PTSD and Alcoholism: How Does Alcohol Affect Post-Traumatic Stress Disorder?

Exposure to an uncontrollable negative event elicits the familiar “fight-or-flight” response. In turn, CRH stimulates the release of proopiomelanocortin (POMC), a hormone that is divided into several components. These components include adrenocorticotropic hormone (ACTH), which increases arousal and produces the fight-or-flight response, and beta-endorphin, which has a numbing effect and thereby reduces both emotional and physical pain. Research in humans has also identified a strong association between PTSD and alcoholism. For example, in a sample of Vietnam combat veterans with PTSD, more than half subsequently showed signs of alcohol addiction (Bremner et al. 1996).

PTSD and Alcoholism: 75% of Trauma Survivors Develop Alcohol Addiction

Interestingly the noradrenergic antidepressant desipramine was as effective as the serotonergic paroxetine for PTSD and desipramine had other advantages in alcohol use outcomes. Prazosin was effective in decreasing alcohol use in one study (Simpson et al. 2015) but not in the other larger trial (Petrakis et al. 2016); prazosin was not effective in treating PTSD symptoms in either study evaluating its efficacy. The neurokinin-1 receptor antagonist aprepitant had no effect on PTSD symptoms or alcohol craving (Kwako et al. 2015). PTSD andalcohol abusemay occur together due to the tendency of people diagnosed with PTSD to engage in self-destructive behavior and the desire to avoid thinking about the trauma.

Psychosocial Interventions

Recovery from psychological issues due to sexual assault related PTSD is not solely an individual challenge, but also a challenge for those close to the affected individual (27). The recovery process is also a sociological issue and societal aspects should not be ignored. Research indicates that initial levels of distress and perceived control are key factors in the onset and severity of PTSD (31). Perceived positive regard and support has also been shown to be important to recovery (28).

Risks of Alcohol Misuse

Proponents of integrative treatments posit that unprocessed trauma-related memories and PTSD symptoms may, at least in part, drive alcohol use. Thus, attending to and treating the trauma-related symptoms early in the process of therapy may improve the chances of long-term recovery from alcohol (Back et al. 2006; Hien et al. 2010). Although more randomized controlled trials of integrative treatments are needed, the studies to date clearly demonstrate that for the majority of alcohol-dependent patients with trauma/PTSD, the inclusion of trauma interventions confers substantial therapeutic benefits.

Treatment of Co-Occurring PTSD and Substance Use Disorder in VA

People with complex post-traumatic stress disorder (CPTSD) often experience chronic emotional distress. Symptoms include emotional dysregulation, intense shame, and a negative self-concept due to prolonged exposure to trauma. Now, indls with comorbid AUD and PTSD, as well as their health care providers, have additional treatment options available.

The Role of Uncontrollable Trauma in the Development of PTSD and Alcohol Addiction

• If you have a drinking problem, you are more likely than others with a similar background to go through a traumatic event.
• There are five main goals for treating PTSD with medications, including a reduction of the core symptoms such as anxiety and flashbacks, an improvement in stress resilience, an improvement in the quality of life, and a reduction in disability and comorbidity (15).
• These findings suggest that early-life experiences can affect the development of the mesocorticolimbic dopamine system and lead to a vulnerability to addiction in later life.
• Data from theDepartment of Veterans Affairsindicates that as many as 63 percent of veterans diagnosed with alcohol use or other substance use disorder also meet the diagnostic criteria for PTSD.
• People persistently avoid things—activities, situations, or people—that are reminders of the trauma.

Over a three-month course of treatment, Margaret exhibited progressively less distress during imagined exposure, her memories for the traumatic events gradually became less disjointed, and she eventually expressed a sense of resolution regarding these events. As a result, she felt much more capable of combating temptations to drink, which she continued to encounter from a variety of triggers not related to PTSD. At the end of treatment, Margaret stated that for the first time in her life she felt “ free” and truly able to put her past behind her. Margaret was encouraged to maintain contact with her treatment providers for continued support to help maintain her gains and cope with setbacks.

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• Subjects as a group decreased their drinking significantly over time, but there were no significant group differences.
• Symptoms may include flashbacks, nightmares, severe anxiety and uncontrollable thoughts about the event.
• Everyone should try to maintain a healthy schedule of eating, sleeping, and exercise.
• People may have experienced a single trauma or, as is common, multiple traumas.
• There was at best weak evidence to support the use of medications to treat AUD among those with comorbidity with PTSD.
• A few differences were noted for example, the Hein study included subjects with sub-threshold PTSD and only one study included PTSD severity as a criterion for entry into the study (Foa et al. 2013).

Addressing trauma through various therapeutic approaches, including trauma-focused therapy, EMDR, and motivational interviewing, can effectively reduce alcoholism and anger PTSD symptoms and substance misuse. According to a 2023 study involving female participants, dissociation increases suicidal behavior and is a mediator between childhood sexual abuse and suicidal behavior. Childhood trauma can increase the risk of developing alcohol use disorder (AUD) in adulthood. People with both conditions often report experiences of repeated childhood sexual and physical abuse and have complex treatment needs. The opioid blocker naltrexone blocked the poststress increase in alcohol consumption. Consuming alcohol can serve as a distraction from a range of negative feelings, including anger.

Research Regarding the Treatment of Co-Occurring PTSD and SUD

• The final RCT was a 4-week inpatient study conducted with 53 individuals with PTSD and AD (Kwako et al. 2015).
• Reduced responsiveness to CRH causes overactivation of the HPA axis and can disturb negative feedback by cortisol (Figure 1).
• Findings from the current study suggest several possible future directions for this line of research.
• Naltrexone was effective in decreasing craving in those studies that evaluated it (Foa et al. 2013, Petrakis et al. 2012).

Nine RCTs were identified; three focused on medications to treat PTSD, four focused on AUD, and three to target both. One study included both a medication to treat PTSD and one to treat AUD so was discussed twice. All but one of the studies found that PTSD symptoms and drinking outcomes improved significantly over time. The results for medications to treat PTSD are inconclusive because of contradictory results.