Post-traumatic stress disorder (PTSD) and alcohol abuse are often related. The PTSD is an anxiety disorder developed by an individual due to subsequent exposure to traumatic events. The traumatic events are harmful physical integrity and serious injury that is responded by helplessness, horror, or intense fear. PTSD is debilitating since it affects an individual's emotions, hence interfering with their ability to complete their daily tasks. There is a high co-occurrence between PTSD and alcohol abuse (Gilpin and Weiner, 2017). Comorbidity of PTSD and alcohol abuse negatively affects a diverse range of populations and impacts such as loss of self-esteem on a victim.
PTSD and Alcohol Abuse Comorbidity on General Population
People with PTSD are likely to have alcohol drinking problems. Consequently, many people with PTSD are more likely to develop alcohol abuse disorder. The study conducted by Gilpin and Weiner (2017) argued that PTSD could be triggered by alcohol abuse. Likewise, alcohol abuse can be triggered by PTSD.
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There is a co-occurrence of alcohol abuse and PTSD. Epidemiology data collected indicated that most people having drinking problems are more likely to experience PTSD during their lifetime ( Lewis et al., 2019 ). Alcohol abuse leads to the development of traumatic events that can make an individual develop PTSD. People with co-occurring PTSD and alcohol abuse tend to develop heightened psychiatric challenges such as stress and depression.
The co-occurrence of alcohol abuse and PTSD has been proposed and explained by several theories. The self-medication theory is an outstanding theory that explains the co-occurrence of PTSD and alcohol abuse. This theory is primarily driven by clinical observations of patients with addiction disorders ( Smith et al., 2017 ). According to the theory, individuals with addiction explore some specific effects or actions of some commonly abused drugs to change or relieve physical or emotional pain.
Currently, the self-medication theory has received pragmatic support. This theory postulates that people with PTSD are at a higher risk of developing drinking problems since their alcohol abuse degree helps mitigate the sequelae and distressing PTSD symptoms. An empirical study by Hawn, Cusack, and Amstadter (2020) supported this theory positing that PTSD normally emerges before alcohol abuse co-occurrence. The self-medication theory indicates that PTSD is the primary rationale for an individual to develop drinking problems.
Self-medication contending theories alternatively claim that alcohol abuse precedes the development of PTSD and, more so, increases the level of PTSD. The causal ways can increase the probability of an individual developing PTSD. First, an alcohol abuser's lifestyle can result in the development of PTSD ( Thayer et al., 2017 ). Alcohol abuse involves engaging in highly risky behaviors, which increases the likelihood of an individual experiencing traumatic events that lead to PTSD. Secondly, the susceptibility hypothesis can also explain the co-occurrence between PTSD and alcohol abuse. Chronic alcohol and substance abuse is normally accompanied by increased arousal and anxiety and accompanied by poor coping skills leading to traumatic events exposure, increasing biologic susceptibility for an individual to develop PTSD ((Thayer et al., 2017). Despite not addressing the theoretical perspective, there is some evidence of other factors such as genetics and previous exposure to traumatic events that play a role in developing comorbid alcohol abuse and PTSD.
The development of PTSD and subsequent extreme stress exposure frequently occurs in individuals with drinking problems. Externalizing pathologies such as antisocial personality disorders and hyperactive disorder, common when one has drinking problems, normally leads to risk-taking and impulsive behaviors that cause trauma ( Loomis, 2020 ). These risk-taking behaviors increase anxiety among individuals with drinking problems, increasing individuals' susceptibility to developing PTSD.
According to Schultebraucks et al. (2020), alcohol abuse can co-occur with PTSD, and individuals who survived traumatic events or violent abuse tend to have an alcohol addiction. Typically, alcohol abuse is most common for those individuals with PTSD, pain, or having unending health problems. Alcohol abuse normally elevates trauma symptoms and increases stressful life events that develop PTSD. Across the world, more than half of the samples examined with alcohol abuse suffered from PTSD ( Schultebraucks et al., 2020) . Thus, the comorbidity of alcohol abuse and PTSD is evidenced by the study.
Over the past two decades, a large-scale epidemiological study conducted by Hassan et al. (2017) on the general population showed a high co-occurrence of alcohol abuse and PTSD. The survey assessed the comorbid and the prevalent range of psychiatric disorders using statistical and diagnostic manuals. According to Hassan et al. (2017), the statistical and diagnostic manual provides reviewed criteria that extensively estimate the problem's scope. From the study, individuals with PTSD were more likely to have alcohol drinking problems than individuals without PTSD.
The co-occurrence between alcohol abuse and PTSD can be established by consistently observing and examining the population seeking treatment on either of the two conditions. The American Psychiatric Association indicated that patients with PTSD are fourteen times more likely to have drinking problems compared to patients without PTSD ( Smith, & Cottler, 2018 ). Conversely, the study also posited that patients seeking alcohol abuse treatment are more likely to develop PTSD. Other studies mentioned above generated different estimates but backed up the arguments of the study. The observed variation in estimates can be attributed to the differences in the employed measurement technique, variance in the patient population, and clinical sample types.
The comorbidity of PTSD and alcohol abuse can be explained through the increased alcohol abuse and PTSD with other psychiatric disorders, including conduct disorder and major depressive disorder. Major depressive disorder and conduct disorder is associated with an elevated rate of alcohol abuse. These psychiatric disorders typically occur with PTSD and are more so associated with trauma. Rates of psychiatric disorders are normally elevated in trauma-exposed populations. Hence, when determining the co-occurrence between alcohol abuse and PTSD, it is vital to adjust the co-occurring psychiatric conditions associated with PTSD. It argues that people think drinking alcohol reduces problems, but the case is that it is only for a short time. Drinking makes it hard for someone to concentrate, enjoy life, and cope with normal stress. It is also hard to cope with stress and other trauma challenges. According to the study, more than ¾ of individuals who survived cases such as abuse or violence indulge in drinking.
