Behavioral intervention is considered a first-line approach in the treatment of PTSD. Several empirically supported behavioral interventions have been disseminated across populations and treatment settings. As with treatments for AUD, various treatment modalities for PTSD have been studied. The second serotonin reuptake inhibitor study used a 2 X 2 designed and evaluated paroxetine (40 mg) with an active control, the noradrenergic antidepressant desipramine (200 mg) (Petrakis et al. 2012).
Alcohol and Trauma: Drinking as a Way to Cope with the Past
Second, because this study focused on coping-related drinking motives, we excluded other relevant mediators that could support the self-medication hypothesis (such as “avoidant” coping, “maladaptive” coping; alcohol expectancies; negative urgency; and emotion regulation). We also excluded measures of coping that assessed ‘coping through substance abuse’ more broadly since we could not be sure that the substance being used was alcohol. Integrated treatment that addresses both disorders is important to begin recovery.Treatment for co-occurring PTSD and alcohol use disordersmay include bothindividual therapy and group therapy.
- The reasons for these differences are likely not due to significant methodologic differences as outlined above.
- However, it is also possible that compared to daily PTSD, overall PTSD severity is a more sensitive marker for the negative impact of PTSD on functioning and perceived effects of alcohol use.
- Most of the veterans showed clinically reliable reductions in their percentage of days of heavy drinking.
- These results were the opposite of what we expected based on a tension-reduction theory of alcohol use.
Getting Help for PTSD and Alcohol Problems
- Many people with PTSD self-medicate with alcohol because it temporarily makes them feel better.
- Because these two issues are so intimately connected, it is essential that treatment address them both.
- 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.
- People seeking co-occurring PTSD and alcoholism treatment need to work with treatment professionals experienced in PTSD and alcohol treatment.
Alcohol problems are more common for those who experience trauma if they have ongoing health problems or pain. Another similarity between learned helplessness as seen in animal models and PTSD is the co-occurrence of excessive alcohol consumption. In an experiment in which some rats were exposed to shocks they could escape from and others were exposed to shocks that were inescapable, rats that were presented with inescapable shocks increased alcohol preference compared with rats that received escapable shocks (Volpicelli 1987; Volpicelli and Ulm 1990). The rats’ alcohol consumption did not increase on the days that they experienced the shocks, however, but did increase 1 day later. Research in the past quarter century has shown that experiencing trauma does not necessarily lead to psychopathology.
Treatment Must Address Both PTSD and Drinking.
Additionally, we conducted univariate analyses to avoid over parametrizing our model. As a result, there is likely overlapping variance in our study that remains unaccounted for. Additionally, we found evidence for a file-drawer effect ptsd blackouts via the one study removed analysis. Results suggest that 22 studies would have to exist with null findings in order to reduce the size of the indirect effect by 50%.
Bivariate analysis of gender and binge and hazardous drinking (Table
This score was then aggregated and averaged across observations to yield a person mean. Participants completed an initial phone screen and then came into the lab where they provided written informed consent, underwent further screening for study inclusion, and a baseline assessment consisting of interview and self-report measures. Participants received instruction on the telephone daily Interactive Voice Response (IVR) protocol. All study procedures were approved by the VA Puget Sound Health Care System Human Subjects Division Internal Review Board.
Compared to those with PTSD or AUD alone, individuals with this comorbidity often have a more severe symptom expression of both conditions (Blanco et al., 2013), poorer levels of psychosocial functioning (Straus et al., 2018), and a higher risk for suicide (Norman et al., 2018). In addition to the psychological ramifications of harmful alcohol use, the societal cost of excessive consumption is significant, including a 249 billion dollar estimate for the U.S. government in 2010 (Sacks et al., 2015). Thus, the pervasiveness, severity, heavy disease burden, and high societal cost of this comorbidity highlights the importance of understanding its etiology. By studying the relationship between PTSD and harmful alcohol use, researchers may work towards developing treatment approaches and prevention efforts for those with this comorbidity. A combination of psychotherapy and pharmacotherapy may be an effective treatment strategy for service members and veterans with comorbid PTSD and AUD.
Future research in this area should also consider using a more trauma-informed measure of coping-related drinking motives, such as the recently developed Trauma Related Drinking Questionnaire (TDR). This measure assesses the desire to drink in response to four PTSD symptom clusters. Psychometric research on the TDR suggests that it is a more specific measure than the DMQ coping subscale, whose questions focus on depression and anxiety more generally (Hawn, Aggen, et al., 2020). It is also clear from the moderator analyses we described that the effect of self-medication will vary widely based on multiple domains, and that there are likely to be subsets of individuals who do not drink to cope with their internal emotional states at all. For these individuals, other relevant theories such as the high-risk hypothesis or the shared vulnerability hypothesis may be more relevant.
However, neither of these studies found an advantage for sertraline over placebo for alcohol use outcomes. 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). There is a small but growing literature of pharmacotherapies to treat AUD with comorbid PTSD. The conclusions from this review suggest that there is not one agent that has clear evidence of efficacy in this comorbid group.
