PTSD and the impact alcohol/substance abuse has on symptoms

Shelby Ramsey

Special to the Village News

When looking at the large number of individuals suffering from PTSD, it is important to acknowledge the unfortunate role alcohol and substance abuse play in this particular population.

Expertly explaining this is Dr. Debra Kaysen, Professor of Psychiatry and Behavioral Sciences – public mental health and population sciences at Stanford.

Kaysen is well-published and active in research in the areas of overlap between post-traumatic stress disorder and alcohol-use disorders, and accessible interventions for individuals suffering from mental health symptoms following traumatic events. She has conducted extensive research in the field of PTSD.

Kaysen's research has been primarily focused on why alcohol/substance use and PTSD are so often commingled. This includes her research findings as to if PTSD patients tend to use alcohol or other substances to self-medicate their condition.

"For lots of people, there's a belief that alcohol is an effective way of coping with negative emotions," Kaysen said.

We, as a society, see this commonly. If you take the time to reflect on many experiences in your past, you may be able to recall seeing this behavior on a number of occasions. It seems glaringly obvious to me that alcohol is used by some people when they are struggling in one way or another.

Kaysen explains many find alcohol a "reasonable way to cope." "There are a lot of different groups of people who talk about using alcohol or other substances as a way to cope with feeling crappy," she said. We see these behaviors in real life and it is also routinely depicted in movies and on television shows.

She underscored that "those beliefs by themselves aren't always a problem – but they are a risk." A risk factor for "using substances in more problematic ways," Kaysen said.

Kaysen's research has determined that individuals with PTSD "tend to have higher levels of what we call 'coping motives' or 'I am using this substance to cope.'"

When comparing men to women, Kaysen said men have a higher risk of substance/alcohol use disorders across the board. Women are typically at a lower risk for alcohol disorders, unless they have experienced trauma and have PTSD – which increases the risk.

For women, she said "that relationship between PTSD and alcohol use in particular is much higher."

Kaysen's expertise has led her to determine that alcohol and other substances are reached for as an effort to manage certain PTSD symptoms, and that is due to an individual's increased "baseline level of stress" (therefore it's easy for levels of distress to spike very high).

Going back to the hallmark symptoms of PTSD – experiencing nightmares and the inability to clear the trauma out of your mind, Kaysen explained that "sleep is often one that drives the [alcohol/substance use] relationship" when living with PTSD.

How often have you heard, "All I need is a good night's sleep" during conversations with someone who is struggling?

There are various opinions as to what will help bring about a good night's sleep. Kaysen pointed to one very bad opinion. "The problem is that both alcohol and cannabis are horrible medications for sleep," she said. The confusion in society could be attributed to the reality that alcohol "helps with sleep initiation, you fall asleep faster and may fall into deep sleep more quickly," and "that may be what people notice," she said.

"The problem is it disrupts your sleep quality" and in turn you may wake up more during the night and have poorer quality sleep, Kaysen advised.

This does not pertain to just PTSD sufferers; it goes for everybody. "Alcohol and substance use disrupts your next night's sleep; therefore you get this spiraling set of problems," she said.

Her insight on cannabis is worth noting. Knowing very little about the true effects of cannabis, Kaysen helped me gain an understanding that it too can assist in sleep initiation. The major drawback, she said, is that "it also disrupts the sleep architecture in slightly different ways than you see with alcohol."

"Cannabis is more complicated than alcohol since it depends on the compounds in the cannabis, as some are more sedating and some are more stimulating. There is also a lot less research on cannabis and sleep."

"However, what we tend to see is that cannabis can help with falling asleep more quickly, like alcohol. It can also reduce the number of hours of sleep, and can reduce REM sleep," she stated.

"Cannabis is a super-interesting drug in general because it has a biphasic effect on anxiety," Kaysen said.

A biphasic effect simply means that low and high doses of a substance/compound can produce opposite effects.

