PTSD and Alcoholism: 75% of Trauma Survivors Develop Alcohol Addiction

PTSD and alcohol use disorder can be related, as one can lead to or exacerbate the other. Studies show that those who misuse alcohol may also experience post-traumatic stress disorder (PTSD). In a self-reporting survey, 28% of women diagnosed with PTSD reported concerns about alcohol abuse and dependence and just under 52% percent of men diagnosed with PTSD reported the same concerns.1

What Is Alcoholism?

Alcoholism, a common term for the clinical mental health condition alcohol use disorder (AUD), is defined as a “primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations.”2 Studies show that those with alcohol use disorder often experience a progression in their symptoms, which affect emotional, mental, physical, and social well-being, as well as other life areas such as financial health. The physical effects of AUD can be potentially life-threatening if left untreated.2

Individuals with alcohol use disorder may experience the following symptoms, either periodically or continuously:2

  • Impaired thinking
  • Loss of control over how much or how often they use alcohol
  • Obsessive thinking about and preoccupation with alcohol
  • Continued alcohol use despite direct negative consequences
  • Denial of their alcohol misuse or its consequences
  • Continued alcohol use despite their drinking causing or exacerbating physical or mental health problems
  • Alcohol dependence, resulting in uncomfortable and even potentially dangerous withdrawal symptoms
  • Tolerance, which means they need to drink more to experience intoxication

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What Is PTSD?

Post-traumatic stress disorder, also known as PTSD, is a set of symptoms that occur after someone experiences a traumatic event. PTSD is commonly associated with military veterans but can happen to anyone after they experienced a traumatic event, such as: 1,3

  • The death of a loved one
  • A life-threatening experience for self or others
  • Overcoming immense suffering or illness

Not everyone who experiences a traumatic event will develop PTSD. Most people experience a traumatic event at some point in their lives and many do not experience long-term emotional, mental, or behavioral impact. However, for others, the trauma leads to PTSD symptoms.1

During any traumatic experience, an individual experiences intense heightened emotion—often feelings of fear and helplessness—which can profoundly impact their emotional and psychological well-being, potentially leading to the following PTSD symptoms:1

  • Re-experiencing a traumatic event through dreams or flashbacks
  • Actively avoiding locations, people, or stimuli that could trigger a memory of the traumatic event
  • Showing emotional numbness and detachment from previously enjoyed experiences
  • New or increased anxiety, startle responses, or hypervigilance
  • Difficulty falling asleep or staying asleep, sometimes due to nightmares of the traumatic event

How Do Alcohol Use Disorder and PTSD Relate?

Alcohol and PTSD can relate to one another, as trauma leads to PTSD, and PTSD can contribute to the development of substance use disorders. In veterans with alcohol use disorder, about 20% also have PTSD. Studies demonstrate a close relationship between alcohol use disorder and other substance use disorders and an increased occurrence of symptoms of PTSD.

The National Center for PTSD estimates that up to 75% of trauma survivors develop alcohol use disorder. Rates of co-occurring PTSD and alcohol use disorder appear higher among women than men, yet data shows that both men and women who have alcohol use disorder have a high co-occurring rate of PTSD. 1, 5

The most frequently observed reason for co-occurring PTSD and alcohol use disorder in studies appears to be a pattern of individuals using alcohol to manage their PTSD symptoms—a practice commonly called “self-medicating.”6

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Trauma and Alcohol Use

The primary reason that alcohol and PTSD relate to one and another is due to a shared correlation with trauma history.

Children and women appear most at risk for prolonged trauma response. Children are largely unable to control their environment, including to whom and what they are exposed. Additionally, their developing brains and limited emotional coping skills keep them in a vulnerable state, where a traumatic event can impact them more greatly than an adult.1

Women are observed to have a higher risk  of experiencing trauma than men according to self-reported instances, such as physical or psychological mistreatment or assault.1

However, because traumatic experiences that can lead to the development of PTSD include events such as natural disasters, car accidents, and witnessing a loved one experience trauma, men are just as vulnerable as women to unexpected forms of environmental trauma. Much of the data gathered relies on self-reported incidents of trauma inflicted by another person, which may skew researchers’ ability to accurately compare trauma risk based on gender.

Self-Medicating PTSD with Alcohol

Alcohol is sometimes used to manage anxiety, hypervigilance, sleep disturbances, pain, and other common symptoms of PTSD due to its characteristics as a central nervous system depressant.1

Immediately following a traumatic event, bodies experience an increased level of endorphins in the brain—the neurological trigger for the fight, flight, or freeze response. Endorphin levels return to normal after the perceived danger passes and, over time, the endorphin response when thinking about the trauma also decreases.1

However, depending on the nature of the trauma, the endorphin response may remain elevated as a biological coping mechanism. This coping mechanism keeps the body ready to react to a threat that is perceived as still existing in the present moment, in theory allowing for the management of emotional and physical pain stemming from the trauma.3 These heightened endorphin levels can be linked to PTSD symptoms like startle responses, hypervigilance, and insomnia.

Endorphin levels may eventually decrease, which results in endorphin withdrawal symptoms lasting from hours to days. With this endorphin withdrawal, people may begin to experience uncomfortable symptoms, such as emotional distress, which may worsen some symptoms of PTSD.3 This withdrawal can be linked to PTSD symptoms like feelings of depression and disconnect from reality.

