Post-traumatic stress disorder (also referred to as PTSD) is an anxiety disorder that changes the body’s ability to respond to stress. It may arise following involvement in something highly traumatic involving the threat of injury or death, or the witnessing of a traumatizing event. PTSD is common among soldiers returning from combat, but may also affect victims of assault, domestic abuse, natural disasters, or other traumatic experiences. In a person with PTSD, the natural fear and “fight or flight” response to danger may be present even when there is no danger. Sufferers may relive their traumatic experience through flashbacks or strong reactions to anything that reminds them of the experience. Other symptoms fall into the category of “avoidance” – emotional numbing, lack of interest in activities, or hiding moods – or under the category of “arousal” – hyperawareness and being easily startled, difficulty concentrating or sleeping, or outbursts of anger. Although awareness of PTSD has grown tremendously in the last few decades, the condition is still not fully understood, and too many cases continue to go undiagnosed and untreated. The large numbers of U.S. Military veterans who suffer from substance use disorders suggests that many veterans are attempting to self-medicate rather than seeking treatment for the effects of combat trauma. History of Post-Traumatic Stress Disorder Post-Traumatic Stress Disorder has probably existed in some form throughout human existence, but was not officially named and recognized until the second half of the 20th century. The first acknowledgement of the negative mental health consequences that may result from combat came in the 1800s, when soldiers were first diagnosed with “exhaustion” or “Soldier’s Heart” following battle experience. This was considered to be a physical affliction, since soldiers were not supposed to exhibit any sign of mental weakness, and could be executed for any actions perceived as cowardice. The term “shell shock” came out of the First World War, followed by “combat fatigue” during World War II. For the first time, people began to understand than genuine mental illness could result from combat exposure. However, the belief still persisted that these conditions could be treated by simply removing soldiers from battle. If their symptoms persisted for months, it was believed that they must be suffering from some previous condition that had gone undiagnosed. In the third edition of the Diagnostic and Statistical Manual of Mental Disorders published in 1980, PTSD was finally given its modern name and classified under anxiety disorders. Post-Traumatic Stress Disorder and Alcoholism Statistics for PTSD and substance abuse are still incomplete, largely due to the relatively recent acceptance of the condition in medicine and the military. However, the Department of Veterans Affairs reports that among individuals with similar backgrounds, those with PTSD are more likely to abuse alcohol than those who do not have PTSD. Alcohol abuse is the largest substance use problem facing military personnel, affecting an estimated 27 percent of returning soldiers. PTSD received official recognition following the Vietnam War and the many problems facing returned Vietnam veterans – currently, up to 80 percent of Vietnam veterans receiving treatment for PTSD also report drinking problems. Alcohol problems also affect many people outside the military who have been exposed to trauma. As many as 75 percent of people who experience violent or abusive trauma also have problems with alcohol, even if they do not develop PTSD. Women with PTSD or history of trauma are at the greatest risk for alcohol abuse, although alcoholism overall affects men at a much higher rate. Diagnosis and Self-Medication Although PTSD has now received official recognition, many old stigmas regarding mental illness and expectations for soldiers persist. The male-dominated and often extremely macho society of the military can make it difficult for soldiers to admit that they may be suffering from mental illness. Unfortunately, misconceptions persist that PTSD or other mental disorders are not “true” illnesses, but result from an inherent mental or moral failing. Without diagnosis and proper treatment, PTSD or other mental illnesses can lead suffers to self-medicate with alcohol, illicit drugs, or prescription drug abuse. Self-medication is the attempt to treat symptoms with substances that have not been prescribed and controlled by a physician or other treatment expert. Alcohol and illicit drug use can lead to serious consequences, but prescription drugs used improperly or without a prescription can also be dangerous – all the more so because people are less likely to understand the risks. Self-medication often exacerbates the symptoms of PTSD, and may lead to the development of co-morbid, or co-occurring mental disorders. Developing an addiction or substance use disorder may also overshadow the existence of PTSD, making it more difficult to diagnose and treat the initial condition.