The association between AUD and PTSD has been elucidated due to the development of standardized assessments for the ECA using the DSM-III DIS. Assessments that followed have used the foundational structure and question format of the DIS to interview participants. They include the CIDI, AUDADIS, and, recently, the Psychiatric Research Interview for Substance and Mental Disorders.
Simple activities like going for a walk, calling a friend, or engaging in journaling or reading can be excellent substitutes. By retraining your brain to embrace positive actions during these times, you pave the way for healthier habits. One of the most crucial aspects of this journey is to eliminate any sense of shame. We know that this can be difficult, especially if you have thought negatively about your drinking for a long time, but it is an important step. Recognise that this is the first step towards an incredibly empowering life decision. Alcohol is a depressant, which means it can exacerbate PTSD symptoms such as anxiety and depression.
Behavioral Treatments for PTSD
Potential screeners with psychometric support include the Trauma Assessment of Adults (Gray et al., 2009), Life Events Checklist (Gray, Litz, Hsu, & Lombardo, 2004), and the Trauma Life Events Questionnaire (Kubany et al., 2000). Evidence of noradrenergic dysregulation in both PTSD and in withdrawal from CNS depressants has prompted the use of the α2-adrenoceptor agonist clonidine in both disorders (57, 58). Data from both preclinical and clinical research suggest that this agent, as well as the selective α2-adrenoceptor agonist guanfacine, would be effective in reducing noradrenergic hyperactivity in patients with PTSD and comorbid substance dependence. Guanfacine, given its greater selectivity, may offer a more favorable side effect profile.
Further research is needed to better understand the findings and to identify factors that are related to the development of AUD in AA women. The authors emphasized that even though AUD was found to be less common in AA women as compared to EA women, AUD is still prevalent and problematic among AA women. Furthermore, research shows that AA individuals experience more severe symptoms of AUD as compared to EA individuals (Mulia et al., 2009).
Drinking May Prolong PTSD.
The literature currently lacks studies that examine the association between premorbid functioning and the ability to engage in manual-guided, evidence-supported therapies. Also needed is examination of how adding PTSD-focused treatment to AUD treatment will be feasible in terms of treatment costs, training requirements, and staff workload. Studies examining outcomes of integrated treatments among people with comorbid AUD and PTSD, when compared with people who have PTSD and substance use disorder involving multiple substances, is necessary to identify and target specific alcohol-related treatment needs. Finally, given the heterogeneous nature of AUD120 and the complex etiology, course, and treatment of both AUD and PTSD, studies that examine commonalities underlying effective behavioral treatments are essential. Taken together, the papers included in this virtual issue on AUD and PTSD raise important issues regarding best practices for the assessment and treatment of comorbid AUD/PTSD, and highlight areas in need of additional research. First, all patients presenting with AUD should be assessed for trauma exposure and PTSD diagnosis.
Also, there may be opportunities for prevention during predeployment and postdeployment periods, but research on such programs is scarce. More information about military-specific factors and barriers will help guide prevention and intervention efforts. In one case study of an OEF/OIF veteran, researchers examined the effectiveness of concurrent treatment of PTSD ptsd and alcohol abuse 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.
Posttraumatic Stress Disorder and Co-Occurring Substance Use Disorders: Advances in Assessment and Treatment
Finally, several studies investigated medications that were hypothesized to treat both AUD and PTSD (e.g., prazosin and aprepitant), with no clear benefit on AUD or PTSD outcomes. A number of factors may have influenced the findings noted in this review, including gender differences, veteran vs. civilian status, and the various behavioral platform employed. In summary, Petrakis and colleagues conclude that clinicians can be reassured that medications that are approved to treat AUD can be used safety and with some efficacy in patients with PTSD, and vice versa. Addressing both disorders, either by pharmacological interventions, behavioral interventions or their combination, is encouraged and likely to yield the most effective outcomes for patients with comorbid AUD/PTSD.
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. Social determinants of health for the diagnoses may vary considerably based on likelihood of being exposed to an event or exposure to a substance.
Psychotherapy, also known as talk therapy, can help people identify their emotions and triggers for symptoms to help them develop better coping mechanisms. The type of treatment that is best for you can depend on the type of trauma you experienced. 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. The term alcohol usage disorder covers a broad spectrum that affects individuals differently, and many don’t fit the conventional stereotype.
- Investigators may also want to report on a subgroup of participants who completed the minimum therapeutic dose deemed adequate for that particular treatment, but the minimum dose needs to be based on a strong theoretical rationale, supported by empirical data, and defined a priori.
- In the next section, two studies focus on the prevalence and correlates of AUD and PTSD in racial and ethnic minority communities.
- At SoberBuzz, they understand the complexities and challenges that can arise when re-evaluating your connection with alcohol.
- It should be noted, however, that to exclude patients with comorbid PTSD and AD who are taking psychotropic medications would not only make recruitment more challenging, it would also decrease the generalizability of the findings.
This progressive augmentation of response with repeated stress has previously been conceptualized as kindling (67). A feed-forward interaction between the CRH and noradrenergic systems may represent one neurobiologic underpinning of both PTSD and substance use disorders. More specifically, stress, including stress related to self-administration of or withdrawal from substances, may https://ecosoberhouse.com/ stimulate CRH release in the locus ceruleus, leading to activation of the locus ceruleus and release of norepinephrine in the cortex, which in turn may stimulate the release of CRH in the hypothalamus and amygdala (20). Such an interaction between the brain noradrenergic and CRH systems may mediate the symptoms of hyperarousal seen in PTSD, including exaggerated startle response.
Other issues that may have extra-medication bearing on findings include the different treatment settings noted across studies. As mentioned above, studies have been conducted at VA settings with male patients who have experienced combat, while others are in predominately female civilian populations, limiting the ability to compare findings across studies. Several comments about methodologic challenges in conducting these studies should be highlighted. The first issue is how to handle providing treatment of multiple psychiatric disorders in a safe and ethical manner. Most of the studies provided treatment for both disorders using either a combination of medications (Petrakis 2012) or a medication plus a psychosocial intervention (Brady et al. 2005, Foa et al. 2013, Hien et al. 2015). In the Brady study, the psychosocial intervention was provided to all participants to treat addiction and the Hien study provided all participants an integrated treatment to address both PTSD and AUD.
It is important to understand this connection and to seek professional, effective mental health treatment for PTSD instead of turning to alcohol. Research on the factors leading to participant dropout and on ways of increasing treatment engagement and retention is critical. Overall, clinicians can be reassured that medications approved to treat one disorder can be used safely and with some efficacy in this comorbidity. Addressing both disorders, whether by using a combination of medications to treat each disorder or by combining medication with behavioral treatments seem most likely to be effective.