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The Connection Between PTSD and Alcohol and Drug Use

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Updated June 18, 2014

It may not be surprising that PTSD and drug and alcohol use commonly co-occur. That is, study after study has found that people with PTSD often also have problems with alcohol and drug use.

Rates of Co-Occurrence

The consistent finding is that individuals with PTSD are more likely to have problems with alcohol and/or drug use.

For example, in a large survey of people from communities across the United States, it was found that 34.5% of men who had PTSD at some point in their lifetime also had a problem with drug abuse or dependence during their lifetime. Similar rates (26.9%) were found for women who had PTSD at some point in their lifetime.

Big differences were found between men and women with a history of PTSD when it came to experiencing problems with alcohol abuse or dependence. Whereas 27.9% of women with a history of PTSD reported problems with alcohol abuse or dependence at some point in their lifetime, almost twice as many men (51.9%) with a history of PTSD reported such problems. As a point of comparison, Kessler and colleagues found that, on average, 24.75% of men and 10.55% of women without PTSD had problems with alcohol or drugs at some point in their lifetime.

Why Are Drug and Alcohol Use Rates Elevated in PTSD?

Researchers have proposed a number of theories or explanations as to why people with PTSD have higher rates of alcohol and drug use. These are briefly reviewed below.

  1. High-Risk Theory
    The high-risk theory states that drug and alcohol problems occur before PTSD develops. Proponents of this model believe that the use of alcohol and drugs puts people at greater risk for experiencing traumatic events, and therefore, at greater risk for developing PTSD.

  2. Self-Medication Theory
    The self-medication theory states that people with PTSD use substances as a way of reducing distress tied to particular PTSD symptoms. For example, alcohol (a depressant) may be used to reduce extreme hyperarousal symptoms.

  3. Susceptibility Theory
    The susceptibility theory suggests that there is something about alcohol and drug use that may increase a person's risk for developing PTSD symptoms after experiencing a traumatic event.

  4. Shared Vulnerability Theory
    This theory states that some people may have a genetic vulnerability that increases the likelihood that they will develop both PTSD and substance abuse problems following a traumatic event.

Which Explanation is Correct?

Research actually supports all of these theories. How can this be? Well, one explanation may be more applicable than another depending on a number of factors, such as a person's family history, age, gender, or whether or not they have another disorder such as depression. The truth is, we really do not know yet.

Despite knowing for sometime now that PTSD and drug and alcohol use problems co-occur quite regularly, research examining the reasons why this is the case is still in its earliest stages. However, this research is now being done by an increasing number of people and findings are leading to the development of more effective treatments for people with PTSD and drug or alcohol use problems.

Sources:

Brady, K.T., Back, S.E., & Coffey, S.F. (2004). Substance abuse and posttraumatic stress disorder. Current Directions in Psychological Science, 13, 206-209.

Kessler, R.C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C.B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048-1060.

Tull, M.T., Baruch, D., Duplinsky, M., & Lejuez, C.W. (in press). Illicit drug use across the anxiety disorders: Prevalence, underlying mechanisms, and treatment. In M.J. Zvolensky & J.A.J. Smits (Eds.), Health behaviors and physical illness in anxiety and its disorders: Contemporary theory and research. New York, NY: Springer.

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