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POST-TRAUMATIC STRESS DISORDER (PTSD) AND ALCOHOL ADDICTION
1
Mansurova Barchinoy Lutfullo qizi
2
Mo‘minova Mehrangiz Munisovna
3
Sharapova Dilfuza Nematillayevna
1-2
Student of group 505 of the Faculty Medical Pedagogy of Samarkand State Medical
University, Samarkand, Republic of Uzbekistan
3
Course of Psychiatry, Clinical ordenator, Samarkand State Medical University, Samarkand,
Republic of Uzbekistan.
https://doi.org/10.5281/zenodo.14926683
Abstract.
The relevance of the comorbidity of post-traumatic stress disorder and alcohol
addiction has significantly increased in recent decades due to the occurrence of various natural
and man-made disasters, accidents, military conflicts, and other extreme events. According to
several authors, the natural response to highly intense and life-threatening stressors often
manifests in the form of various psychogenic mental illnesses, including the rising prevalence of
post-traumatic stress disorder.
Keywords:
comorbidity, post-traumatic stress disorder, alcohol addiction, natural and
man-made disasters, accidents.
Introduction.
These disorders are considered delayed reactions to the negative impact of
extreme events and situations. As such, in modern psychiatry, the issue of comorbidity, post-
traumatic stress disorder (PTSD) has become particularly urgent, as it reflects the long-term
psychological effects caused by traumatic experiences. Additionally, the combination of PTSD
with alcohol addiction, where individuals may turn to alcohol or other substances as a way of
coping with trauma, creates a complex and multifaceted problem that requires targeted
intervention and comprehensive treatment strategies. This comorbidity further complicates the
recovery process and underscores the need for a more holistic understanding of the psychological
and physiological impacts of trauma [1-3].
Post-traumatic stress disorder is a mental health condition triggered by experiencing or
witnessing a traumatic event. It is characterized by symptoms such as flashbacks, nightmares,
severe anxiety, and emotional numbness. Individuals with PTSD often experience heightened
arousal, emotional dysregulation, and avoidance of reminders of the trauma. The disorder can
significantly impair an individual's ability to function in daily life, affecting their social
relationships, work, and overall well-being [4].
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Alcohol addiction, also known as alcohol dependence or alcoholism, is a chronic condition
where an individual develops a compulsive need to consume alcohol, often leading to physical and
psychological dependence. Alcohol addiction is marked by an inability to control drinking habits,
tolerance to alcohol's effects, and withdrawal symptoms when alcohol consumption is reduced or
stopped. Over time, alcohol addiction can have severe consequences on one's physical health,
leading to liver disease, cardiovascular issues, and neurological impairments, while also affecting
emotional stability and interpersonal relationships [5-7].
Both PTSD and alcohol addiction are complex, multifaceted disorders that can have a
profound impact on an individual's life. Often, individuals suffering from PTSD may turn to
alcohol or other substances as a form of self-medication to cope with the overwhelming emotions
and memories associated with their trauma, leading to the development of alcohol addiction. The
interplay between these two conditions further complicates treatment, as both psychological and
physical aspects must be addressed simultaneously for effective recovery [8-11].
Throughout the history of studying post-traumatic stress disorder, the primary focus has
been placed on the stress factors, such as military actions, natural and transportation disasters,
accidents, violence, torture, rape, and the presence of other individuals during events like fires.
These stressors are considered crucial in understanding the development of PTSD, as they
often involve life-threatening situations and extreme emotional or physical trauma. The impact of
these events on an individual's psychological well-being has been a key area of research,
highlighting the complex relationship between trauma exposure and the subsequent mental health
challenges that arise [12-14].
An analysis of research on the comorbidity of alcohol addiction and post-traumatic stress
disorder reveals that many aspects of this issue remain unresolved. At the same time, the
uniqueness of clinical manifestations and the severity of the progression of mental and addiction-
related disorders present practitioners with complex, previously unrecognized challenges in both
diagnosis and therapy. This underscores the need for continuous efforts to address these issues, as
they require ongoing attention and adaptation of diagnostic and therapeutic approaches to better
manage the interplay of these disorders and improve patient outcomes [15-18].
Studying the peculiarities of the combined course of alcohol addiction and mental disorders
is of particular importance due to the increasing trend of such cases. This growing prevalence
highlights the need for a deeper understanding of how these conditions interact and develop
together, and calls for more comprehensive research and improved clinical approaches to better
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address the complexities of these dual diagnoses in order to provide more effective treatment and
intervention strategies [19-21].
