| 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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