In summary, although prior studies indicated PE is an effective PTSD treatment for patients with co-occurring PTSD and SUD, effects were small and treatment drop-out rates were high. EMDR and ImRs are other promising treatment options for PTSD, that have not yet been examined in this difficult to treat patient group. Furthermore, head-to-head comparisons of these active PTSD treatments are scarce, and completely lacking in SUD/PTSD patients.

There are several general issues to consider when treating co-occurring alcohol dependence and trauma/PTSD. When pharmacological agents are used, treatment should generally follow routine clinical practice for the treatment of PTSD. Regardless, relapse is common, and it is critical to consider the potential toxic interactions that may occur between the prescribed medication and alcohol. Given the high co-occurrence of alcohol and illicit drug use, potential toxic interactions between the prescribed medication and other substances of abuse must also be addressed. The pharmacological agent with the least abuse liability potential should be chosen for this population. Although benzodiazepines are effective in providing immediate relief of anxiety symptoms, they are generally not considered a first-line treatment for patients with alcohol dependence given the abuse potential of benzodiazepines.

Conditional disorders

It’s a spectrum of drinking behaviours that encompass everything from occasional binge drinking to daily consumption that negatively impacts one’s life. Research shows that people with PTSD are around four times more likely to be affected by alcohol use disorders than the general population. PTSD and alcohol abuse may occur together due to the tendency of people diagnosed with PTSD to engage in self-destructive behavior and the desire to avoid thinking about the trauma.

ptsd and alcohol abuse

Take our short alcohol quiz to learn where you fall on the drinking spectrum and if you might benefit from quitting or cutting back on alcohol. Complex PTSD (or C-PTSD) is a similar condition that can occur when someone experiences repeated, ongoing trauma. Symptoms can be similar, but people with C-PTSD also tend to experience emotional flashbacks, disassociation, and low self-esteem.

Compensated Work Therapy/Transitional Residence

The proclivity toward misuse of CNS depressants by patients with PTSD may reflect an attempt to interrupt this feed-forward interaction by suppressing activity of the locus ceruleus with these agents (68). Our review of the literature on the pathophysiologic basis of comorbid PTSD and addiction selectively focuses on studies of the hypothalamic-pituitary-adrenal (HPA) axis and the noradrenergic system, as these have been most extensively studied in PTSD. It must be emphasized that many other neurobiological systems are involved in both the acute and chronic adaptation to stress and to substance use. These systems include the dopaminergic, γ-aminobutyric acid, benzodiazepine, and serotonergic systems, as well as the thyroid axis. Interactions among these systems in patients with comorbid PTSD and substance dependence are enormously complex. Thus, the potential relationships we discuss between the HPA axis, the noradrenergic system, and symptoms in patients with comorbid PTSD and substance use disorders should be viewed as one part of a far more complex whole.

There are different causal pathways that may explain this high co-occurrence, that are not mutually exclusive. Firstly, SUD could lead to an increased risk of developing PTSD by leading a more risky lifestyle, which increases chances to experience traumatic events (e.g. being assaulted violently or sexually when being under influence of substances) [4]. Secondly, several studies indicated that PTSD can lead to the development of SUD as people attempt to self-medicate PTSD symptoms by using substances (e.g. [4, 5]. Thirdly, the onset or maintenance of both SUD and PTSD could be related to a shared underlying factor such as genetic vulnerability [6, 7]. Besides studies that have examined PTSD treatments that were added to SUD treatments, there are several studies that have examined the effectiveness of integrated treatments that integrate SUD and PTSD components within one treatment. Most consistent evidence is found for COPE (concurrent treatment of substance use disorders and PTSD using prolonged exposure), that includes motivational enhancement and CBT for SUD, psychoeducation relating to both disorders, and PE for PTSD [11, 35].

Concurrent treatments

Between six and eight of every ten (or 60% to 80% of) Vietnam Veterans seeking PTSD treatment have alcohol use problems. Binge drinking is when a person drinks a lot of alcohol (4-5 drinks) in a short period of time (1-2 hours). Veterans over the age of 65 with PTSD are at higher risk for a suicide attempt if they also have drinking problems or depression.