PTSD in Sobriety

Connection between PTSD and Alcoholics/Addiction

PTSD (Post-Traumatic Stress Disorder) and alcoholism / addiction often go hand in hand. Self-medicating symptoms of anxiety and depression associated with PTSD can lead to substance abuse. Also, active alcoholics or addicts may be more susceptible to experiencing certain types of trauma based on circumstances and potential risky behavior sometimes associated with addiction. Therefore while people who have endured trauma are more likely to have drinking problems, people with drinking problems are also more likely to have experienced psychological trauma of some kind.

What is PTSD

Post Traumatic Stress Syndrome can develop after exposure to an event that causes psychological trauma. The exposure can involve actually experiencing the event or witnessing the trauma. Symptoms of PTSD may include nightmares or flashbacks, sleep disturbances, avoidance or negative responses to associations with the trauma (i.e. people, places, situations), emotional numbing, anger, hypervigilance, or anxiety. The symptoms must be present for more than a month after the event, otherwise it may be “acute stress disorder” which is short-term. Untreated, the symptoms of PTSD can be experienced for years beyond the initial trauma. Finally, for the official diagnosis of PTSD, the set of symptoms must impair normal life functions i.e. in work or relationships. Note: “unmanageability” comes to mind.
People commonly associate PTSD with individuals who have suffered an obvious major trauma such as with combat veterans and abuse or rape survivors… Indeed, there is a prevalence of PTSD in those populations but it is certainly not limited to those.

ACOA and PTSD

PTSD is not always caused by a single traumatic event; it can be from a series of intense or even more subtle traumatic experiences. Adult Children of Alcoholics (ACOA) are an example of a subgroup that may be particularly likely to have endured traumatic events in childhood leading to PTSD as an adult. Abuse, neglect, or other psychological trauma may be experienced as the result of growing up in an alcoholic environment, in which one or more parents or caregivers were untreated alcoholics / addicts.

Many recovering alcoholics and addicts are also ACOA. Adult Children of Alcoholism in particular should consider ruling out PTSD if suffering any of the symptoms associated with post-traumatic stress. While they may not recall one particularly traumatic event, an ACOA may have experienced a series of less intense but traumatic experiences which can lead to PTSD alike.

Which Came 1st: the PTSD or the Addiction?

It’s sort of a “chicken or the egg” situation. Trauma can lead to unhealthy coping mechanisms in an effort to numb the pain, and thus lead to substance dependence. By the same token, when engaging in behaviors that accompany an addictive lifestyle, an alcoholic or addict is more likely to be in a situation where trauma can occur. Or both may be the case; some alcoholics may experience traumatic events prior to active addiction as well as during their active years. Binge drinkers may even not recall exposure to a traumatic event if it occurred during a blackout!

Dealing with PTSD in Sobriety

Regardless of when the trauma occurred - before or during active addiction - untreated PTSD is sure to affect an individual after starting the process of addiction recovery. As most therapists will tell you, you have a much better chance at healing your psychological traumas if you first put down the alcohol and drugs. Once the initial fog lifts and you are sober, it can be your first time really experiencing the effects of PTSD if you have been self-medicating with booze or drugs for years.

In early sobriety, previously numbed anger or anxiety associated with PTSD may surface. The alcohol and drug use could have masked sleep disturbances otherwise present with PTSD, thus resulting in sleep difficulties or insomnia in recovery (see related article on dealing with insomnia in sobriety). Certainly anger, anxiety and sleep problems can only aggravate the daily struggle to stay sober in early recovery. These symptoms alone do not necessarily equate to PTSD but it is a good idea to consider ruling it out.

“You’re as sick as your secrets.” Intrusive thoughts regarding old memories can surprise the newly recovering alcoholic who may have thought he/she had dealt with the memories or left the past in the past. Consider how many people relapse in anticipation of step 4, or when between step 4 and 5. Imagine uncovering memories of old traumas which trigger heavy emotions… leading to the danger of picking up a drink or drug before sharing it all with a sponsor.

Even when the recovering alcoholic with PTSD makes it through the 5th step with a sponsor, he/she may be disheartened by a lack of relief that may have been anticipated based on the experiences shared by others who successfully complete the 5th step who do not suffer from PTSD and thus may find more relief from the steps alone.

Treatment for PTSD in Sobriety

Clearly if there are concerns of potential PTSD in sobriety, it is crucial to seek treatment. The 12 steps are a great tool that will help support the process of addressing the PTSD, but outside help is recommended for recovering alcoholics/addicts who may suffer from post-traumatic stress. Remember, A.A. literature states: 

“God has abundantly supplied this world with fine doctors, psychologists, and practitioners of various kinds. Do not hesitate to take your health problems to such persons.”

The ideal treatment for any disorder is one which treats the underlying cause of the disorder. Let’s face it: PTSD is not a deficiency of medication… although sometimes people suffering from PTSD can end up on anti-depressants or anti-anxiety drugs from their primary physician or psychiatrist. 

Medication alone is not appropriate treatment for PTSD; the drugs only serve to medicate some of the symptoms in that case. This is why the typical recommendations for treatment of PTSD involve psychotherapy (not psychiatry), typically in the form of a cognitive behavioral therapy.

A particularly effective and clinically supported modality in this field is EMDR (Eye Movement Desensitization and Reprocessing). EMDR has been rated by the APA in the highest category of effectiveness and research support for treating trauma, based on the extensive clinical research performed validating it as a significantly effective treatment modality for PTSD in particular. EMDR can safely accelerate the healthy processing and healing from the traumatic memories underlying PTSD. To learn more about this effective modality, visit the EMDR Institute.

Emotional Freedom Technique (EFT) is another effective method used by therapists as well as coaches and holistic practitioners to help clients deal with the effects of PTSD. Similar to EMDR, EFT utilizes is a mind-body modality but that can be utilized for self-care in addition to guided sessions with certified practitioners. Research on EFT supports it's efficacy in the treatment of PTSD including with combat veterans; and a published review of recent research concluded: 

"According to published reports, systematic reviews of the published evidence, a meta-analysis of seven RCTs, and practitioner consensus, most cases of PTSD are remediated in ten EFT sessions or less. As a safe, efficacious, and easily learned self-help method, EFT should be offered to clients as an initial treatment option immediately after diagnosis." 

Note: the long term emotional stress of PTSD can contribute to physical stress on the body as well – see related article on nutritional support during stress to address the physical aspect.

In summary, when present PTSD is a crucial component to address in sobriety. Whether newly recovering or sober for a number of years, whenever this becomes evident it is necessary to address. You need not suffer silently with PTSD, and the symptoms can put you at risk for relapse. As with alcoholism, there is a solution! Utilize all the tools and outside resources available to effectively deal with PTSD in sobriety, and subscribe to this blog for more health information pertaining to recovering alcoholics and addicts.