A UK study found a shocking statistic: nearly 38.5% of individuals with a substance use disorder, including alcohol, also met the diagnostic criteria for PTSD. Individuals who experience traumatic events are more likely to develop PTSD, which is often connected to alcohol dependence. The co-occurrence of PTSD with alcohol and substance abuse, usually referred to as drug-alcohol issues, is well documented.
For effective treatment, it’s necessary to manage both issues simultaneously, which requires a deeper understanding of how they correlate. Seeking treatment for both PTSD and alcohol dependency concurrently is crucial for a comprehensive recovery. In this blog post, we will explore everything about PTSD and alcohol addiction, along with integrated treatment approaches used to address both.
So, let’s get started!
Historical Evidence of PTSD and Alcohol Addiction
Several complex aspects of history indicate a solid link between PTSD and alcohol addiction, which we will discuss in this section:
Various traumatic events in history, such as combat threats, life-threatening accidents, and sexual abuse, have significantly contributed to the development of PTSD and alcohol addiction.
Brief History of PTSD
Back in the 1980s, when PTSD wasn’t officially recognised, it was termed shell shock or combat fatigue. This implied that soldiers who were a part of World War I and II faced severe trauma due to heavy bombardment. Sexual abuse has also been a significant traumatic event, leading to PTSD, especially in women. The resultant psychological and physical symptoms were categorised as war neurosis.
However, 1980 marked the year of PTSD’s official recognition as it was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).
Brief History of Alcoholism
Alcohol addiction dates back to ancient times, with historical records from Egypt and Mesopotamia depicting heavy consumption of beer and wine along with the problems caused by it. It was during middle age that doctors finally began to identify and treat addiction as a disease.
However, this issue was still seen as a moral failing or lack of willpower rather than as a disease or a response to trauma. Finally, the American Medical Association classified it as a disorder in 1956.
Historical Link Between PTSD and Alcohol Addiction
Documented evidence related to Vietnam veterans displays a solid relationship between experiencing a traumatic event, developing PTSD, and subsequent alcohol addiction. According to research, almost 60% to 80% of veterans who sought PTSD treatment also reported problems with alcohol misuse.
Studies from the UK also showed similar results. According to them, almost 8% of veterans on a military operation suffered from PTSD, while 11% misused alcohol, compared to 5% and 6% of non-veterans, respectively.
This highlights the fact that many people may see alcohol consumption as a coping mechanism to deal with traumatic experiences. It is usually characterised by binge drinking, where one consumes a large quantity of alcohol in a short period of time.
Studies have also found that the severity of PTSD symptoms can significantly influence the extent of alcohol use. Veterans who faced severe issues indulged in heavy drinking. This illustrates a direct relationship between trauma’s impact and substance use as a form of self-medication.
The research also stated that:
● Alcohol use is often viewed by military combat veterans as an effective and socially acceptable way to cope with PTSD symptoms and related distress.
● Certain personality traits, masculinity-related gender norms, or prevailing attitudes towards alcohol in the military may influence this perception.
How PTSD is Related to Alcohol Addiction
Often overlooked, post-traumatic stress disorder (PTSD) tends to be a major cause of alcoholism. Individuals who develop PTSD are more likely to develop alcohol dependence. Both conditions co-occur and influence each other in complex ways.
To understand this better, we have discussed the biological, psychological, and social link between the use of alcohol and PTSD. Let’s explore how alcohol affects PTSD and vice versa:
Psychological Mechanism
Common PTSD symptoms include intense, disturbing thoughts and feelings that arise after a traumatic experience. These uncomfortable sensations persist even long after the event has ended. Besides this, individuals with PTSD might also experience flashbacks, nightmares, severe anxiety, and uncontrollable thoughts.
To cope with these issues, they may turn to drug and alcohol use, as it temporarily relieves these negative emotions. Binge drinking works as an escape from painful memories for PTSD sufferers.
However, since it’s a form of self-medication, there is a higher risk of developing dependence. A report suggests that almost 600,000 people in England are dependent on alcohol. This is primarily because long-term intake of alcohol leads to tolerance due to the following reasons:
● The brain reduces the natural production of dopamine (feel-good hormone) and the sensitivity of its receptors. It causes tolerance, where the body needs more substance to produce the same numbing and pleasurable effects.
