PTSD and Alcoholism: Correlation, Trauma, and Co-Morbidity

Introduction

The purpose of this study is an examination of the relationship between post-traumatic stress disorder (PTSD) and alcoholism/addiction, in an effort to determine whether a correlation exists between the two conditions.

There is a large body of evidence suggesting that alcohol abuse is common in patients diagnosed with PTSD (Thornton, 2003; Weinstein, 1999; Jaycox et al., 2004). Much of the research conducted in the past has focused on the co-morbidity of traumatic disorders, other psychological disorders, and the presence of alcohol abuse or other substance abuse problems in patients seeking treatment for alcohol abuse.

This study is important because it will link past research and data in order to develop a scientifically grounded explanation for the co-existence of such disorders, further clarifying the body of research conducted thus far. A majority of the evidence available on PTSD and addiction-related disorders is qualitatively based. The intent of this research is to find empirically based relationships that demonstrate a statistical link between PTSD and addiction; thus, the study will be quantitatively based.

The researcher will examine the historical literature available with regard to PTSD and alcoholism/addiction in order to derive a hypothesis grounded in theory and supported by scientific data. Based on the preliminary results of the literature review, the researcher proposes the following:

Hypothesis A: A direct correlation between post-traumatic stress disorder and alcoholism/addiction exists.

Null Hypothesis: A direct correlation between post-traumatic stress disorder and alcoholism/addiction does not exist.

Background to the Problem and Statement of the Problem

The proposed hypotheses are grounded in a large body of evidence suggesting a direct link between alcoholism and other addictive behaviors and the occurrence of traumatic experiences in youth and/or adulthood (Thornton, 2003; ISTSS, 2003; Weinstein, 1999; Jaycox, Ebener, Damesek & Becker, 2004).

The author proposes that a correlation does exist between alcoholism/addiction and post-traumatic stress disorder. To confirm this hypothesis, the author proposes an in-depth examination of the historical literature and case studies available on PTSD and alcoholism/addiction — specifically, whether a relationship exists between the two, and if so, what the extent of that relationship is.

This research will help confirm the relationship that may exist between PTSD and substance abuse, and will hopefully assist researchers and medical authorities in developing more targeted treatment programs that acknowledge the relationship (if any) between alcohol or chemical dependency and post-traumatic stress disorder.

Studies suggest that the use of alcohol or other drugs may provide patients dealing with trauma with a temporary distraction and relief from the thoughts, feelings, and negative emotions associated with a traumatic event (ISTSS, 2003), and that substance abuse is generally chronic because the relief provided is only temporary. There is further evidence to suggest that alcohol abuse may be utilized as a means of self-medication against traumatic memories and experiences (ISTSS, 2003; Thornton, 2003).

Given this information, it is critical to examine whether a specific relationship exists between substance abuse and PTSD in order to identify treatment methods most likely to benefit patients demonstrating co-morbid PTSD and substance abuse problems.

Methods

The aim of this study is to assess whether a correlation exists between alcohol/substance abuse and PTSD. Studies suggest that patients with PTSD are diagnosed with lifetime alcoholism at a rate two to three times that of the typical population, and that patients seeking treatment for alcoholism are three times more likely to demonstrate symptoms of PTSD (Thornton, 2003; Kessler, Sonnega, Bromet, Hughes & Nelson, 1995).

Research also suggests a strong link between exposure to trauma and substance abuse problems (ISTSS, 2003). Trauma-related disorders including PTSD are found to occur more frequently in people with substance abuse disorders such as alcohol abuse (ISTSS, 2003). Gender links have also been associated with PTSD and alcoholism, with some studies confirming that women are five times more likely to receive a dual diagnosis of alcoholism and PTSD (Thornton, 2003; Kofoed, Friedman & Peck, 1993).

More than 50% of adults with co-occurring alcohol abuse problems and PTSD are also thought to have other serious behavioral or psychological problems, including anxiety disorders, mood disorders, disruptive behavioral disorders, and other addictive behaviors (ISTSS, 2003).

A comprehensive literature review will be compiled examining the nature of PTSD and substance abuse problems. Specifically, the research will first broadly examine PTSD with regard to alcoholism, then investigate the role of trauma in the co-morbidity of PTSD and alcoholism, then examine childhood influences and gender differentiation in patients with a dual diagnosis, then attempt to identify whether a relationship exists between PTSD, alcohol abuse, and emotional disturbances, and finally examine whether genetic and environmental factors influence the relationship between alcohol abuse and PTSD.

Alcoholism and PTSD: Overview

There is a large body of evidence suggesting that a quantitative approach to behavioral analysis and PTSD is appropriate (McKeehan & Martin, 2002; Weinstein, 1999). A majority of the studies conducted on PTSD and substance abuse are qualitatively based (Jaycox, Ebener, Damesek & Becker, 2004; Langeland, Van Den Brink & Draijer, 2002; Brown, 2001). This study aims to provide more empirical data related to the phenomena of alcoholism and PTSD; thus, a correlation study will be conducted.

The author proposes development of a questionnaire to be distributed to patients attending alcohol treatment programs. The questionnaire will assess whether patients have experienced some level of trauma during their lives that may be directly linked to their substance abuse problems. It will also investigate whether patients undergoing treatment for alcohol abuse demonstrate underlying PTSD symptoms, and whether patients with co-morbid PTSD are more likely to relapse or fail to complete a program than those without a dual diagnosis. The research proposes that anonymity be provided to all participants given the sensitive nature of the topics being discussed.

There are numerous studies suggesting a link between substance abuse and the experience of trauma in patients of all ages. The literature review begins with a broad analysis of the relationship between alcoholism and post-traumatic stress disorder and continues by narrowing the focus to specific areas: the role of trauma in abuse and PTSD, childhood abuse and gender differentiation among patients with PTSD, the link between alcoholism and pre-existing emotional or cognitive disorders, and genetic or environmental links to PTSD and alcoholism in patients seeking treatment for alcohol abuse.

