a comprehensive, integrated approach to manage both your substance use and mental health issues.
If you’re interested in learning more about your treatment options, our admissions navigators are available to chat with you 24/7. Call our hotline at 1-888-685-5770
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. National Institute of Mental Health. (2020). Post-traumatic stress disorder.
. Anxiety and Depression Association of America. (n.d.). Posttraumatic stress disorder (PTSD).
. Carter, A. C., Capone, C., & Short, E. E. (2011). Co-occurring posttraumatic stress disorder and alcohol use disorders in veteran populations. Journal of Dual Diagnosis, 7(4), 285–299.
. U.S. Department of Veterans Affairs. (2019). PTSD and problems with alcohol use.
. Jacobsen, L. K., Southwick, S. M., & Kosten, T. R. (2001). Substance use disorders in patients with posttraumatic stress disorder: A review of the literature. The American Journal of Psychiatry, 158(8), 1184–1190.
. Volpicelli, J., Balaraman, G., Hahn, J., Wallace, H., & Bux, D. (1999). The role of uncontrollable trauma in the development of PTSD and alcohol addiction. Alcohol Research & Health: The Journal of the National Institute on Alcohol Abuse and Alcoholism, 23(4), 256–262.
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol use disorder.
. Souza, T., & Spates, C. R. (2008). Treatment of PTSD and substance abuse comorbidity. The Behavior Analyst Today, 9(1), 11-26.
. Neupane, S.P., Bramness, J.G. & Lien, L. (2017). Comorbid post-traumatic stress disorder in alcohol use disorder: relationships to demography, drinking and neuroimmune profile. BMC Psychiatry 17, 312.
. McCauley, J. L., Killeen, T., Gros, D. F., Brady, K. T., & Back, S. E. (2012). Posttraumatic stress disorder and co-occurring substance use disorders: Advances in assessment and treatment. Clinical Psychology: A Publication of the Division of Clinical Psychology of the American Psychological Association, 19(3), 10.1111/cpsp.12006.
. Ralevski, E., Olivera-Figueroa, L. A., & Petrakis, I. (2014). PTSD and comorbid AUD: A review of pharmacological and alternative treatment options. Substance Abuse and Rehabilitation, 5, 25–36.
. U.S. Department of Veterans Affairs. (2020). Medications for PTSD.
. Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment improvement protocol (TIP) series, no. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment.
. National Institute on Drug Abuse. (2018). DrugFacts: Comorbidity: Substance use disorders and other mental illnesses.
. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing.