During the initial phase of treatment, when latency of onset of antidepressants is an issue, benzodiazepines may be considered as adjunctive medication. The amount of benzodiazepines prescribed to the patient should be limited, and the patient should be closely monitored for relapse or nonmedical use of benzodiazepines or other medications. The reasons for these differences are likely not due to significant methodologic differences as outlined above. First, four of the nine alcoholism and anger studies were conducted in primarily male veteran subjects; the rest had significant numbers of women. There is evidence of gender differences in medication response for both the antidepressants (Keers and Aitchison 2010) and naltrexone (Garbutt et al. 2014, Roche and King 2015).

PTSD and Alcohol Use Disorder: A Critical Review of Pharmacologic Treatments

The systems most closely linked to emotion and survival — heart, circulation, glands, brain — are called into action. If you have PTSD, this higher level of tension and arousal can become your normal state. In people with PTSD, their response to extreme threat can become “stuck.” This may lead to responding to all stress in survival mode.

Do People Use Alcohol to Cope with PTSD?

• In a large sample of over 19,000 participants, prevalence rates of AUD, PTSD, as well as comorbid AUD/PTSD were found to be significantly higher in AIAN participants as compared to NHW participants.
• 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.
• For example, they may feel guilty that they survived when other people did not.
• The alarmingly high rate of PTSD in survivors of sexual assault is a strong indication that the current therapies for rape victims are inadequate and in need of improvement.
• In a series of studies, Meaney and colleagues (2002) demonstrated that repeated periods of maternal separation in the early life of rats decreased dopamine transporter expression and increased dopamine responses to stress and behavioral responses to stress, cocaine, and amphetamine.
• The randomized clinical trials treating AUD and comorbid PTSD were mostly well-designed studies that used similar inclusion/exclusion criteria, notably current DSM-IV diagnosis of alcohol dependence and PTSD, with current drinking requirements for entry.

Anger helps us cope with life’s stresses by giving us energy to keep going in the face of danger or trouble. If a loved one is experiencing co-occurring PTSD and alcohol use disorders it is important to know how to get them the treatment they need. CPTSD is a subtype of PTSD that develops in response to prolonged, repeated traumatic experiences, typically lasting months or years. Women who have PTSD at some point in their lives are 2.5 times more likely to also have alcohol abuse or dependence than women who never have PTSD.

• Individuals with CPTSD may use substances like alcohol or drugs to cope with their emotional distress and psychological symptoms resulting from prolonged trauma exposure.
• The naloxone blocked the analgesia produced by the trauma reminder; and, with their opioid receptors blocked, patients with PTSD felt the pain as severely as did people who did not have PTSD.
• Many people enjoy alcoholic drinks as a way of relaxing, sometimes to reduce the tension of socializing or to quiet an overactive mind.
• Research has shown that thought suppression may contribute to alcohol-related aggression.
• We speculate that as trauma-related memories brought up during therapy may cause a release of endorphins and subsequent emotional numbing, this may interfere with the patient’s ability to engage in therapy fully.

Treatment

A few differences were noted for example, the Hein study included subjects with sub-threshold PTSD and only one study included PTSD severity as a criterion for entry into the study (Foa et al. 2013). Similarly, the outcome measures were mostly comparable; reporting on alcohol consumption based on the Time Line Followback Method and PTSD symptoms using Clinician Administered PTSD (CAPS) or its derivative, the PTSD Checklist (PCL). Only two studies reported on a “clinically meaningful change” (Foa et al. 2013, Hien et al. 2015) and one study characterized subjects based on onset of PTSD and onset of alcohol dependence (Brady et al. 2005) but the validity of these subgroups is not well established. Because the studies used similar inclusion/exclusion criteria and similar outcomes, making overall conclusions based on these studies seems reasonable.

• Assisting PTSD alcoholic family members may be especially difficult because people aren’t labels, they’re just a loved one struggling with analcohol addiction.
• Nor is it known why some people witness or experience the same trauma many times over years without developing PTSD, but then develop it following an apparently similar episode.
• Higley and colleagues (1991) found that adult rhesus monkeys raised in peer groups without maternal care showed increased HPA response to stress and increased alcohol consumption during periods of stress (Higley et al. 1991).
• Margaret sought treatment from an alcoholism treatment provider after yet another extended bout with heavy drinking left her physically exhausted.
• Anger is also a common response to events that seem unfair or in which you have been made a victim.
• The current investigation builds on the evidence for elevated rates of AUDs in women who have experienced traumatic events—both leading to and in the absence of PTSD—and the high rates of co-occurrence of both AUDs and PTSD with CD, MDD, and misuse of other substances.
• Although there are some promising studies for medications, reviews of pharmacotherapies for PTSD have revealed that most treatments are inadequate, aside from some supportive evidence of SSRI effectiveness (24).

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. For additional review of the two papers addressing behavioral and pharmacological treatments for comorbid SUD and PTSD, refer to Norman and Hamblen (2017). Cognitive factors play a large role in the onset, severity, and outcome of PTSD after sexual assault (28). These factors include mental defeat and confusion, negative appraisal of emotions and symptoms, avoidance and perceived negative responses from others (5). If the survivor of sexual assault believes that others have failed to react in a positive and supportive manner, there is a greater risk of PTSD (9).

For example, victims of childhood physical and sexual abuse are at higher risk for developing PTSD symptoms following traumatic events in adulthood (Breslau et al. 1999). Both pharmacotherapy and CBT are viable treatment options for PTSD, however it is clear that empowering victims by giving back control is crucial in successful recovery. In one study, survivors were asked to choose between CBT with prolonged exposure to traumatic stimuli or the SSRI medication Sertraline (39). Participants of the study rated CBT as more credible and had more positive feelings towards this treatment option, citing effectiveness and potential side effects as the two primary factors in their decision.