Brief presentations of information on
aspects of PTSD:
Warning signs of trauma-related stress,
from Los Angeles County Department of Mental Health.
Signs from APA
Warning signs of trauma-related stress,
from the American Psychological Assn.
You are not alone! description of normal emotions following a disaster,
from the American Red Cross.
CENTER FOR PTSD
Research and Education on Post-Traumatic
and Problems with Alcohol Use
A National Center
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
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
- 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
- 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
- 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
PTSD Treatment: The Peniston