An example that might help us better understand a biphasic effect can be given with alcohol consumption. Let's say you know a friend who can drink one beer and be very chatty and the life of the party, but if that same friend goes on to drink six beers, he is crying on the floor or becomes belligerent and may be on the verge of passing out.

It is also known that if two different people partake in using the same substance, you may see two polar opposite reactions (one tired, one wired or one sad, one jumping for joy).

Chronic use of cannabis "can increase anxiety symptoms," whereas lower levels or occasional use "can reduce anxiety," Kaysen explained. "Folks who are using [cannabis] really chronically or who are using it in high quantities can actually increase their anxiety – it's paradoxical."

In addition, "For some kinds of trauma, substance use can also increase your risk of experiencing a traumatic event," she said. "There is a decent-sized relationship, for example, between alcohol use and sexual assault, but that doesn't mean that causes sexual assault."

Research has shown that "in about half of sexual assaults, either the victim or perpetrator have been drinking," Kaysen said.

It can be viewed as a vicious cycle – reaching for a substance to ease pain, nightmares, and to calm nerves, yet alcohol/substance use can, at times, increase a person's risk of experiencing a traumatic event.

In study results Kaysen has seen, on "light drinking" days, individuals have an increased risk of sexual assault four times greater than when not drinking; "heavy drinking" days increased the risk nine times.

How can we, as a society, best help individuals suffering from PTSD? The answer is two-fold.

"One of the things that is protective, that is helpful, is social support," Kaysen said.

Social support can be listening to what a person has experienced, letting them know that if "they want to talk, you are here, and that you can hear it."

Help can also mean motivating a person to seek out professional advice. Or it could be offering more practical support, i.e., helping to watch their kids during therapy sessions or driving them to their appointments.

In terms of avoiding getting help, Kaysen explained, "It's the fuel that keeps [the PTSD] going." Avoidance is "pushing it away, not thinking about it, not feeling it."

Recall how Kaysen explained avoidance means keeping things at arm's-length.

By encouraging individuals to talk about their experience and not avoid it, we could all be instrumental in helping them find relief from their symptoms and seek professional help.

What isn't advised is an avoidance attitude. "Often as a society we also give messages of 'put it behind you,' 'don't talk about it,'" said Kaysen. Additionally, "we as a society will endorse beliefs that perpetuate PTSD."

Instead of starting with an accusatory tone, why not start with a blank slate, and a kind and compassionate tone.

When asking questions like "Where were you?" "Were you drinking that night?" and "What were you wearing?" it immediately shifts blame to a person who has experienced trauma and is living with PTSD.

It's time for us as a society to change the narrative. We do not need to make others feel as if they are to blame, that the trauma that was experienced was their fault, that they brought these things on, or that they deserve to feel this way.

What we can do as a society is "make treatments accessible; make it okay for people to talk about PTSD." As Kaysen further clarified, "These are normal reactions to going through terrible things."

If you or someone close to you is experiencing any of the PTSD symptoms discussed, please know that you have a large group of supporters that hope you take steps to reach and work with professionals.

"I think this conversation [on PTSD] is really important for people," Kaysen remarked.

Professional treatment coupled with social support will make the future more manageable, positive, and healthy. It is very encouraging to know, via Kaysen, that treatment, such as psychotherapy, can be very successful for individuals.

Here are some (free) resources to learn more:

General information on trauma and PTSD:

https://istss.org/public-resources/trauma-basics

https://www.ptsd.va.gov/family/effects_ptsd.asp

Information on PTSD treatments:

https://www.ptsd.va.gov/understand_tx/tx_basics.asp

https://www.ptsd.va.gov/appvid/mobile/

Stanford's new web app was developed to help with distress for healthcare workers around Covid-19 but can be beneficial for anyone:

https://pam.stanford.edu/.

Shelby Ramsey is the author of the blog, thehonestmigraine.com, which also features interviews with patients and medical experts.