A large number of studies confirm that a relationship exists between post-traumatic stress disorder and alcoholism (Thornton, 2003; ISTSS, 2003). There is also evidence of other addictive behaviors in patients diagnosed with PTSD or similar disorders (Jaycox et al., 2004). Many studies suggest that trauma is often mitigated by the effects of alcohol or substance abuse — meaning that trauma victims frequently rely on substances including alcohol to lessen the anxiety, stress, emotional duress, and depression that trauma produces (Langeland, Van Den Brink & Draijer, 2002; Brown, 2001).

There is also evidence suggesting that patients undergoing treatment for alcoholism are more likely to relapse if they have been victims of severe trauma or have been diagnosed with PTSD (Brown, 2001). If a direct correlation is found between alcoholism and PTSD, it will be crucial for caregivers to develop treatment protocols that address the relationship between the two and find effective methods of encouraging participants to remain in treatment programs until a successful outcome is reached (Brown, 2001).

Findings from numerous studies further suggest that the symptoms of alcoholism and PTSD may mimic one another, and that a dual diagnosis of PTSD and alcohol abuse may produce less optimistic treatment outcomes and more severe behavioral difficulties (Thornton, 2003). Thus, it is important that the researcher differentiate between alcoholism, PTSD, and a dual diagnosis. For the purposes of this research, the author is concerned primarily with patients exhibiting symptoms of both PTSD and alcoholism simultaneously, and will attempt to discern whether one is directly related to the other via cause and effect or another type of relationship.

Some studies suggest that alcohol abuse among patients often develops as a response to trauma, and that alcoholism may worsen pre-existing disorders including PTSD (Thornton, 2003; Jaycox et al., 2004). Research provides strong evidence that many patients with PTSD and other trauma-related disorders are more likely to exhibit substance abuse problems (ISTSS, 2003). Statistics suggest that up to three-quarters of people who have experienced abuse or trauma report alcohol abuse; that up to 80% of veterans seeking PTSD treatment have alcohol use disorders; and that women show an increased risk for a dual diagnosis of PTSD and alcohol abuse (ISTSS, 2003).

Children experiencing abuse are also 4.5 times more likely to report alcohol abuse than those who are not abused in early or late childhood (ISTSS, 2003). This pattern often continues throughout the adult lives of such children and may even extend into future generations — a topic discussed in further detail in the section on genetics and environmental factors.

PTSD and Co-Morbidity of Alcoholism: The Role of Trauma

The role of trauma has been linked in numerous studies with the existence of PTSD and alcoholism. Many of these studies have focused on examining the co-morbidity of PTSD and other psychiatric disorders in patients with alcoholism. The primary emphasis of this study is the examination of the relationship between the two conditions.

PTSD by nature and definition involves some form of trauma. For the purposes of this study, the exact nature of the trauma experienced by patients with PTSD will not be restricted. By "trauma," this researcher intends to examine studies related to any or all of the following: sexual abuse, physical abuse, neglect, emotional abuse, perceived parental dysfunction, accidents, or personal injury.

All of these factors appear in the studies conducted on trauma, though the majority of available research on PTSD has focused on trauma related directly to abuse — whether physical, mental, or emotional. Many studies on the role of trauma have also focused on the experiences of veterans in war, and have found that a relationship exists between PTSD and the prevalence of alcoholism in that population (ISTSS, 2003; Thornton, 2003). The present study will not focus exclusively on veterans, but rather on the population at large, in order to produce findings most applicable and generalizable to a broad audience.

Bulijan, Vreek, Cekic, Karlovic, Zoricic & Golik (2002) conducted a study investigating the prevalence of PTSD with regard to co-morbid alcohol dependence in displaced persons. The authors analyzed patient experiences via personal interviews and examination based on DSM-IV criteria and the Los Angeles Symptom Checklist, combined with a medical examination. Their findings showed that 50% of displaced persons demonstrated symptoms of PTSD and 43% had co-morbid alcohol dependence. Among other findings, the study concluded that war trauma may influence the development of alcohol dependence and other medical problems associated with PTSD.

The methodology utilized by Bulijan et al. (2002) suggests a positive experience with survey and interview methods for assessing whether a relationship exists between PTSD and alcoholism/addiction, lending support to the author's premise that a survey-type analysis is appropriate for the field research portion of this study.

In a study conducted by Volpicelli, Balaraman, Hahn, Wallace & Bux (2000), the role of trauma in the development of PTSD and alcohol addiction is examined. The researchers present a model explaining the effects of trauma on psychological distress and hypothesize that alcohol consumption is influenced by PTSD. The authors conclude that alcohol may help relieve many symptoms associated with post-trauma — including anxiety, irritability, and depression — because alcohol compensates for deficiencies in endorphin activity in patients who have experienced traumatic events. They further suggest that alcohol increases endorphin activity and that drinking following trauma can compensate for the decrease in endorphins demonstrated after emotional distress.

Jaycox, Ebener, Damesek & Becker (2004) find that trauma exposure and related symptoms are associated with substance abuse. Their survival analysis also indicated that adolescents exposed to trauma and with co-morbid PTSD are more likely to drop out of an abuse treatment program than those without PTSD. More behavioral problems, including gender-specific patterns, were evident in patients with PTSD.

Based on the evidence presented above, the researcher concludes that PTSD is more likely to be associated with alcoholism in patients who have been exposed to trauma. Given that a large body of evidence suggests that a majority of the population (up to 70%) will experience some form of trauma at some point in their lives (Thornton, 2003), it is critical to assess the extent of the relationship between PTSD and alcohol abuse.