Veterans With PTSD ‘Moral Injury’ Often Use Alcohol as Therapy

From flashbacks to feeling numb, the symptoms of posttraumatic stress disorder (PTSD) can make it hard – or virtually impossible – for a veteran to live a full and healthy life. This troubling mental health condition impacts everything in a person’s life – from being able to hold down a job to keeping a marriage intact. The situation becomes even more serious when that veteran struggles with alcoholism. If a veteran in your life is battling both PTSD and alcoholism, it’s critical to learn more so you can determine the best way to help him or her.

The Trauma of PTSD

Combat veterans often experience life-threatening situations or witness horrors that most of us could never fathom.  These traumatic events often trigger PTSD. Furthermore, increasing evidence points to an additional factor that may play a role in its development among veterans: guilt. Several studies suggest that guilt, like the guilt that often accompanies killing another human being in combat or failing to save a comrade, may be more strongly linked to PTSD than the survival of a life-threatening event. For example, one study suggests that killing while in combat was a strong predictor of PTSD, alcohol abuse, anger management problems and marital problems in Iraq veterans. This deep wound to a soldier’s soul – a “moral injury” as many clinicians who treat veterans call it – is not an official psychiatric diagnosis.  However, the research findings are convincing enough that the departments of Defense and Veterans Affairs are supporting a 4-year study of the issue.

The PTSD-Alcohol Link

A staggering 75% of those who have survived violent trauma reports struggling with alcohol abuse or alcoholism, according to the U.S. Department of Veterans Affairs. In addition, alcohol abuse tends to be more common among veterans who have chronic pain issues or other challenging health problems. It’s not uncommon for people to turn to drinking to relieve anxiety or stress after a traumatic event. Research suggests that during trauma, endorphin levels spike to help numb the physical and emotional pain of the event. Once the trauma is over, endorphin levels decrease, creating a feeling similar to withdrawal. Alcohol use increases endorphin activity, allowing the user’s brain to raise levels and alleviate the emotional distress.

Alcohol Makes PTSD Symptoms Worse

Alcohol affects the brain in ways that worsen symptoms of PTSD. For instance, it elevates feelings of anger, irritability and the need to be “on guard.” Drinking also has a profound effect on sleep in PTSD sufferers. Your loved one may believe the alcohol is helping him or her sleep, but in reality it creates poorer sleep quality, so they feel less rested, and that can make other symptoms feel worse. Using alcohol also allows your loved one to avoid painful memories, which means the healing process cannot start. He or she cannot manage or recover from the condition until they get professional help for alcoholism.

Barriers to Treatment of PTSD-Alcohol Abuse

Stigma — Veterans face a host of challenges when coming back from combat duty. Despite increasing public awareness of PTSD, there is still a stigma attached to the diagnosis. One study of a British effort to modify attitudes toward the condition in the Royal Navy had a “non-significant” effect. When a veteran internalizes stigma, it can lower motivation to seek help for what can be a debilitating mental health condition. Health care barriers –– Your loved one may not seek treatment because they perceive barriers to health care. Researchers in one study found that vets did not seek help because of reasons such as: “I don’t have transportation” or “I do not have insurance that would cover behavioral care.” The same study found that some veterans expressed concern that mental health professionals would have limited experience treating service members for PTSD. Beliefs about care availability or the skill of clinicians could easily discourage an already-hurting veteran from reaching out for help. Medication concerns –– The study above also discovered that fear of the side effects of PTSD medications discouraged some veterans from getting support or help. Participants expressed worry that prescription drugs, like antidepressants, would change their personality or limit their normal functioning. Alcoholism –– Drinking itself can make it harder for a veteran to manage PTSD. When your loved one is intoxicated, he or she may be unable to take action regarding their health. They may forget to take prescribed PTSD medications or be unwilling or unable to attend therapy. In addition, long-term alcohol abuse damages brain cells, reducing the ability to make reasonable decisions, such as deciding to find help for PTSD.

PTSD and Alcoholism Can be Treated

The best chance for treatment success comes with addressing both issues. If your loved one experiences a barrier to treatment, such as medication concerns, you may need to work with a PTSD/alcohol addiction professional able to help him or her overcome those concerns and enter treatment. Therapy is the foundation for any recovery plan. During sessions with a mental health professional, preferably one experienced in PTSD, the veteran will learn to cope with the previous trauma and the emotions related to it. Medications to supplement therapy are available to treat PTSD and alcohol dependence separately, but a new drug may be able to treat both. The drug topiramate (Topamax) is already being used to treat epilepsy and migraines, but new research suggests that it may significantly reduce alcohol consumption and cravings while generally having a positive effect on PTSD symptoms [6]. Treating PTSD and alcohol abuse often involves finding help for the entire family. Military members may come home as a very different person as a result of what they’ve experienced.  This can make it difficult for family members to adjust. Likewise, veterans may return home to find that loved ones have changed too. Family or marriage therapy can help veterans and loved ones work through difficult emotions as well as find strategies for resolving conflicts.

Help Your Loved One Find Help

Contact a mental health professional or the local VA center for guidance. Addiction treatment centers and VA medical centers offer mental health assessments, therapy, family counseling, and inpatient and / or outpatient care. Some programs may be designed specifically to help veterans with substance abuse problems. PTSD is a serious mental health condition on its own – combining it with alcoholism can make it much worse. If your loved one is a veteran struggling with this problem, please seek help.  He or she deserves the peace that comes from healing.

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