The Link Between PTSD and Alcohol Misuse

For many of us, waking up on a workday morning is generally not the highlight of our day. Still, we pull ourselves together, grab a coffee, and head out (or head to our home office), even if we do it begrudgingly. And that’s the way it goes! However, this is not the case for all of us. 

Imagine waking up every morning with the weight of yesterday's nightmares on our mind. Worse yet, every routine task, whether a trip to the grocery store or a simple phone call, becomes a potential trigger for past traumas.

Unfortunately, some of us don’t have to imagine this scenario. Struggles like these are the reality for those of us living with post-traumatic stress disorder (PTSD). It’s a condition in which life becomes a daily struggle to find a semblance of stability in the midst of persisting traumatic memories. 

Let’s delve into the challenging aspects of PTSD by exploring its causes, risk factors, connection to alcohol misuse, and ways of coping with it. 

Defining Post-Traumatic Stress Disorder

The American Psychiatric Association defines PTSD as a psychiatric disorder that may occur in people who experienced or witnessed one or more traumatic events. Examples of traumatic events include:

• Natural disasters
• Serious accidents
• Terrorist acts
• War or combat
• Rape or sexual assault
• Intimate partner violence
• Bullying

Traumatic events may be emotionally or physically harmful, or even life-threatening. The consequences of being exposed to traumatic events include mental, physical, social, and spiritual well-being effects. 

How Common Is PTSD?

Although an estimated 70% of adults in the United States will experience at least one traumatic event in their lifetime, only 20% will go on to develop PTSD. The disparity between those exposed to traumatic events and others who develop the disorder may be based on the level of trauma experienced or possibly the stigma around seeking professional help, which hides the reality of this statistic.

Looking at the overall picture, approximately 3.6% or 9.25 million adults in the U.S. have PTSD in any given year. Women are twice as likely as men to develop the disorder, with 1 in 9 women developing PTSD at some point in their lifetime. 

PTSD Symptoms

People who have PTSD experience a wide range of symptoms.

• Nightmares 
• Anxiety
• Depression
• Headaches
• Gastrointestinal problems

Flashbacks are the most common and well-known symptom of PTSD. These are more than “bad memories” — they are vivid experiences in which parts of a traumatic event are re-experienced. It may feel like the event is happening again in the moment.

How Is PTSD Diagnosed?

Not all PTSD sufferers experience all symptoms. Furthermore, not everyone with these symptoms meets the requirements of PTSD. To better understand PTSD, the Diagnostic and Statistical Manual for Mental Disorders (DSM-V) identifies these key diagnostic criteria.

1. One or more incidents of exposure to actual or threatened death, serious injury, or sexual violence


2. One or more intrusive symptoms associated with the traumatic event, starting after the traumatic event occurred

• Recurring and distressing memories
• Recurring and distressing dreams
• Recurring flashbacks
• Intense or prolonged psychological distress by triggers related to the event


3. Persistently avoiding triggers associated with the traumatic event


4. Negative changes in thoughts and mood associated with the traumatic event


5. Loss of interest or participation in significant activities


6. Two or more changes in arousal and reactivity associated with the traumatic event

• Irritability and angry outbursts 
• Reckless or self-destructive behavior
• Hypervigilance
• Exaggerated startle response
• Problems with concentration
• Sleep disturbance 


7. The above symptoms are present for more than one month.


8. The symptoms cause distress or impairment in social, occupational, or other important areas of functioning.


9. The symptoms are not a result of the effects of a substance such as medication, alcohol, or another medical condition.

PTSD Risk Factors

The most obvious risk factor for PTSD is exposure to a traumatic event. However, as we learned, not everyone who experiences or witnesses a traumatic event will develop PTSD. This discrepancy is primarily due to the type of trauma, the length or frequency of exposure, and the increased vulnerability of some groups of individuals. The following is a list of individuals who are more at risk for developing PTSD.

• Women are twice as likely as men
• Children who experienced abuse or neglect
• Individuals who have a family history of PTSD
• Combat veterans
• First responders
• Individuals who are victims of sexual assault
• Individuals with a history of alcohol and substance abuse
• Survivors of natural disasters
• Crime victims or witnesses to a crime
• Individuals with lower income and education

Sadly, many people with PTSD suffer in silence. Perhaps it’s the stigma or a fear that no one will understand. Unfortunately, their silence stands in the way of treatment and recovery. Recently, celebrities have stepped forward to share their stories of PTSD and raise awareness of this often debilitating condition. Lady Gaga and Prince Harry are two vocal advocates of PTSD awareness. 

Alcohol’s Role

Those of us who drink do so for many reasons. Some of us like to drink to relax, chill out, or unwind, while others enjoy having a glass or two of wine with a meal or a beer while socializing. Still, for some, drinking alcohol serves an entirely different purpose. Some of us may consume alcohol as a coping mechanism or a form of self-medication. For those of us struggling with the distress of PTSD, alcohol can transform from a social lubricant into a temporary respite from pain.

There’s a reason everything feels a little less intense when drinking: alcohol is categorized as a depressant, meaning it slows down signals in our brain. Drinking affects our body and brain by slowing our reaction time, impairing our coordination and judgment, and generally relaxing us. 

