Don’t Make it Worse! Use of Alcohol or Drugs After Trauma by Angie Panos, Ph.D., CEAP and Patrick Panos, Ph.D., ABPP

panos221.jpg - 30137 Bytes

“My friend has survived a traumatic event and I want to help them. Wouldn’t the best thing be to just take them out and get them drunk?” This is a common question posed by many friends, neighbors or family members. Alcohol is ubiquitous in our culture. It plays a part of many family, social and religious celebrations and traditions. Confusion about its safety occurs because it is a legal substance for people 21 years of age and older. The use of alcohol or minor tranquilizers after a traumatic event used to be a fairly standard treatment protocol. However, the research over the last decade clearly shows the deleterious effects of alcohol to a traumatized person. Alcohol produces changes in their neurochemistry and nervous system that are ultimately harmful and exacerbate, rather than reduce, the symptoms of traumatic stress. Emergency room doctors no longer prescribe minor tranquilizers to trauma victims as a standard treatment protocol, as they did several decades ago. Despite this new knowledge in the medical field, myths and misinformation still abound. Every one of us knows someone whose life has been tragically altered by alcohol, yet the idea that it would be beneficial to a traumatized person, somehow seems to be so ingrained in our culture that it continues.

In addition to the deleterious effects on the nervous system, the traumatized person is also more vulnerable to psychological addiction to alcohol or substances. The problem is that the temporary numbing from getting inebriated becomes attractive to them. They then begin to anticipate the use of substances to prevent themselves from feeling anything. In this altered state they do not heal. When they finally become clean and sober, they will still have to face all the feelings only their healing process will be more complicated and delayed.

So how do you know if your drinking, or that of someone you love, is getting out of control? “Social drinking” refers to patterns of drinking that are accepted by our particular culture, but is not necessarily free of problems. “Moderate drinking” is the term used by health experts to describe drinking patterns that do not cause problems for the drinker or society. It is tricky to make a specific set of guidelines because alcohol affects people differently. However, the U.S. Department of Agriculture and the U.S. Department of Health and Human Services have developed these general guidelines: “Moderate drinking” is no more than one drink a day for most women, and no more than two drinks a day for most men. A standard drink is generally considered to be 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits. Each of these drinks contains roughly the same amount of absolute alcohol–approximately 0.5 ounce or 12 grams. These guidelines exclude the following persons, who should not consume alcoholic beverages: women who are pregnant or trying to conceive; people who plan to drive or engage in other activities that require attention or skill; people taking medication, including over-the-counter medications (including SSRI’s which are often recommended in the healing process for PTSD); recovering alcoholics; and persons under the age of 21. Alcohol use also is not for people with certain medical conditions such as peptic ulcers, among others (NIAAA, 1992).

What if you have drinking behaviors that are not within these limits? First, it is important to honest with yourself. Researchers believe that part of the disease of alcoholism is a paradox, that is the more you are out of control with drinking, the less awareness and ability you have to be honest with yourself. Your brain plays tricks on you, and there is denial of the problem despite the loss of relationships, sometimes even careers. There may, however, be tiny “windows of opportunity” in which you clearly see reality. When this occurs, get help immediately! Call and talk to a drug and alcohol addiction specialist that also understand the treatment of trauma. It is important to seek help before you talk yourself back into a state of denial.

If you are trying to help a loved one, get help from a treatment center to plan how to intervene. Most treatment centers offer classes, groups or one time individual support for family members at no cost. They also offer help for someone living with an alcoholic or drug addict.

The trauma will not get better and you cannot heal while using drugs or drinking heavily. The first thing to attend to is to get clean and sober. The next thing is to deal with is healing from the traumatic event(s). People often feeling “stuck” in their healing process when they have been abusing substances or drinking. Know that you will begin to heal faster once you are clean and sober. Don’t give up hope- there is lots of help available.

For more help or information see:

Hazelden Foundation – Center City, MN – nonprofit organization providing rehabilitation, education, prevention, and professional services and publications in drug addiction and related disorders.
Betty Ford Center – Rancho Mirage, CA – alcohol and drug dependency treatment services.

National Association for Children of Alcoholics

National Clearinghouse for Alcohol and Drug Information

National Institute on Alcohol Abuse and Alcoholism and FAQs about alcohol abuse and alcoholism

SAMHSA – Alcohol and Drug Facts

Substance Abuse & Mental Health Services Administration
Alcoholics Anonymous
AA Meetings Online
Al-Anon/Alateen Family Group


Blum, K., Braverman, E. R., Holder, J. M., Lubar, J. F., Monastra, V. J., Miller, D., Lubar, J. O., Chen, T. J., & Comings, D. E. (2000). Reward deficicency syndrome: A biogenetic model for the diagnosis and treatment of impulsive, addictive, and compulsive behaviors. Journal of Psychoactive Drugs, 32, 1-68.

Bremner, J. D. (2001). Hypotheses and controversies related to effects of stress on the hippocampus: An argument for stress-induced damage to the hippocampus in patients with posttraumatic stress disorder. Hippocampus, 11, 75-81.

