Can Alcohol Cause Traumatic Responses? The Two-Way Street Between Alcohol and PTSD

Tuesday, July 26, 2016 by Meg   •   Filed under Trauma

In people ages eighteen and older, Post-Traumatic Stress Disorder (PTSD) occurs in about three and a half percent of the population in any given year1. PTSD is common following situations that involve threatened death or serious injury, such as robbery or rape, an earthquake or a car accident.

Post-Traumatic Stress Disorder leads many to feel out of control. The symptoms may be so overwhelming some turn to the use of substances in an effort to calm themselves. However, there is a great deal of evidence to suggest that alcohol not only exacerbates the symptoms of PTSD, but also increases the likelihood of getting PTSD in the first place.

Let’s lay out exactly what we’re talking about.

What Are The Symptoms of Post-Traumatic Stress Disorder (PTSD)?

  • Re-experiencing symptoms like flashbacks 
  • Bad dreams or trouble sleeping 
  • Intrusive thoughts 
  • Avoiding places, people or things (even words) that are reminders of the trauma
  • Feeling numb
  • Guilt
  • Angry outbursts often as an offshoot of fight or flight (the fight is there for a reason)
  • Depression 
  • Worry
  • Anhedonia, or losing interest in things you used to enjoy
  • Trouble remembering parts (or all) of the event
  • Hyper-arousal, such as feeling constantly on edge or being easily startled 

While these symptoms usually follow a stressful event involving an individual or a loved one, for those with heightened anxiety responses, seemingly mundane experiences may trigger similar symptoms. In addition, some who experience traumatic events never go on to have Post-Traumatic Stress Disorder. 

What gives? 

Some of these differences may come from early stress priming, attachment issues and genetic factors. But substance abuse can create another cyclic roadblock to healing for reasons you may not expect.   

Early Trauma and Substance Abuse

It has been well documented that substance abuse and trauma go hand in hand, with trauma usually preceding the use of alcohol or other drugs2. It is no small effect; some research indicates that childhood trauma like rape doubled the incidence of alcohol abuse symptoms for adult women3.

From these numbers, it appears that those with a history of trauma are simply using substances to deal with unwanted symptoms. However, recent research, published in “The Journal of Abnormal Psychology”, found that PTSD and alcohol use, as opposed to being a simple A causes B system, actually predicted each other over a three year assessment period. In this study, not only did having PTSD increase the risk of alcohol usage, but using alcohol increased the risk of having PTSD4. Other reports have found similar relationships 5

Now, some will argue that this is simply a function of alcohol or other substances leading to risky behaviors that culminate in being traumatized again. But it isn’t so simple, because having a traumatic experience doesn’t always lead to Post-Traumatic Stress Disorder. 

But trauma leads to PTSD more often if you use substances. 

One study, published in “The Journal of Traumatic Stress”, compared two groups of women, both of whom had been through traumatic experiences. They found higher rates of PTSD in women with any history of substance abuse issues6. Not only that, but this study found that over the course of three months, those with substance abuse issues had slower rates of recovery, showing more symptoms at the three month mark than women who had PTSD but did not drink. 

But why would this be?

Alcohol, Endorphins and Brain Alteration: “Why Do I Feel So Good While I’m Drinking and So Bad Afterwards?”

Some research indicates that alcohol might play a role in rewiring the brain, particularly in relation to anxiety and issues like PTSD. In one study, researchers tested how long it took mice to lose their fear of a tone after being traumatized with shocks. The ones who had been exposed to heavy alcohol use took longer to recover, freezing(link) for longer periods than those who had not been exposed to alcohol7. Further, the alcohol-exposed mice had changes in the prefrontal cortex of the brain, a site strongly linked to depression and negative thought processes in humans.

Seriously, crappy day for mice, no matter how drunk they got beforehand.  

Drunk mice aside, what this suggests is that alcohol use reduces the brain’s ability to recover from the effects of stress. But, alcohol may play yet another role in the brain that actually triggers increased usage following traumatic events, a role that predisposes individuals to a self-sustaining cycle of brain damage and less resilience, leading to further depression and PTSD symptoms. 

Can Trauma Lead To Alcohol Cravings?

Trauma increases the level of endorphins in the brain within minutes of a traumatic event, a physiological phenomenon that evolved to reduce the initial pain associated with the trauma8. If you’re going to be exposed to something shitty, you might as well feel less of it.  

However, over time, those endorphin levels decrease, leading individuals to experience the physical or emotional pain that they may have missed during the event. 

And guess what increases endorphins?

You guessed it: alcohol. Because alcohol has the ability to increase endorphin levels in the brain, researchers believe that drinking after a traumatic event may serve to lessen the effects of an endorphin crash9. In other words, it numbs you from the pain so you can put off actually dealing with the event in question. 

This explains why higher rates of drinking are reported on days when people are experiencing more intrusive PTSD symptoms like avoidance, scary thoughts and low mood10. Alcohol provides a release when symptoms are bad.

And that’s not all. According to psychiatrist Peter Kramer in Listening to Prozac, alcohol alters neurotransmitter function that can be persistent over time11. In those with depressive symptoms, Kramer notes that evidence of damage is usually found in areas that control serotonin and other emotion controlling hormones, and that glial cells—the brain’s way of processing toxins—are also damaged. Alcohol primes the brain for further degeneration by increasing immediate damage and by impairing the ability to recover, actions which speed the degeneration and can make depression and trauma-related symptoms worse faster. 

So, as opposed to simply increasing the rate of risky behaviors, alcohol usage may increase rates of post-traumatic stress by altering brain chemistry, making PTSD more likely in those who use, and particularly during times of intoxication. Alcohol also primes the brain to crave it in times of stress, which may lead to a cycle of inadequate repair and trouble coping. And those changes may persist over time, setting up a bumpy road where healing is thwarted at every intersection. 


But healing is possible, and there are a number of treatment options available. The road is long but it doesn’t last forever. 


There is always hope. There is always help. 

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Topic-Relevant Resources

Listening to Prozac: The Landmark Book About Antidepressants and the Remaking of the Self, Revised Edition
Psychiatrist Peter Kramer discusses the implications of preferred personality on mental health along with the evolution of Prozac as a preferred treatment for undesired traits.

The Anxiety and Phobia Workbook
Great resource to keep you on track with exercises for overcoming anxiety, panic and phobias