● Similarly, it reduces the number of GABA receptors or alters their sensitivity. Due to this, one may face symptoms of withdrawal during periods of sobriety as the brain becomes habitual of alcohol to maintain GABAergic activity.
Biological Connection Between PTSD and Alcohol Use Disorder
From a biological point-of-view, PTSD can significantly alter the chemistry and function of the brain, which correlates with alcohol addiction. Here’s how:
● HPA Axis Dysregulation: People suffering from PTSD exhibit dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to abnormal levels of cortisol (stress hormone). As a result, there is a heightened or impaired stress response, which can make it challenging for one to cope with daily stressors. This increases the likelihood of turning towards substances like alcohol for temporary relief.
● Increased sensitivity to stress: PTSD enhances the brain’s sensitivity to stress, which leads to overactivation of the amygdala, a region involved in managing emotional responses like fear. The disorder also underactivates the prefrontal cortex, which helps regulate emotions and impulses. This imbalance makes emotional regulation more challenging, thus increasing vulnerability to alcohol for managing the negative feelings.
● GABA reduction: PTSD tends to lower GABAergic activity in the brain, which is one of the major causes of anxiety and hyperarousal associated with it. Since alcohol binds to GABA receptors and enhances their inhibitory effects, it can provide relief from these symptoms for some time. This encourages repeated use of this substance, further enhancing the risk of developing dependence.
● Dopamine dysfunction: With post-traumatic disorder, the dopamine system also goes through specific alterations. Typically, this neurotransmitter’s pathway changes, leading to a lack of pleasure. To overcome this, one may start drinking alcohol,, as it boosts dopamine levels temporarily.
● Serotonin imbalance: Alcohol consumption leads to an initial increase in serotonin levels, which uplifts the mood and causes temporary relaxation. This effect may appeal to PTSD sufferers, for it helps them overcome common symptoms like depression, anxiety, and impulsivity.
Social Factors
Individuals with PTSD often withdraw from social interactions due to feelings of fear, mistrust, or shame related to their traumatic experiences. This aggravates the feelings of loneliness and depression.
Besides, there’s a certain stigma associated with PTSD, especially in communities where mental health challenges are misunderstood. It prevents one from seeking appropriate professional help. Therefore, it is crucial for individuals, particularly military veterans and those with substance use disorder, to understand the importance of seeking treatment for both PTSD and alcohol dependency concurrently.
These factors combine altogether to contribute towards alcohol abuse, as one finds it to be a suitable solution in such situations.
Exploring the Link Between PTSD and Alcohol Blackouts
Alcohol blackout refers to episodes where one consumes so much alcohol that they can’t form new memories as the brain’s hippocampus stops working completely. This leads to gaps in recalling events that occurred while they were intoxicated. It is also referred to as anterograde amnesia.
But how is it related to PTSD?
Alcohol blackouts increase the risk of re-traumatization. During such an instance, one may unknowingly put themselves in a harmful situation. This can potentially lead to new traumatic experiences or reactivation of past trauma memories, thereby intensifying PTSD symptoms.
Does Alcohol Make PTSD Symptoms Worse?
While alcohol may offer temporary relief to PTSD symptoms, its frequent consumption can aggravate one’s situation over time. For instance, research suggests that long-term use of alcohol can increase anxiety and depression due to specific chemical changes that can make PTSD worse.
Those chemical changes are discussed as follows:
● Disruption of neurotransmitters: Drinking alcohol daily can deplete neurotransmitters like dopamine, serotonin, and GABA in the brain. This manifests in the form of increased restlessness, mood swings, and depressive feelings.
● Neurocircuit changes: When one tries to withdraw alcohol consumption after a long period of abuse, the activity in the reward circuits of the brain’s basal ganglia decreases. Simultaneously, there is an increase in the release of stress-related neurotransmitters. Both these actions combine to trigger a negative emotional state.