The co-occurrence between alcohol abuse and PTSD has been realized in the United States and in Europe, where traumatic events vary from one nation to another. The general population survey on mental disorders epidemiology conducted in six European countries portrayed that individuals with PTSD were likely to develop alcohol abuse than those without PTSD ( Hoppen & Morina, 2019 ). Additionally, an Australian study reported that one in four individuals with PTSD had drinking problems.
PTSD And Alcohol Abuse Comorbidity on Women
Gender is an essential factor in the relationship between PTSD and alcohol. Women who have PTSD tend to indulge in drinking and later becoming dependent on it two times their male counterparts. In both genders, they are likely to develop alcohol dependence if they have PTSD than those without (Smith & Cotler, 2018). The main result is that these victims tend to have trouble with family members and relationships. PTSD leads to other problems, too, such as poor communication, trust, and lack of closeness. Apart from the victims, it also affects loved ones.
A study by Smith and Cottler (2018) on PTSD and alcohol dependence in young women portrayed high comorbidity of alcohol abuse and PTSD. The study distinguished various PTSD influences on alcohol abuse from trauma and alcohol abuse. Smith and Cottler (2018) claimed that the collected community samples have constantly portrayed a high co-occurrence between alcohol abuse and PTSD. The National Comorbidity Survey indicated that the number of women with PTSD suffering from alcohol abuse was double the number of women without PTSD disorder ( Conway et al. 2016 ). Smith and Cottler (2018) also postulated that the rate of alcohol abuse in women who developed PTSD is higher. However, the co-occurrence source of PTSD and alcohol abuse has not yet been established.
As per the statistics provided by the National Comorbidity Survey, women are less exposed to traumatic events such as life-threatening accidents and combat stresses, but they are more likely to develop PTSD and struggle with alcohol abuse than men ( Conway et al., 2016 ). When women experience some traumatic events such as sexual abuse, they often turn to heavy alcohol consumption to cope with the situation. Heavy alcohol consumption increases the prevalence of developing PTSD, particularly in women.
A study by Sullivan et al. (2020) on the elevated increase in alcohol abuse in women found out that PTSD contributed to the additional variance of women developing alcohol drinking problems after accounting for violence or sexual assault. Normally, sexual assaults traumatic events have a higher conditional probability for an individual to develop PTSD. Sullivan et al. investigated the elevated increase in alcohol abuse in women aimed at determining the specificity of risk deliberated by PTSD with trauma effects, and alcohol abuse has generated contradicting results. Despite the contradiction, Sullivan et al. (2020) 's research on the elevated increase in alcohol abuse in women found out that PTSD contributed to individuals developing drinking problems after experiencing some traumatic sexual assaults.
PTSD And Alcohol Abuse Comorbidity on Veterans
PTSD and alcohol abuse co-occurrence can be portrayed by the study conducted by Murphy, Palmer, and Busuttil (2016), on the United Kingdom veterans. Over the past decades, PTSD has emerged as the most prevalent form of psychopathology for most veterans returning from combat zones. Significantly, PTSD symptoms and alcohol drinking problems are highly correlated among the returning veterans. From the study, veterans normally experience various traumatic events such as death, severe injuries, stressful environment, violence, and being threatened. As a result of these traumatic events, the veterans experience intrusive memories and flashbacks from wars. To cope up with these traumatic events, the veterans use alcohol as a coping mechanism. For instance, most Vietnam veterans who sought some medication on PTSD suffered from alcohol abuse. Currently, the veterans receiving some treatment on alcohol abuse have the PTSD. This study portrays that PTSD and alcohol abuse co-occurs in most cases.
Conclusion
Indeed, the association between PTSD and alcohol abuse has been elucidated and has shown some consistency in a diverse population and over many decades. The strong co-occurrence has been portrayed by several surveys conducted in Australia, Europe, and the United States. The associations between these two conditions have persisted in studies conducted on populations at higher risks, such as veterans of the war in Vietnam and women. Even though the prevalence of alcohol abuse in men tends to be higher, women are more likely to suffer from PTSD when exposed to traumatic events.
Typically, the interplay mechanism underplaying between PTSD and alcohol abuse is complex and multifaceted. The majority of the research portrayed no discrete pattern for the development of the two disorders. In reflecting on the self-medication theory, some research reveals that veterans tend to first develop PTSD before developing an alcohol drinking problem. Other studies portray that individuals with drinking problems are exposed to traumatic events that make them develop PTSD. The two evidence approaches represent the separate association between alcohol abuse and PTSD. The conditional nature between alcohol abuse and PTSD makes the relationship complex to intervene for treatment.
Presently, there are several developing questions concerning the co-occurrence of the two conditions. One of the outstanding questions is the difference in outcomes when one or the other condition develops first. The other question is on specific traumatic events that can prevent an individual from developing alcohol drinking problems. PTSD with intense stress and alcohol dependence changes the personality of victims and lead to harmful social behaviors. After following all the 5 phases of PTSD (Impact, Denial, Short- Term Recovery, and Long- Term Recovery Stage), it is essential to keep track of the victim to avoid relapse. Alcohol dependence worsens the stress level of individuals. Also, there is a question on the difference between the two conditions among different ethnic and racial minorities. Further research should be conducted to address these and other questions to minimize the harm to individuals experiencing either or both PTSD and alcohol abuse.
References
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