PTSD: National Center for PTSD

PTSD and Problems with Alcohol Use

Studies show that the relationship between PTSD and alcohol use problems can start with either issue. For example, people with PTSD have more problems with alcohol both before and after they develop PTSD. Having PTSD increases the risk that you will develop a drinking problem. Also, drinking problems put people at risk for traumatic events that could lead to PTSD.

Trauma and PTSD Can Lead to Problems with Alcohol

Going through a trauma—whether or not you develop PTSD—can lead to alcohol use problems. Up to three quarters of people who survived abuse or violent traumatic events report drinking problems. Up to a third of those who survive traumatic accidents, illness, or disaster report drinking problems. Alcohol problems are more common for those who experience trauma if they have ongoing health problems or pain.

Gender is an important factor as well. Women who have PTSD at some point in their lives are 2.5 times more likely to also have alcohol abuse or dependence than women who never have PTSD. Men are 2.0 times more likely to have alcohol problems if they have PTSD than men who never do not have PTSD.

Between six and eight of every ten (or 60% to 80% of) Vietnam Veterans seeking PTSD treatment have alcohol use problems. War Veterans with PTSD and alcohol problems tend to be binge drinkers. Binge drinking is when a person drinks a lot of alcohol (4-5 drinks) in a short period of time (1-2 hours). 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 Can Lead to Trauma and Problems in Relationships

If you have a drinking problem, you are more likely than others with a similar background to go through a traumatic event. 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 life that lacks order and feels out of control. This lifestyle leads to distance from others and more conflict within a family. Because it is difficult to manage life with a drinking problem, it is harder to be a good parent.

Alcohol Can Make PTSD Symptoms Worse

You may drink because using alcohol distracts you from your problems for a short time. You should know, though, that drinking makes it harder to concentrate, be productive, and enjoy 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:

• feeling numb or having no emotions
• being cut off from others
• feeling angry and irritable
• feeling depressed
• feeling jittery or as if you are always 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 help you avoid bad dreams or how scary they are. Yet avoiding the bad memories and dreams actually prolongs PTSD—avoidance makes PTSD last longer. 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

Getting Help for PTSD and Alcohol Problems

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 talk with your therapist about 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 for 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 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.