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.
Additional Mental Health Issues
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.)
References
Evans, K. & Sullivan, J. M. (1995).
Treating addicted survivors of trauma. New York: Guilford
Press.
Kofoed, L., Friedman, M.J., & Peck, R. (Summer 1993).
Alcoholism and drug abuse in patients with PTSD.
Psychiatric Quarterly, 64(2), 151-171.
Matsakis, A. (1992).
I can't get over it: A handbook for trauma survivors.
Oakland, CA: New Harbinger Publications.