PTSD and Alcoholism

Some people develop a dependency on alcohol to cope with trauma, including people with post-traumatic stress disorder or PTSD. In fact, people who have PTSD are 1.5 times more likely to have substance use disorder and 1.2 times more likely to have alcohol use disorder.^[1]

What is PTSD?

For many people, traumatic events trigger a stress and reaction response that fades over time. Yet, for some people, these reactions continue for months or even years. In some cases, the trauma is so severe that a PTSD diagnosis is warranted.

While PTSD is often associated with combat veterans, it is a prevalent condition. For example, roughly six percent of Americans have PTSD at some point.^[2]

Well-known symptoms of PTSD include angry outbursts, flashbacks, and sensitivity to loud noises. This is just part of the PTSD story, though. Our PTSD guide offers much more detail.

What is alcohol use disorder?

Alcohol use disorder, or AUD, is an umbrella term that includes common alcohol-related disorders, like alcohol addiction, alcohol abuse, and alcohol dependence. It is a legitimate disorder even when it occurs in mild forms and is especially serious in moderate or severe forms.

People with AUD face many difficulties that range from strained relationships to job loss to permanent brain damage. However, AUD is highly treatable with behavioral therapy, medication, and participation in support groups like Alcoholics Anonymous (AA).^[3]

AUD is a complex disorder – far more complex than can be described in a few paragraphs. Consult our alcohol use disorder guide for detailed information about AUD.

Can PTSD cause alcoholism?

While PTSD does not appear to cause alcoholism, physiological mechanisms might make alcoholism more likely to develop when PTSD is also present.

Traumatic or stressful events trigger the release of endorphins, which are neurotransmitters that assist in reducing stress and pain.^[4] However, when the traumatic or stressful event subsides, the increased levels of endorphins also begin to decline. People with PTSD sometimes turn to alcohol to replace the lower level of endorphins.

The problem is that more and more alcohol is needed to achieve the same effect. This, in turn, can lead to addiction and a comorbid diagnosis of PTSD and alcoholism.

Additionally, there are many risk factors for developing an alcohol use disorder, one of which is a history of trauma (a primary cause of PTSD as well). In other words, most cases seem to follow a pattern of experiencing trauma, developing PTSD, and turning to alcohol as a self-treatment for PTSD, which can lead to an alcohol use disorder. ^[3]

Likewise, a history of mental health conditions – from PTSD to ADHD to a depressive disorder – increases the risk of AUD developing.^[3] So, while PTSD doesn’t necessarily cause alcoholism, it’s easy to see why the two conditions often present together. 

For example, some people with PTSD use alcohol as a coping strategy to deal with their symptoms, like intrusive thoughts, hypervigilance, and a persistent negative emotional state. Laboratory testing supports this hypothesis – people with PTSD and an alcohol use disorder report more alcohol cravings after experiencing a trauma stimulus when compared to experiencing a neutral stimulus.^[5]

Unfortunately, as discussed in the next section, alcohol exacerbates PTSD symptoms. Moreover, each condition comes with its own set of distressing symptoms, so the situation can be quite tenuous when they occur together.

How does alcohol affect PTSD symptoms?

Simply put, alcohol and PTSD are not a good combination. People with PTSD often have symptoms related to depression. Since alcohol is a depressant, it can make these depressive symptoms even worse.^[4]  

As the depressive symptoms become worse, people with PTSD might feel the need to drink even more. This, in turn, can lead to increased risky behaviors, like violent physical outbursts or drunk driving. 

Furthermore, people with PTSD might already experience anger, irritability, or feel cut off from others. They might also have a flat affect or feel like they have no emotions. Alcohol can make these symptoms much worse.^[6]

Another factor to consider is that as alcohol use increases, there’s a reduced likelihood that someone with PTSD will recognize that they have PTSD, let alone seek treatment for their PTSD. Untreated, PTSD can become a severe, debilitating disorder that can have life-changing ramifications in terms of mental health, the stability of relationships, and the ability to work.

Best treatment options for alcoholism and PTSD

The most effective treatment for PTSD and alcoholism is a combination of therapy, participation in support groups, and education.^[6] These treatments should address both alcoholism and PTSD, though the issues related to each condition might be explored in more detail in separate sessions or support groups. 

For example, cognitive behavioral therapy (CBT) effectively treats PTSD. It’s also effective for treating alcohol use disorder.^[7] So, a patient with PTSD and alcohol use disorder might participate in individual therapy, like stress inoculation therapy, to learn healthy and effective strategies for coping with PTSD symptoms.

Then, the patient might participate in a group CBT session to explore internal and external triggers that lead them to drink alcohol in excess. All the while, the patient might also attend a support group for PTSD and another support group for their alcoholism. CBT heavily focuses on education, so the education component would be met in therapy. 

However, addressing both conditions at the same time is critical. To the extent possible, issues related to alcohol should be explored in PTSD treatment, and PTSD issues should be explored in treatment for alcoholism.^[6]

Medication might also be part of the treatment regimen for PTSD and alcohol use disorder. For example, the Food and Drug Administration (FDA) has approved three drugs – disulfiram, naltrexone, and acamprosate – to treat alcohol use disorders. 

These drugs are non-habit-forming, and when combined with support groups and behavioral therapy, they can be extremely effective in reducing alcohol consumption. They are also effective in preventing relapse.^[3]

This is a critical component of treating PTSD and alcoholism because once a patient becomes sober, PTSD symptoms can seem to be much worse. Yet, the cessation of drinking is crucial for addressing PTSD symptoms; by doing so, the patient will be more successful in coping with both conditions in a healthy manner.