Brief presentations of information on aspects of PTSD:

  • Warning Signs
    Warning signs of trauma-related stress
    , from Los Angeles County Department of Mental Health.

  • Warning Signs from APA
    Warning signs of trauma-related stress, from the American Psychological Assn.
  • Normalizing Emotions
    You are not alone! description of normal emotions following a disaster, from the American Red Cross.

The Peniston Protocol
PTSD Treatment

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Research and Education on Post-Traumatic Stress Disorder

PTSD and Problems with Alcohol Use
A National Center Fact Sheet

PTSD does not automatically cause problems with alcohol use: many people with PTSD do not have problems with alcohol use. However, PTSD and alcohol can be serious trouble for the trauma survivor and for the family, for three scientifically documented reasons:

PTSD and alcohol problems often occur together. People with PTSD are more likely than others of similar background to have alcohol use disorders both before and after being diagnosed with PTSD, and people with alcohol use disorders often also have PTSD.

  • 25-75% of survivors of abusive or violent trauma report problematic alcohol use.

  • 10-33% of survivors of accidental, illness, or disaster trauma report problematic alcohol use, especially if troubled by persistent health problems or pain.

  • Being diagnosed with PTSD increases the risk of developing an alcohol use disorder.

  • 60-80% 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 experience problematic alcohol use or depression.

Alcohol problems often lead to trauma and also disrupt relationships. Persons with alcohol use disorders are more likely than others of similar background to experience psychological trauma and to have problems with conflict and intimacy in relationships.

  • 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 life.

  • Men and women reporting sexual abuse have higher rates of alcohol and drug use disorders than other men and women.

  • 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 feeling of distraction and relief, it also reduces the ability to concentrate, to enjoy life and be productive, to sleep restfully, and to cope with trauma memories and stress. Alcohol use and intoxication also increases emotional numbing, social isolation, anger and irritability, depression, and the feeling of needing to be on guard (hypervigilance).

  • Alcohol use disorders reduce the effectiveness of PTSD treatment.

  • War veterans diagnosed with PTSD and alcohol use tend to be binge drinkers. Binges may be the result of reexperiencing memories or reminders of trauma

  • Many individuals with PTSD experience sleep disturbances (trouble falling asleep or waking up after they fall asleep). When a person with PTSD experiences sleep disturbances, using alcohol as a way to "self medicate" becomes a "two edged sword": it may help with one sleep-related problem but exacerbate another.

  • Alcohol use may decrease the severity and the number of frightening nightmares commonly experienced in PTSD, but may continue the cycle of avoidance found in PTSD. When a person withdraws from alcohol, nightmares often increase.

Finally, 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 other 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 dysthymic disorder)

  • disruptive behavior disorders (such as attention deficit or antisocial personality disorder)

  • addictive disorders (such as addiction or abuse of street or prescription drugs)

  • chronic physical illness (such as diabetes, heart disease, or liver disease)

  • chronic physical pain, both due to physical injury/illness and with no clear physical cause

As a result, 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.

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.

PTSD Treatment: The Peniston Protocol

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The information on this Web site is presented for educational purposes only. It is not a substitute for informed medical advice or training. Do not use this information to diagnose or treat a mental health problem without consulting a qualified health or mental health care provider.
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