Coffey, S. F., Saladin, M., Drobes, D. J., Brady, K. T., Dansky, B. S., & Kilpatrick, D. G. (2002). Trauma and substance cue reactivity in individuals with comorbid posttraumatic stress disorder and cocaine or alcohol dependence. Drug & Alcohol Dependence, 65, 115-127.

De Bellis, M. D. (2002). Developmental traumatology: A contributory mechanism for alcohol and substance use disorders. Psychoneuroendocrinology, 27, 155-170.

de Jong, J. T., Komproe, I. H., Van Ommeren, M., El Masri, M., Araya, M., Khaled, N., van de Put, W., & Somasundaram, D. (2001). Lifetime events and posttraumatic stress disorder in 4 postconflict settings. JAMA: Journal of the American Medical Association, 286, 555-562.

Feusner, J., Ritchie, T., Lawford, B., Young, R. M., Kann, B., & Noble, E. P. (2001). GABA-sub(A) receptor beta3 subunit gene and psychiatric morbidity in a post-traumatic stress disorder population. Psychiatry Research, 104, 109-117.

Freeman, T. W., & Roca, V. (2001). Gun use, attitudes toward violence, and aggression among combat veterans with chronic posttraumatic stress disorder. Journal of Nervous & Mental Disease, 189, 317-320. O’Shea, B. (2001). Post-traumatic stress disorder: A review for the general psychiatrist. International Journal of Psychiatry in Clinical Practice, 5, 11-18.

Gilbertson, M. W., Gurvits, T. V., Lasko, N. B., Orr, S. P., & Pitman, R. K. (2001). Multivariate assessment of explicit memory function in combat veterans with posttraumatic stress disorder. Journal of Traumatic Stress, 14, 413-432.

Handelsman, L., Stein, J. A., Bernstein, D. P., Oppenheim, S. E., Rosenblum, A., & Magura, S. (2000). A latent variable analysis of coexisting emotional deficits in substance abusers: Alexithymia, hostility, and PTSD. Addictive Behaviors, 25, 423-428.

NIAAA (April, 1992). Alcohol Alert. National Institute on Alcohol Abuse and Alcoholism,16, p. 315.

Nishith, P., Resick, P. A., & Mueser, K. T. (2001). Sleep difficulties and alcohol use motives in female rape victims with posttraumatic stress disorder. Journal of Traumatic Stress, 14, 469-479.

Post, R. M., Leverich, G. S., Xing, G., & Weiss, S. R. (2001). Developmental vulnerabilities to the onset and course of bipolar disorder. Development & Psychopathology, 13, 581-598.

Raap, J. W., Beckwith, M. C., & Reimherr, F. W. (2000). Clinical uses and differences among the selective serotonin reuptake inhibitors. Journal of Pharmaceutical Care in Pain & Symptom Control, 8, 23-38.

Semple, W. E., Goyer, P. F., McCormick, R., Donovan, B., Muzic, R. F., Jr., Rugle, L., McCutcheon, K., Lewis, C., Liebling, D., Kowaliw, S., Vapenik, K., Semple, M. A., Flener, C. R., & Schulz, S. C. (2000). Higher brain blood flow at amygdala and lower frontal cortex blood flow in PTSD patients with comorbid cocaine and alcohol abuse compared with normals. Psychiatry: Interpersonal & Biological Processes, 63, 65-74.

Stewart, S. H., Conrod, P. J., Samoluk, S. B., Pihl, R. O., & Dongier, M. (2000). Posttraumatic stress disorder symptoms and situation-specific drinking in women substance abusers. Alcoholism Treatment Quarterly, 18, 31-47.

Thaller, V., Marusic, S., Katinic, K., Buljan, D., Golik-Gruber, V., & Potkonjak, J. (2003). Biological Factors in Patients with Post-traumatic Stress Disorder and Alcoholism. European Journal of Psychiatry, 17, 87-98.

Villarreal, G., Hamilton, D. A., Petropoulos, H., Driscoll, I., Rowland, L. M., Griego, J. A., Kodituwakku, P. W., Hart, B. L., Escalona, R., & Brooks, W. M. (2002). Reduced hippocampal volume and total white matter volume in posttraumatic stress disorder. Biological Psychiatry, 52, 119-125.

Young, R. M., Lawford, B. R., Noble, E. P., Kann, B., Wilkie, A., Ritchie, T., Arnold, L., & Shadforth, S. (2002). Harmful drinking in military veterans with post-traumatic stress disorder: Association with the D2 dopamine receptor A1 allele. Alcohol & Alcoholism, 37, 451-456.

Zlotnick, C., Bruce, S. E., Weisberg, R. B., Shea, M. T., Machan, J. T., & Keller, M. B. (2003). Social and health functioning in female primary care patients with post-traumatic stress disorder with and without comorbid substance abuse. Comprehensive Psychiatry, 44, 177-183.

Angie Panos, Ph.D. is a therapist that specializes in trauma and grief, she has 20 years of experience in helping survivors. She is a board member of Gift From Within.