Alcohol’s feel-good effects are short-lived. The National Institute on Alcohol Abuse and Alcoholism explains this phenomenon as the brain’s attempt to quickly adjust to alcohol’s induced positive effects to maintain balance. When the buzz wears off, we may feel more restless and anxious than we did before we drank. In other words, alcohol really does more harm than good.

The Connection Between PTSD and Alcohol Abuse

We just learned that excessive consumption of alcohol often has a boomerang effect on those of us who use it as a coping method or self-medication. This effect has particular relevance for anyone who struggles with PTSD.

Research on the connection between alcohol and PTSD dates back 40 years and has consistently found that alcohol use disorder (AUD) is much higher among people with PTSD diagnoses than those with no PTSD symptoms. Over the years, research on PTSD and alcohol (and PTSD and alcohol abuse, in particular) shows constant comorbidity and point sto self-medicating as a reasonable hypothesis.

For people struggling with alcohol and PTSD, it’s clear that consuming alcohol does little to help them cope; instead, it only temporarily numbs traumatic memories. In other words, the combination of PTSD and alcohol abuse is not only a poor coping mechanism, it can also be a harmful one. 

The Fallout From Combining Alcohol and PTSD

The unfortunate consequence of PTSD and alcohol abuse is often a worsening of PTSD’s symptoms. We learned that one of PTSD’s symptoms is increased reactivity. In some people who drink excessively while struggling with PTSD, their increased reactivity translates into panic attacks. While panic attacks on their own are not dangerous, for someone with PTSD, they can induce intense fear, anxiety, and flashbacks. 

Many people with post-traumatic stress disorder (PTSD) experience blackouts. These can also occur as a result of excessive alcohol intake. PTSD-alcohol blackouts may include intense flashbacks, or they may involve a dissociation from reality. 

Other mental or physical health problems often accompany PTSD and drinking problems. According to the U.S. Department of Veterans Affairs, up to half of adults with both PTSD and drinking problems also have one or more of the following serious problems.


• Panic disorder
• Mood problems such as depression
• Attention problems
• Behaving in ways that harm others
• Addiction to or abuse of street or prescription drugs
• Long-term physical illness such as diabetes, heart disease, or liver disease
• Ongoing physical pain


Without treatment for PTSD and alcohol abuse, a person can develop a destructive cycle of PTSD symptoms followed by drinking for relief of symptoms followed by increased PTSD symptoms and so on.

Treatment Options for PTSD and Alcohol Abuse

Current treatment strategies for the control of trauma-associated symptoms of Post Traumatic Stress Disorder (PTSD) related to alcohol misuse have recently been updated by Veterans Affairs (VA) and the Department of Defense (DoD) after over a decade of dedicated research. The most recent evidence suggests dramatic benefits from the use of trauma-focused therapies: 

• Cognitive Processing Therapy (CPT)
• Prolonged Exposure Therapy (PE)
• Eye Movement, Desensitization, and Restructuring (EMDR)

Drug treatment options are an evidence-based supplement to therapy, but neither of these work on their own. Common drugs prescribed to treat PTSD include antidepressants, anxiolytics, and antipsychotics. Evidence suggests particularly strong benefits from sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor).

Healthy Ways to Cope With PTSD 

Dealing with PTSD symptoms can be a struggle. Healthy coping mechanisms offer a lifeline through alternative paths to relief of PTSD symptoms. From mindfulness practices to therapeutic interventions, the journey toward healing involves reclaiming the semblance of normalcy that trauma seeks to unravel.

1. Mindful journaling. Create a daily journal to explore and express your emotions. Use prompts to delve into both positive and challenging experiences. This practice fosters self-awareness, allowing you to identify triggers and feelings that may contribute to alcohol misuse.

2. Strong support systems. Connect with friends, family, or support groups who understand the complexities of PTSD and alcohol misuse. Share your journey, lean on others for support, and let them be a guiding light during challenging times.

3. Quitting or cutting back on alcohol. If you choose to consume alcohol, do so mindfully. Set limits, be aware of your triggers, and recognize when it's becoming a coping mechanism. Consider exploring alcohol-free alternatives during social events.

4. Physical activity. Engage in regular physical activity, as it has proven benefits for mental health. Whether it's a brisk walk, yoga, or dance, movement can be a powerful tool in managing both PTSD symptoms and alcohol misuse.

5. Artistic expression. Explore creative outlets as a form of therapy. Whether it's painting, writing, or playing music, artistic expression can provide a channel for processing emotions and breaking free from the constraints of trauma.

6. Professional guidance. Reach out to mental health professionals specializing in trauma and addiction. They can provide personalized guidance, therapeutic interventions, and a roadmap to recovery tailored to your unique journey.

7. The Reframe app. A mindful drinking app like Reframe is an excellent supplement to the above options. Reframe offers a holistic approach to your well-being with daily readings on a variety of topics, a 24/7 forum of fellow Reframers ready to cheer you on, 1-on-1 coaching, daily Zoom meetings, courses, and challenges.

Moving Forward

If you’re experiencing PTSD, you are not alone. There are many resources out there to help you develop coping skills so you can move forward and thrive.

If you are experiencing a mental health crisis, please dial 988 (in the United States) to be connected with mental health resources in your area. If you live outside the U.S., dial your local mental health crisis line.