Substance Use and PTSD
Although this is a short film is from the US much of what is said in the film is relevant also in the UK.
PTSD and Problems with Alcohol Use
PTSD and alcohol use problems are often found together. This pairing can be big trouble for the trauma survivor and his or her family.
People with PTSD are more likely than others with the same sort of background to have drinking problems. By the same token, people with drinking problems often have PTSD. Those with PTSD have more problems with alcohol both before and after getting PTSD. Having PTSD increases the risk that you will develop a drinking problem.
Women who go through trauma have more risk for drinking problems. They are at risk for drinking problems even if they do not have PTSD. Women with drinking problems are more likely than other women to have been sexually abused at some time in their lives. Both men and women who have been sexually abused have higher rates of alcohol and drug use problems than others.
Up to three quarters of those who have survived abusive or violent trauma report drinking problems. Up to a third of those who survive traumatic accidents, illness, or disasters report drinking problems. Alcohol problems are more common for survivors who have ongoing health problems or pain.
Sixty to eighty percent of Vietnam Veterans seeking PTSD treatment have alcohol use problems. War Veterans with PTSD and alcohol problems tend to be binge drinkers. Binges may be in response to memories of trauma. Veterans over the age of 65 with PTSD are at higher risk for a suicide attempt if they also have drinking problems or depression.
Alcohol use problems often lead to trauma and problems in relationships
If you have a drinking problem, you are more likely than others with your same sort of background to go through a psychological trauma. You may also have problems getting close to others. You may have more conflicts with those people to whom you are close.
Problems with alcohol are linked to a confused and disorderly life. This kind of life leads to less closeness and more conflict within a family. The confusion of a life with a drinking problem makes it harder to be a good parent.
Alcohol can make PTSD symptoms worse
You may drink because using alcohol can distract you from your problems for a short time. You should know, though, that drinking makes it harder to concentrate, be productive, and enjoy all parts of your life.
Using too much alcohol makes it harder to cope with stress and your trauma memories. Alcohol use and intoxication (getting drunk) can increase some PTSD symptoms. Examples of symptoms that can get worse are numbing of your feelings, being cut off from others, anger and irritability, depression, and the feeling of being on guard.
If you have PTSD, you may have trouble falling asleep or problems with waking up during the night. You may “medicate” yourself with alcohol because you think it’s helping your sleep. In fact, using too much alcohol can get in the way of restful sleep. Alcohol changes the quality of your sleep and makes it less refreshing.
If you have PTSD, you may have bad dreams or nightmares. You may drink because you think using alcohol will decrease the number of bad dreams or how scary they are. Yet drinking just continues the cycle of avoidance found in PTSD. Avoiding the bad memories and dreams actually prolongs the PTSD. You cannot make as much progress in treatment if you avoid your problems. Alcohol use problems make PTSD treatment less effective.
When you suddenly stop drinking, the nightmares often get worse. Working with your doctor on the best way to reduce or stop your drinking makes cutting back on alcohol easier. You will be more likely to have success in your efforts.
Other Mental Health Issues
If you have both PTSD and drinking problems, you are likely to have other mental or physical health problems. Up to half of adults with both PTSD and drinking problems also have one or more of the following serious problems:
- Panic attacks, extreme fears or worries, or compulsions (being driven to do things like checking the door locks over and over)
- Mood problems such as depression
- Attention problems or behaving in ways that harm others
- Addiction to or abuse of street or prescription drugs
- Long-term physical illness such as diabetes, heart disease, or liver disease
- Ongoing physical pain
What are the most effective treatment patterns?
Having both PTSD and a drinking problem can make both problems worse. For this reason, alcohol use problems often must be part of the PTSD treatment. If you have PTSD, plus you have, or have had, a problem with alcohol, try to find a therapist who has experience treating both issues.
In any PTSD treatment, several points related to alcohol should be stressed:
- When planning your treatment, you should discuss with your therapist the possible effects of drinking on your PTSD symptoms. As noted above, alcohol can affect sleep, anger and irritability, anxiety, depression, and work or relationship problems.
- Treatment should include education, therapy, and support groups that help you with your drinking problems in a way you can accept.
- Treatment for PTSD and alcohol use problems should be planned in a way that gets at both problems together. You may have to go to separate meetings on each issue, or see providers who work mostly with PTSD or mostly with alcohol problems. In general, though, PTSD issues should be included in alcohol treatment, and alcohol use issues should be included in PTSD treatment.
- Once you become sober (stop drinking entirely), you must learn to cope with your PTSD symptoms in order to prevent relapse (return to drinking). This is important because sometimes the PTSD symptoms seem to get worse or you notice them more right after you stop drinking. Remember that after you have stopped drinking, you have a better chance of making progress in your PTSD treatment. In the long run, you are more likely to have success with both problems.
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.