● Brain structure and function: Heavy alcohol usage causes structural changes in the brain. This mainly involves the reduction of white and grey matter and specific alterations in the hippocampus. These changes can enhance anxiousness and also make it difficult for one to stay sober. Besides, an abnormal hippocampus also increases the risk of developing PTSD.
Some of the common PTSD symptoms that are worsened by alcohol use include:
➢ Irritability
➢ Heightened flashbacks and nightmares
➢ Impaired judgement and risky behaviours
➢ Worsening avoidance symptoms
➢ Emotional numbness
➢ Jitters
Even when one tries to quit alcohol as a part of rehab, the withdrawal symptoms, along with that of PTSD, make it more difficult. Stopping the use of alcohol abruptly could cause anxiety, tremors, seizures, headaches, insomnia, nausea and vomiting, high blood pressure, etc.
5 Effective Treatment Approaches For Co-Occurring Disorders: PTSD and Alcohol Addiction
For those suffering from complex PTSD and alcohol abuse, integrated treatment approaches work best. It’s because they address both conditions simultaneously to ensure complete recovery. It is crucial for individuals, especially military veterans and those with substance use disorder, to prioritise seeking treatment for both PTSD and alcohol dependency concurrently.
Usually, treatment programmes for PTSD and alcohol addiction comprise different techniques, including:
1. Cognitive-behavioural therapy (CBT)
Cognitive behavioural therapy is a form of psychotherapy focusing on identifying and changing negative thought patterns that can influence one’s behaviour and emotions.
One study indicates that this therapy had a success rate of 61% to 82.4% in PTSD sufferers. Moreover, 60% of individuals who take CBT recover from substance abuse effectively.
2. Prolonged Exposure (PE)
PE is a specific type of CBT that involves repeated, controlled exposure to trauma-related cues and memories. This is implied to reduce the intense emotional responses that they evoke.
The key is to help one confront and gradually diminish fear and avoidance behaviours related to PTSD. Around 53% of patients who initiate prolonged exposure treatment successfully recover from PTSD.
3. Motivational Interviewing (MI)
MI is a counselling approach to enhance one’s motivation to change their approach towards alcohol misuse by encouraging personal commitment to specific goals.
This method uses open-ended questions, reflective listening, and affirmation to promote a supportive and respectful dialogue between the client and therapist. A study highlights that motivational interviewing has been effective for 75% of participants, specifically for addiction treatment.
4. Safety Programme
It’s a widely recognised programme that focuses on enhancing the coping skills of PTSD and alcohol addiction patients, allowing them to attain safety from trauma and substance abuse. Being a present-focused strategy, it does not require recalling past memories, which can be particularly beneficial for those at risk of relapse.
5. Use of Medication
Besides therapies, patients are also prescribed some medicines, depending on the severity of their condition. For instance, to treat PTSD, SSRIs like sertraline and paroxetine are commonly used.
Even SNRIs, including venlafaxine, have shown effective outcomes for this condition. They perform both serotonin and norepinephrine uptake, particularly at higher dosages. At times, physicians also recommend taking medicines to treat specific PTSD symptoms, like prazosin for nightmares.
For alcohol addiction, disulfiram, naltrexone, and acamprosate are primary medications that FDA has approved. They not only help reduce drinking behaviour but also prove effective in managing cravings.
A medication noted for its potential to treat both disorders is topiramate. It has been found to reduce alcohol consumption in individuals with alcohol use disorders and may also help alleviate PTSD symptoms. However, its cognitive side effects warrant careful consideration.
How Can PCP Help?
While PTSD and alcohol use disorder appear to be complex issues, effective treatment models help patients recover successfully. At the Perry Clayman Project (PCP), we offer comprehensive residential treatment programmes that provide medical alcohol detox, which is crucial for managing withdrawal symptoms.
This is followed up by tailored rehab services and evidence-based therapies like CBT to ensure integrated treatment for co-occurring disorders like PTSD. Our primary focus is to address both the psychological aspects of PTSD and the physical dependencies of alcohol misuse.
Furthermore, the environment at PCP is designed to promote recovery by offering continuous professional support and therapy. This helps patients not only overcome their addiction but also deal with the underlying trauma that might contribute to their substance use.