In the past decade, the characteristics of the development and progression of alcohol
addiction in patients suffering from post-traumatic stress disorder have been studied. This research
has focused on understanding the unique ways in which PTSD may contribute to the onset and
course of alcohol dependence, exploring the complex interplay between the psychological trauma
associated with PTSD and the physiological and behavioral aspects of alcohol addiction. These
studies have revealed important insights into how these two conditions interact, emphasizing the
need for integrated treatment approaches to address both disorders simultaneously [22-24].
It has been proven that 1% of the population suffers from post-traumatic stress disorder at
some point in their life, and after severe injuries, such as those sustained in military operations,
PTSD symptoms are identified in 15% of cases. The lifetime prevalence of PTSD ranges from
3.6% to 75% in individuals who have survived extreme events. Unfortunately, in our country, there
have been no large-scale studies conducted specifically on the prevalence of PTSD, but selective
clinical studies have shown that 27.6% of Afghanistan war veterans, 35.1% of Chechen conflict
veterans, and 2.13% of refugees from "hot spots" experience PTSD. According to this data, 15%
of individuals who have undergone severe psychological trauma experience this condition, and
PTSD develops in 3-6% of the general population [25-27].
It is known that 62-91% of patients with post-traumatic stress disorder exhibit symptoms
of at least one other disorder that meets the DSM-IV criteria, and 35% have symptoms of two or
more additional disorders. According to the literature, comorbidities include endogenous
depression, panic attacks, as well as substance use disorders, such as alcohol and drug abuse.
Comorbid conditions are predominantly manifested through depression, behavioral
disorders, and alcoholism. Studies conducted among military veterans and the civilian population
who have experienced severe stress show that alcohol abuse or addiction can be comorbid in men
with post-traumatic stress disorder. Following this, depression, other anxiety disorders, behavioral
disorders, and other substance abuse or addictions are also observed. The pattern is slightly
different for women, where depressive and anxiety-related disorders are the most common,
followed by alcoholism [28-31].
It is known that some individuals exposed to stressful factors resort to consuming alcoholic
beverages or psychoactive substances as a way to cope with emotional stress and artificially
deactivate psychotraumatic situations. These behaviors can be explained by their specific
characteristics.
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Psychoactive substances not only improve mood and energy levels but can also neutralize
negative states: they reduce fear and anxiety, insomnia, and other somatic illnesses. This coping
mechanism, however, may lead to the development of dependency, further exacerbating
psychological and physical health issues [32-34]. Thus, it has been observed that in both men and
women with endogen depression, alcohol consumption significantly reduces depressive
symptoms, which leads to its misuse. Specific research on the pharmacological effects of ethanol
has shown that intravenous ethanol rapidly (even for a short period of time) decreases the signs of
depression. This characteristic of psychoactive substances (surface-active compounds) explains,
to a greater or lesser extent, why individuals with existing mental pathologies are more likely to
engage in initial contact with alcohol or drugs, often leading to addiction. This early exposure to
alcohol or other substances can significantly contribute to the development of dependence and
complicate the treatment of the underlying mental health condition [35-38].
In individuals with post-traumatic stress disorder, it has been observed that the
consumption of alcohol can quickly alleviate the symptoms of the disorder. Furthermore, in PTSD,
both the CRH (corticotropin-releasing hormone) system and the noradrenergic system function in
such a way that the stress response gradually intensifies. However, psychoactive substances (PAS),
particularly alcohol, can rapidly reduce the symptoms. On the other hand, during withdrawal,
significant excitability can occur, and for individuals who experience PTSD-like symptoms,
drinking alcohol may become an unbearable compulsion. This reinforces the complex interplay
between substance use and the exacerbation of PTSD symptoms, making it more challenging to
treat both the addiction and the underlying mental health condition simultaneously [39-42]. In
some cases, the consumption of alcohol can help individuals self-medicate the trauma itself. This
is particularly noticeable in individuals who encounter traumatic situations during adolescence. In
these instances, alcohol may temporarily relieve emotional pain or distress, providing a sense of
relief or escape from the overwhelming feelings associated with the trauma. However, while
alcohol may offer short-term alleviation, this coping mechanism often leads to a cycle of
dependence, exacerbating the trauma and making it more difficult for individuals to process their
experiences in a healthy and constructive manner over time [43-45].
The relationship between post-traumatic stress disorder and alcohol or substance abuse has
been confirmed by large-scale studies conducted on non-combatant adults, with epidemiological
data from the United States. In individuals suffering from PTSD, alcoholism is found to be more
frequent (ranging from 21.6% to 43%) compared to those without PTSD.
