Co-Occurring Post-Traumatic Stress Disorder and Alcohol Use Disorder in U S. Military and Veteran Populations PMC

Post-traumatic stress disorder (PTSD) is a mental health condition characterized by elevated psychological distress, usually following direct or indirect exposure to a traumatic event.1 PTSD can be a devastating condition, and can appear as a co-occurring mental health disorder alongside substance use disorders (SUD). These two condition can share a bi-directional nature, and may require dual diagnosis treatment in order to help one recover. Luckily, such programs exist, and can help one achieve recovery from PTSD and SUD.

Post-Traumatic Stress Disorder (PTSD) and Co-Occurring Substance Use Disorder – The Recovery Village

Post-Traumatic Stress Disorder (PTSD) and Co-Occurring Substance Use Disorder.

Posted: Fri, 11 Aug 2023 07:00:00 GMT [source]

Rates of PTSD appear to be higher among patients in inpatient substance abuse treatment (up to 42.5%) (6) and among pregnant women in residential treatment for substance abuse (62%) (7). Surveys of substance-dependent adolescents have also found rates of PTSD ranging up to 19.2% (8). 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. Studies that compare other outcomes related to treatment retention and symptom improvement, such as sleep, mood symptoms, somatic medical conditions, and safety profiles (including violence and suicidality), would also be helpful.

What are the symptoms of PTSD?

When patients have sleep-related concerns such as insomnia, early morning awakening, or fatigue, it is wise to screen them for heavy alcohol use and assess for AUD as needed. If they use alcohol before bedtime, and especially if they shift their sleep timing on weekends compared to weekdays, they may have chronic circadian misalignment. ptsd and alcohol abuse If they report daytime sleepiness, one possible cause is alcohol-induced changes in sleep physiology. Among trauma-exposed participants, re-experiencing symptoms were present in 72 participants (52%), hyper-arousal symptoms were present in 51 participants (37%) and avoidance/numbing symptoms were present in 47 participants (34%).

Serum tryptophan and kynurenine levels were determined by high-performance liquid chromatography, using an ultraviolet absorption detector for kynurenine and a fluorescence detector for tryptophan on Agilent Infinity 1290 systems (Agilent Technologies, CA, USA). The ratio of kynurenine to tryptophan concentrations × 103 (KT ratio) was calculated and used as a measure of the tryptophan degradation index. Serum BDNF concentration was determined by enzyme-linked immunosorbent assay (ELISA), using a commercially available kit Human BDNF Quantikine ELISA kit (R&D Systems, Minneapolis, MN, USA) based on a sandwich enzyme immunoassay technique. is a health technology company guiding people towards self-understanding and connection. The platform offers reliable resources, accessible services, and nurturing communities. Its mission involves educating, supporting, and empowering people in their pursuit of well-being.

Couples therapy

Binge drinking is particularly prevalent among veterans with PTSD as compared to other groups. Behavioral interventions are a primary component of the treatment of AUD and can be used as freestanding treatments or as part of a more comprehensive treatment plan that includes pharmacotherapies. Behavioral interventions for AUD include providing psychoeducation on addiction, teaching healthy coping skills, improving interpersonal functioning, bolstering social support, increasing motivation and readiness to change, and fostering treatment compliance.

  • For example, PTSD patients with alcohol dependence exhibit significantly more arousal symptoms that do PTSD patients with cocaine dependence (10).
  • Are there particular traumatic experiences that provide some resilience against developing AUD?
  • To have a full picture for patient care, patients with AUD should be screened for other substance use.
  • The evidence suggests that there is no distinct pattern of development for the two disorders.

Soldiers with PTSD who experienced at least one symptom of AUD may be disinhibited in a way that leads them to make risky decisions, including the potential for aggression or violence. One study conducted with veterans of the wars in Iraq and Afghanistan demonstrated a link between PTSD and AUD symptoms and nonphysical aggression.42 Veterans with milder PTSD symptoms who misused alcohol were more likely to perpetrate nonphysical aggression than veterans who did not misuse alcohol. However, this relationship was not demonstrated with significance among veterans who had more severe PTSD symptoms. Importantly, analyses can be conducted on the risk for the exposure to an event among the entire population, and then among those who experienced an event.

Prevalence of PTSD and AUD in Military and Veteran Populations

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. 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.

ptsd and alcohol abuse

A couples therapy called “project VALOR,” which stands for “veterans and loved ones readjusting,” involves 25 sessions of cognitive behavioral therapy for PTSD and alcohol misuse, enhanced for significant others. Two OEF/OIF veterans received VALOR therapy in two separate case studies.49 These veterans greatly reduced their alcohol use at the start of treatment or shortly before beginning the treatment, and their PTSD symptoms substantially decreased over the course of treatment. In one case study of an OEF/OIF veteran, researchers examined the effectiveness of concurrent treatment of PTSD and SUD using prolonged exposure (COPE) therapy.45 COPE involves 12, 90-minute sessions that integrate relapse prevention with prolonged exposure therapy. The veteran who received the therapy reported reduced alcohol use throughout treatment, scored in the nonclinical range for PTSD at the end of treatment, and maintained treatment gains at a 3-month follow-up. Whether the comorbidity between PTSD and AUD accompanies a neuroimmune profile that is predominantly proinflammatory in nature, and whether the added morbidity represents an aggravated proinflammatory state, remains unknown. Furthermore, it is unclear whether the correlates of comorbid PTSD in AUD are uniform across different countries and ethnicities.

Other Mental Health Issues

The differing theories behind sequential versus integrated treatment of comorbid AUD and PTSD are presented, as is evidence supporting the use of integrated treatment models. Future research on this complex, dual-diagnosis population is necessary to improve understanding of how individual characteristics, such as gender and treatment goals, affect treatment outcome. Studies of both combat veterans and civilians with PTSD have demonstrated that, among men with PTSD, alcohol abuse or dependence is the most common co-occurring disorder, followed by depression, other anxiety disorders, conduct disorder, and nonalcohol substance abuse or dependence (1, 2). Among women with PTSD, rates of comorbid depression and other anxiety disorders are highest, followed by alcohol abuse and dependence (1, 2).


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