Alcohol can artificially compensate for an endorphin deficiency following a traumatic event.3 When using alcohol, endorphin levels increase—possibly to the person’s baseline level—which, in turn, seemingly alleviates the uncomfortable symptoms of PTSD, including irritability, depression, and anxiety.3

Those who begin self-medicating their PTSD symptoms with alcohol often do so after the traumatic event and their acute reaction to it have passed. This behavior is observed even among social drinkers where the drinking increases following exposure to immense stress. This is likely due to the uncomfortable symptoms of PTSD developing after the traumatic event and not during, which can occur days, or even weeks, after the trauma.1

Risks of Alcohol Misuse

Although possibly offering a temporary relief from PTSD symptoms, studies show that using alcohol to self-medicate PTSD may increase PTSD symptoms, especially among those who use alcohol in large amounts. Those who experience more intense or frequent PTSD symptoms are also at a heightened risk of using alcohol to manage those symptoms, thereby increasing their risk of developing alcohol use disorder and the subsequent health risks associated with AUD.6

For those with alcohol use disorder, which can develop as a result of alcohol misuse over time, there is an increased risk of developing additional mental health  symptoms, including:7

Additionally, continued and prolonged alcohol use has the potential to lead to physical health problems including:7

  • Heart disease
  • Stroke
  • Liver cirrhosis
  • Cardiovascular problems
  • Gastrointestinal problems
  • Immune system dysregulation
  • Cognitive deficits
  • Peripheral neuropathy
  • Decreased bone density
  • Increased risk for certain cancers

What Are the Treatments for Alcohol Use Disorder and PTSD?

Since PTSD and alcohol use disorder often co-occur, many treatment programs that address dual diagnoses offer specific treatment to address these conditions. Treating both conditions can reduce the symptoms of both conditions and reduce the risk of alcohol relapse.8

Most often, treatment for alcohol misuse and dependency is done within an intensive alcohol addiction program, possibly beginning at the inpatient treatment level.9 Here, complete sobriety is usually expected—sometimes after medically supervised detox—and you receive individual therapy to teach you coping skills and how to identify cravings and triggers.7 Motivational interviewing and cognitive-behavioral therapy (CBT) are two therapeutic modalities commonly used in dual diagnosis inpatient programs. While in treatment, your PTSD symptoms and unresolved trauma may also be addressed within individual therapy sessions.7

During treatment, you receive support as you work through denial, build your self-esteem, and learn to externalize guilt associated with your alcohol use or trauma. You may be encouraged to work through any contentions with family, peers, or environmental stressors, as the resolution of anger, resentment, and other negative emotions with others is associated with positive short– and long-term recovery outcomes.9

If needed, your doctor may prescribe medication to help you manage any uncomfortable PTSD or alcohol withdrawal symptoms. These may include: 10, 11

  • Sertraline
  • Diazepam (Valium)
  • Lorazepam (Ativan)
  • Oxazepam (Serax)

Alcohol use disorder and PTSD are often seen together but do not need to be suffered alone. If you or your loved ones have either alcohol dependence or PTSD, please call 800-839-1686Who Answers? to learn more about alcohol addiction rehab options.

Hannah Sumpter, MSW, holds a Bachelor’s degree in Theology, as well as a Master’s degree in Social Work, with an emphasis in Mental Health. She has combined both degrees to work in the addictions field for over ten years, both as a case manager and therapist. Throughout her professional experience, she has grown in her passion for serving those with an addiction, as she is able to positively impact some of the most vulnerable in our society.

Resources

  1. 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, 23(4), 256.
  2. Morse RM, Flavin DK. The Definition of Alcoholism. JAMA,268(8), 1012–1014.
  3. Maksimovskiy, A. L., McGlinchey, R. E., Fortier, C. B., Salat, D. H., Milberg, W. P., & Oscar-Berman, M. (2014). White matter and cognitive changes in veterans diagnosed with alcoholism and PTSD. Journal of Alcoholism and Drug Dependence, 2(1), 144.
  4. Brinson, T., & Treanor, V. (1989). Alcoholism and post-traumatic stress disorder among combat veterans. Alcoholism Treatment Quarterly, 5(3-4), 65-82.
  5. Brown, P. J., Recupero, P. R., & Stout, R. (1995). PTSD substance abuse comorbidity and treatment utilization. Addictive Behaviors, 20(2), 251-254.
  6. Simpson, T. L., Stappenbeck, C. A., Luterek, J. A., Lehavot, K., & Kaysen, D. L. (2014). Drinking motives moderate daily relationships between PTSD symptoms and alcohol use. Journal of Abnormal Psychology, 123(1), 237–247.
  7. Schuckit M. A. (2009). Alcohol-use disorders. Lancet (London, England), 373(9662), 492–501.
  8. Volkow, N. D. (2011). Principles of Drug Addiction Treatment: A Research-Based Guide (2nd Ed). United States: DIANE Publishing Company.
  9. Schnitt, J. M., & Nocks, J. J. (1984). . Journal of Substance Abuse Treatment, 1(3), 179-189.
  10. Hien, D. A., Levin, F. R., Ruglass, L. M., López-Castro, T., Papini, S., Hu, M.-C., Cohen, L. R., & Herron, A. (2015). Combining seeking safety with sertraline for PTSD and alcohol use disorders: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 83(2), 359–369.
  11. Bayard, M., Mcintyre, J., Hill, K., & Woodside, J. (2004). Alcohol ithdrawal syndrome. American Family Physician, 69(6), 1443-1450.

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