| 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.)
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.
Return
to The American Academy of Experts in Traumatic
Stress Homepage
National Center
for Post Traumatic Stress Disorder
http://www.ncptsd.org/facts/specific/fs_alcohol.html
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