Behavioral Treatments for Alcohol Use Disorder and Post-Traumatic Stress Disorder PMC

Understanding the biochemical changes that occur throughout and after an occurrence of uncontrollable trauma is critical to understanding how trauma may cause mental distress and influence alcohol consumption. Increased levels of endogenous opioids (endorphins) tend to numb the pain of uncontrollable trauma. Rebound endorphin withdrawal after a traumatic incident, on the other hand, may lead to symptoms of emotional distress as well as an increased urge to consume alcohol. The endorphin compensation theory proposes that people drink alcohol after a stressful event to compensate for their lack of endorphins.

theories of ptsd and alcoholism

Limitations include its relatively narrow window of detection (usually 3 days or less for most substances), easy alteration with chemicals or clean urine samples, and susceptibility to false positives (Jaffe, 1998; Widdop & Caldwell, 1991). A large-scale 2018 study in Sweden looked at the link between stress-related disorders and autoimmune disease. The study found that in participants with a history of PTSD, there was a 58% increased risk of these autoimmune diseases compared with those with no PTSD history. This means that to feel the desired effect, the affected individual would require greater and more regular doses of alcohol.

What is PTSD?

Sometimes after a traumatic experience, people believe that their symptoms will eventually go away over time. This eventual lessening of distressing symptoms can happen for some people—but not for everyone. Some people may even experience nightmares, memories about the event, or problems sleeping at night, which are common characteristics of PTSD. Post-traumatic stress disorder can impact every area of a person’s life, but with proper management and support, this disorder can be treated. By Matthew Tull, PhD

Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. AUD and PTSD have shown a consistent comorbidity over many decades and in diverse populations.

The findings were that significantly greater atrophy of visual cortex (and other brain regions) occurred in veterans with PTSD whose symptoms were worsening, whereas such atrophy did not co-occur in those whose PTSD symptoms were improving. Thus, the findings of the limited investigations to date suggest that enhanced activation in visual cortex occurs in PTSD, and likely contributes to the visual sensory symptoms of PTSD. In addition to the incorporation ptsd and alcoholism of prolonged exposure therapy into residential SUD treatment, two integrated treatments that incorporate exposure-based techniques have been tested among individuals with PTSD and SUDs. Triffleman and colleagues (1999 PTSD and SUDs. Triffleman and colleagues (2000) developed an integrated treatment, Substance Dependence Posttraumatic Stress Disorder Therapy (SDPT) delivered as a five-month intervention, including twice-weekly sessions.

Signs and symptoms of PTSD

Women were randomized to one of the two interventions and individual sessions were delivered twice weekly for 12 weeks. Compared to a nonrandomized community care group, both treatment interventions had improved substance use and PTSD severity outcomes at the end of treatment, and at 6 and 9 months follow-up. Of note, PTSD symptom severity scores as measured by the CAPS were still in the moderate severity range (score range 48–60) post treatment, and no significant differences in PTSD or SUD symptoms between the SS and relapse prevention groups were observed. In this article, the author critically reviews studies on the relationship between exposure to trauma, posttraumatic stress disorder (PTSD), and alcohol abuse. After establishing that strong relationships exist between exposure to traumatic events and alcohol problems, and particularly between the diagnoses of PTSD and alcoholism, the author discusses various factors, theories, and possible mechanisms to account for these associations.


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The most prominent current theories – emotional processing, dual representation, and the cognitive model of PTSD – draw on earlier work, in particular conditioning, information processing, and classical cognitive theory. The latest theories combine stimulus and response elements with meaning, interpretation, and appraisal; they argue that successful processing depends on being able to access and assimilate new information within pre-existing schemas. Social factors are also recognized as playing a significant role in the development and maintenance of PTSD. These are considered along with the contention that PTSD is a socio-political construct as opposed to a true disease.

Integrated Behavioral Treatments

This may promote frequent trauma-related anxiety in his benign posttraumatic environment because these roadside objects are ubiquitous in his neighborhood and town. The second mechanism, imputing extinction failure in PTSD to inadequate inhibition of the acquisition memory, has begun to receive support from results suggesting impaired processes of fear inhibition in PTSD (for a review, see Jovanovic & Ressler, 2010). Because these data are directly relevant to both failure-to-extinguish and failure-to-inhibit theories of PTSD, such data will be discussed in the context of both models in the failure-to-inhibit section of this review.

theories of ptsd and alcoholism