Some people don’t have a drinking problem the way everyone around them assumes. They have a sleep they can’t get, a memory that won’t stay buried, a body that stays braced for something bad. The drinking came later. It was the thing that finally turned the volume down.
If that sounds familiar, for you or for someone you love, it’s worth slowing down before you call it a willpower problem. Sometimes the bottle is the second thing. The first thing is trauma.
PTSD is more common than most people think. About 6.8% of U.S. adults will have post-traumatic stress disorder at some point in their lives, and around 3.6% have it in a given year, according to NIMH. A lot of them are drinking or using to get through the day, and a lot of the people who love them have no idea that’s what’s going on.
The drink was doing a job
Here’s the part that gets missed. For a lot of people carrying trauma, alcohol isn’t recreation. It’s a tool.
It knocks out the racing thoughts at midnight. It dulls the flashbacks. It loosens muscles that have been clenched since the thing happened. For a few hours, it does what nothing else has done. It makes the inside of your head quieter.
Researchers have a name for this. It’s called self-medication, and it’s common. In a national study published in the journal Depression and Anxiety (2010), about 20% of people with PTSD said they used alcohol or drugs to try to relieve their symptoms. They weren’t chasing a good time. They were chasing relief.
A scenario that plays out a lot
Picture a man who came home from a deployment three years ago. On paper he’s fine. He goes to work. But he doesn’t sleep, not really, and when he closes his eyes he’s back there. One beer at night turns the noise down enough to drift off. Then it’s three. Then it’s six, and he’s hiding cans in the garage, and his wife thinks he’s developed a drinking problem out of nowhere.
He didn’t. The drinking is the smoke. The trauma is the fire. Treat the smoke and walk away, and the fire keeps burning.
Why getting sober isn’t enough by itself
When someone like that stops drinking without dealing with the PTSD, the relief valve is gone and the symptoms come back hard. The nightmares return. The dread returns. Most people can’t white-knuckle that for long, so they drink again. It looks like a relapse of the drinking. It’s really a flare-up of the trauma.
This is why the two problems feed each other. People with PTSD are 4 to 5 times more likely to develop a substance use disorder in their lifetime than people without it, according to epidemiologic research summarized in a 2020 academic review. When both are present, each one tends to make the other worse, and treating only one leaves the door open for the other to walk back in.
Signs the drinking might be about trauma
You can’t diagnose this from a blog post, and you shouldn’t try. But some patterns are worth paying attention to.
The drinking often starts or spikes after a specific event: combat, an assault, an accident, a loss, a childhood the person doesn’t talk about. They drink mostly to sleep or to stop thinking, not to have fun. Their use climbs around reminders, like anniversaries, certain places, certain news stories. They seem wired and worn out at the same time. They might say they just need something to take the edge off, and mean it literally.
Women are about twice as likely as men to develop PTSD, according to NIMH, so this isn’t only a story about veterans, though it’s a common one there too.
If some of this fits, it isn’t proof of anything. It’s a reason to get a real assessment.
When and how to seek professional help
The thing to look for is treatment that handles both problems at once. Getting sober in one place and treating trauma somewhere else, months apart, tends to work poorly. Trauma care and substance use care belong in the same room.
Start by telling a doctor or a counselor the honest version. Not just how much you drink, but what the drinking is quieting. That one detail points them toward the right kind of help. A program offering treatment for co-occurring PTSD and addiction can screen for both and build a plan that treats the trauma, not just the drinking.
If you’re in the U.S. and things feel dangerous, if the person is talking about not wanting to be here, or you are, call or text 988 to reach the Suicide and Crisis Lifeline. For treatment options, SAMHSA’s national helpline at 1-800-662-HELP (4357) is free, confidential, and open every day.
Trauma-focused therapies like prolonged exposure, cognitive processing therapy, and EMDR have strong track records, and many people improve a great deal with them. The drinking often eases once the thing underneath it finally gets treated.
What changes when you name it
Calling it “a drinking problem” and stopping there keeps people stuck for years. Naming the trauma underneath doesn’t excuse anything. It just aims the help at the right target. For a lot of people, that’s the whole difference between quitting over and over and actually getting free of it.
Sources
- National Institute of Mental Health (NIMH), Post-Traumatic Stress Disorder (PTSD) statistics — https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd
- Leeies M, Pagura J, Sareen J, Bolton JM. The use of alcohol and drugs to self-medicate symptoms of posttraumatic stress disorder. Depression and Anxiety (2010) — https://pubmed.ncbi.nlm.nih.gov/20186981/
- The Comorbidity of Post-Traumatic Stress Disorder (PTSD) and Substance Use Disorders, Springer (2020) — https://link.springer.com/chapter/10.1007/978-3-030-36391-8_93