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This highlights a significant comorbidity, suggesting that individuals with PTSD are more
likely to develop alcohol or substance use disorders as a way of coping with the emotional distress
and trauma-related symptoms they experience. The high prevalence of alcohol abuse among PTSD
patients further complicates treatment, as addressing one condition may not fully alleviate the
other, emphasizing the need for integrated care strategies [46-48].
Moreover, a significant portion of individuals with substance abuse and alcoholism also
exhibit symptoms of post-traumatic stress disorder. Among the general population of drug users,
8.5% have experienced severe trauma, primarily related to a history of assault. Among individuals
with alcohol dependence, PTSD is observed in 26.4% of cases. Similar findings were reported in
a multi-center study involving individuals with alcohol and drug use, as well as those with a
combination of both substances. In this study, PTSD was identified in 25.3% of participants. These
findings highlight the strong association between PTSD and substance abuse, underscoring the
need for a comprehensive approach to treatment that addresses both the psychological trauma and
the addiction simultaneously [49-51].
Thus, it can be hypothesized that post-traumatic stress disorder and substance use disorders
are functionally interconnected. There are two main approaches in the literature for explaining the
comorbidity of these pathologies. One approach suggests that the symptoms of PTSD may lead
individuals to self-medicate with substances, such as alcohol or drugs, to alleviate the distressing
psychological symptoms associated with trauma. The other approach posits that substance abuse
itself may increase the vulnerability to developing PTSD, as the use of drugs or alcohol may alter
the brain's response to stress and trauma, potentially exacerbating the psychological impact of
traumatic experiences. Both of these mechanisms contribute to the complex relationship between
PTSD and substance use disorders, necessitating a multi-faceted treatment strategy that addresses
both aspects of the comorbidity.
In the first scenario, it is believed that the abuse of alcohol and drugs occurs before the
development of post-traumatic stress disorder. Like many other researchers, this view emphasizes
the importance of predisposing factors in the development of PTSD, which include premorbid
characteristics of the individual, such as their gender, age, life experience, stress tolerance, and
previous mental health history. These factors, when combined with concurrent conditions such as
alcoholism, substance abuse, and psychosomatic disorders, may play a significant role in
increasing the vulnerability to PTSD. Moreover, comorbid pathologies can sometimes even
obscure the manifestation of PTSD, complicating its diagnosis and treatment.
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These overlapping conditions require careful clinical attention, as the interaction between
PTSD and substance use disorders can often mask or exacerbate the symptoms of both [38-40].
In the second scenario, the mechanism is reversed: post-traumatic stress disorder develops
before the onset of alcoholism. Most researchers adhere to this second model, considering
addiction as a pathology that co-occurs with PTSD. Many studies emphasize that substance use,
including alcohol consumption, is often used by patients as a self-medication tool. Initially,
psychoactive substances are used to alter or alleviate the symptoms of PTSD. These substances
may temporarily reduce feelings of anxiety, fear, and distress, providing some relief from the
emotional turmoil caused by traumatic experiences. However, this self-medication strategy can
lead to the development of a substance use disorder, creating a vicious cycle where the individual
relies on alcohol or drugs to manage their PTSD symptoms, ultimately worsening both conditions
[41-43].
Once an alcoholic disorder (addiction) has developed, the agitation that occurs within the
framework of withdrawal syndrome exacerbates the symptoms of post-traumatic stress disorder,
thereby prompting further alcohol consumption. As a result, in these patients, the withdrawal
symptoms and agitation associated with PTSD intersect in a complex manner, leading to a need
for new doses of alcohol and creating a continuous, unrelenting cycle. This vicious circle, where
alcohol is used both to alleviate withdrawal symptoms and to temporarily numb PTSD-related
distress, intensifies the severity of both the addiction and the trauma-related disorder [44-46]. The
persistent need for alcohol consumption becomes a coping mechanism, reinforcing the dependence
and exacerbating the overall psychological and physiological state of the individual. Additionally,
alcohol abuse often worsens the well-being of patients, thereby intensifying the course of post-
traumatic stress disorder. Alcoholism can be associated with various risk factors for the
development of PTSD, including female gender, the number of previous traumatic events, and loss
of control. It has been shown that veterans with PTSD symptoms display specific characteristics
in the course of alcoholism: a high rate of alcoholism, greater tolerance to alcohol, the rapid
development of altered forms of intoxication marked by explosions of aggression and cruelty,
amnesia, and more pronounced social and somatic consequences of alcoholism. In nearly all
patients with PTSD, there is a persistent pattern of alcohol abuse, which complicates both the
treatment of PTSD and the overall rehabilitation process. The coexistence of these disorders
creates a cyclical, reinforcing relationship where the alcohol use exacerbates the symptoms of
PTSD, and vice versa, contributing to a chronic, worsening condition [47-49].
