The Link Between PTSD and AUD

Did you know that AUD and PTSD are among the most common coinciding disorders? 

Post-traumatic stress disorder (PTSD) is a condition some people develop after exposure to a distressing event or multiple events. Alcohol use disorder (AUD) is the inability to stop drinking despite its negative consequences. Often, there’s a hidden connection between the two. 

While these conditions have different diagnostic criteria and different effects, they can exacerbate each other, leading to increased symptoms. The co-occurrence is so common that approximately 1 in 3 individuals with PTSD also have AUD (1). The byproduct of heightened symptoms is reduced quality of life. It can be challenging to have meaningful relationships or show up to a fulfilling career with AUD and PTSD. How a condition manifests, and its symptoms, depend on the person. 

What Are the Symptoms of PTSD and AUD?

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Symptoms of PTSD can include:

• Nightmares or trouble sleeping
• Flashbacks
• Avoiding specific places or situations related to the trauma
• Anxiety
• Depression
• Guilt or shame
• Engaging in risky behaviors
• Feeling constantly on edge or alert
• Being easily startled

Symptoms of AUD can include:

• Urges to drink
• Unsuccessful attempts to cut back
• Inability to control drinking despite its consequences on relationships, work life, or health
• Skipping events due to alcohol’s effects or the need to prioritize alcohol
• An increasing need for more alcohol due to increased tolerance

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How Can PTSD Cause AUD?

When someone has PTSD, the emotional effects can feel overwhelming, exhausting, and intolerable. Alcohol is a common choice for those with PTSD. It numbs the distressing sensations. This is often referred to as “self-medication.” 

In these cases, while the use of alcohol is effective to numb sensations in the moment, it heightens post-traumatic stress over time. Drinking alcohol in response to PTSD reinforces the belief that both traumatic memories and the emotional response to them are dangerous. For those with PTSD who develop AUD, what begins as a coping strategy can turn into a dependence and disorder. 

A history of trauma is a risk factor for developing AUD. People with childhood trauma are particularly prone to AUD later in life. Someone with a PTSD diagnosis is more likely to have AUD than someone without it (2).

One study found that people who had experienced emotional or sexual abuse in childhood were more likely to develop PTSD and dysregulated drinking later in life. 75% of people who are survivors of abuse report drinking problems (3). 

There are also high reported rates of veterans with PTSD who develop AUD. ​​55% to 68% of veterans with likely PTSD, compared with 40% to 55% of veterans without PTSD, showed evidence of having alcohol problems (1). Further, up to 60% of people seeking treatment for AUD also meet the criteria for PTSD. 

While there’s a need for more research on the risks for developing co-occurring AUD and PTSD, there are some studies that suggest age, race, gender, and exposure to specific stressors, like early childhood trauma, may play a part. 

How Can AUD Cause PTSD?

We’ve looked at how PTSD can cause AUD. But what about the inverse? There is some research that AUD can lead to PTSD. One of the symptoms associated with AUD is that people are more prone to put themselves in risky situations. They can risk exposure to traumatic events, which can potentially cause PTSD (4). For example, getting behind the wheel while intoxicated could potentially lead to a traumatic event like a severe car crash. 

It’s important to note that not everyone who experiences a distressing event will develop PTSD. About 1 in 3 people who experience severe trauma will develop PTSD. A variety of other factors play a part, such as existing mental health conditions like depression, lack of support at the time of the event, and a family history of mental health conditions. 

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How Do You Treat PTSD and AUD?

Thankfully, you can treat both conditions together. If PTSD causes AUD, treating PTSD can have beneficial outcomes on AUD. One study found that veterans with unresolved PTSD are more likely to relapse after treatment solely for substance use, underscoring the importance of treating the underlying trauma (1). 

Various evidence-based therapeutic approaches can be helpful. Trauma-focused therapy and AUD treatment alongside one another can help produce more effective coping strategies. Trauma-informed therapy aims to understand the permeating impact of trauma and seeks to create an emotionally safe environment, such as avoiding re-traumatization for individuals. 

Which do you treat first? Researchers have different theories around which condition you should tend to first. While there is no gold standard, evidence-based treatment of both conditions is recommended. Having one condition doesn’t mean you shouldn’t receive treatment for the other. A clinician may examine an individual’s history and decide the proper and most urgent course of action. 

According to a study in the Journal of Clinical Psychiatry, goals for the treatment of both AUD and PTSD can include the following (5). 

• Reducing reliance on alcohol
• Engaging safely with traumatic memories
• Building emotional distress tolerance
• Decreasing the intensity of responses

Medication for Treating PTSD and AUD

An older study found that those with PTSD and AUD who used medication to treat alcohol had better outcomes than those on a placebo. Also, symptoms of PTSD improved in participants. (6) Another study found that a low dose of naltrexone may be helpful in the treatment of PTSD (1). 

If you think you may have AUD and PTSD and are unsure of where, how, or what help to receive, one of our clinicians would be happy to answer your questions. Co-occurring PTSD and AUD can be debilitating. You don’t have to suffer alone—healing, help, and hope are available.

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