PTSD and Problems with
Alcohol Use
PTSD does not
automatically cause problems with alcohol use; there are many people
with PTSD who do not have problems with alcohol. However, PTSD and
alcohol together can be serious trouble for the trauma survivor and his
or her family.
How do
PTSD and alcohol use
affect each other and make problems worse?
PTSD
and alcohol problems often occur together.
People with PTSD are more likely than others with
similar backgrounds to have alcohol use disorders both before and after
being diagnosed with PTSD, and people with alcohol use disorders often
also have PTSD.
Being diagnosed with PTSD increases the risk of
developing an alcohol use disorder.
Women exposed to trauma show an increased risk for
an alcohol use disorder even if they are not experiencing PTSD. Women
with problematic alcohol use are more likely than other women to have
been sexually abused at some point in their lives.
Men and women reporting sexual abuse have higher
rates of alcohol and drug use disorders than other men and women.
Twenty-five to seventy-five percent of those who
have survived abusive or violent trauma also report problems with
alcohol use.
Ten to thirty-three percent of survivors of
accidental, illness, or disaster trauma report problematic alcohol use,
especially if they are troubled by persistent health problems or pain.
Sixty to eighty percent of Vietnam veterans
seeking PTSD treatment have alcohol use disorders. Veterans over the age
of 65 with PTSD are at increased risk for attempted suicide if they also
experience problematic alcohol use or depression. War veterans diagnosed
with PTSD and alcohol use tend to be binge drinkers. Binges may be in
reaction to memories or reminders of trauma.
Alcohol
problems often lead to trauma and disrupt relationships.
Persons with alcohol use disorders are more likely
than others with similar backgrounds to experience psychological trauma.
They also experience problems with conflict and intimacy in
relationships.
Problematic alcohol use is associated with a
chaotic lifestyle, which reduces family emotional closeness, increases
family conflict, and reduces parenting abilities.
PTSD
symptoms often are worsened by alcohol use.
Although alcohol can provide a temporary feeling
of distraction and relief, it also reduces the ability to concentrate,
enjoy life, and be productive.
Excessive alcohol use can impair one’s ability
to sleep restfully and to cope with trauma memories and stress.
Alcohol use and intoxication also increase
emotional numbing, social isolation, anger and irritability, depression,
and the feeling of needing to be on guard (hyper-vigilance).
Alcohol use disorders reduce the effectiveness of
PTSD treatment.
Many individuals with PTSD experience sleep
disturbances (trouble falling asleep or problems with waking up
frequently after falling asleep). When a person with PTSD experiences
sleep disturbances, using alcohol as a way to self-medicate becomes a
double-edged sword. Alcohol
use may appear to help symptoms of PTSD because the alcohol may decrease
the severity and number of frightening nightmares commonly experienced
in PTSD. However, alcohol
use may, on the other hand, continue the cycle of avoidance found in
PTSD, making it ultimately much more difficult to treat PTSD because the
client’s avoidance behavior prolongs the problems being addressed in
treatment. Also, when a person withdraws from alcohol, nightmares often
increase.
Individuals with a
combination of PTSD and alcohol use problems often have additional
mental or physical health problems. As many as 10-50% of adults with
alcohol use disorders and PTSD also have one or more of the following
serious disorders:
Anxiety disorders (such as panic attacks, phobias,
incapacitating worry, or compulsions)
Mood disorders (such as major depression or a
dysthymic disorder)
Disruptive behavior disorders (such as attention
deficit or antisocial personality disorder)
Addictive disorders (such as addiction to or abuse
of street or prescription drugs)
Chronic physical illness (such as diabetes, heart
disease, or liver disease)
Chronic physical pain due to physical
injury/illness or due to no clear physical cause
What are
the most effective treatment patterns?
Because the existence of
both PTSD and an alcohol use disorder in an individual makes both
problems worse, alcohol use problems often must be addressed in PTSD
treatment. When alcohol use is (or has been) a problem in addition to
PTSD, it is best to seek treatment from a PTSD specialist who also has
expertise in treating alcohol (addictive) disorders. In any PTSD
treatment, several precautions related to alcohol use and alcohol
disorders are advised:
The initial interview and questionnaire assessment
should include questions that sensitively and thoroughly identify
patterns of past and current alcohol and drug use.
Treatment planning should include a discussion
between the professional and the client about the possible effects of
alcohol use problems on PTSD, sleep, anger and irritability, anxiety,
depression, and work or relationship difficulties.
Treatment should include education, therapy, and
support groups that help the client address alcohol use problems in a
manner acceptable to the client.
Treatment for PTSD and alcohol use problems should
be designed as a single consistent plan that addresses both sources of
difficulty together. Although there may be separate meetings or
clinicians devoted primarily to PTSD or to alcohol problems, PTSD issues
should be included in alcohol treatment, and alcohol use
("addiction" or "sobriety") issues should be
included in PTSD treatment.
Relapse prevention must prepare the newly sober
individual to cope with PTSD symptoms, which often seem to worsen or
become more pronounced with abstinence.
Where can
you get help?
For a listing of professionals in the
USA and Canada who treat alcohol disorders and PTSD, we suggest consulting
the membership directories of the International Society for Traumatic
Stress Studies or the Association of Traumatic Stress Specialists. For
veterans experiencing problems with PTSD and alcohol use, the Department
of Veterans Affairs has a network of specialized PTSD and substance use
treatment programs. For information on these programs, contact the local
VA Vet Center or the Psychiatry Service at a VA Medical Center. (For
addresses and telephone numbers, look under the "United States
Government" listings in the telephone directory.)