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According to foreign researchers, 53% of individuals seeking help for alcohol addiction
have a history of severe trauma, such as rape. Large-scale epidemiological studies in the United
States have shown that individuals suffering from alcohol or drug addiction are 2 to 12 times more
likely to experience comorbid post-traumatic stress disorder than those without such pathology.
Australian authors have also highlighted the strong relationship between PTSD and
substance use disorders, noting that in individuals predisposed to addiction, PTSD symptoms are
present in 6% of cases. Conversely, among individuals with PTSD, approximately one-third are
also affected by alcohol and drug addiction. This correlation between PTSD and substance use
disorders further underscores the complexity of their comorbidity, as each disorder exacerbates
the other, making treatment more challenging and requiring an integrated approach to care [50-
52].
Veterans seeking help for substance abuse, particularly Vietnam War veterans, have often
highlighted that they also suffer from other psychiatric disorders. This emphasizes the complex
nature of their struggles, where substance abuse is closely linked to a history of trauma. Research
has shown that the mechanisms of addiction during the war and post-war periods are distinct.
Specifically, for those with "military" addiction, there is a noticeable difference in the
pattern of substance abuse, with the misuse of substances like alcohol significantly decreasing
once in a peaceful, civilian environment. This suggests that the coping mechanisms employed
during wartime, influenced by stress and trauma, are different from those employed in non-combat,
everyday settings, requiring different approaches to treatment and rehabilitation [53-55].
According to well-known local researchers, over the past 40 years, the prevalence of
neuropsychiatric disorders in Russia has increased by 2.7 times (the highest compared to other
neuropsychiatric disorders), with neuroses increasing by 2.6 times. It is important to note that
during this period, the number of patients suffering from alcoholism also increased by 2.6 times.
The nearly identical rate of increase in alcoholism and neuroses highlights the relationship
between chronic alcoholism and post-traumatic stress disorder, showing a strong correlation
between the two conditions. This suggests that the rising prevalence of both disorders could be
interlinked, with one potentially contributing to the development or exacerbation of the other [56-
58].
Another urgent issue in the problem of chronic alcoholism is its frequent co-occurrence
with other mental pathologies. To date, cases of secondary alcoholism, where alcoholism develops
against the backdrop of other mental disorders, are widespread among patients.
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Treating alcoholism in these cases becomes particularly difficult without first addressing
the underlying primary condition. The presence of another psychiatric disorder complicates the
diagnosis and treatment of alcoholism, as the two conditions may interact in ways that affect the
effectiveness of therapeutic interventions. As a result, a more integrated and comprehensive
approach is needed to address both the alcohol dependency and the co-existing mental health
disorders simultaneously.
One of the most important causes of the development of alcohol dependence is the
experience of severe psychological trauma, which leads to changes at the neurohumoral level in
the div and is expressed in the formation of various psychogenic disorders. Initially, a psycho-
traumatic situation impacts the individual, which leads to the development of a specific
psychogenic illness—such as neurosis, the development of a neurotic personality, or reactive
states—and subsequently, alcoholism develops based on these conditions. The psychological
trauma, whether from a single event or a series of traumatic experiences, triggers an emotional and
psychological response that disrupts the individual's mental equilibrium, which, over time, may
result in the reliance on alcohol as a coping mechanism [59-62].
Conclusion:
The prevalence of PTSD among individuals with alcohol dependence is also
high, highlighting the strong association between the two conditions. PTSD symptoms, such as
anxiety, emotional numbness, and intrusive memories, can be alleviated temporarily by alcohol,
but this coping mechanism often leads to dependency, complicating the treatment of both
disorders. Alcohol abuse during PTSD may provide immediate relief, but the withdrawal
symptoms and psychological agitation during recovery can intensify PTSD symptoms, creating a
cyclical relationship between the two conditions.
The comorbidity of PTSD and alcohol addiction has significant implications for treatment,
as the interplay between psychological trauma and substance use requires a comprehensive,
integrated therapeutic approach. Addressing both conditions simultaneously is crucial for effective
recovery, and the challenge lies in creating tailored treatment plans that account for the unique
needs of individuals experiencing both PTSD and alcohol addiction.
Research has underscored the need for continuous efforts to understand the complexities
of PTSD and alcohol addiction, particularly in high-risk populations such as military veterans,
survivors of violence, and those exposed to severe trauma. More large-scale studies and tailored
therapeutic interventions are essential to improve patient outcomes and provide effective, holistic
care that addresses both the psychological and physiological impacts of trauma and addiction.
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