After trauma, a drink can seem to take the edge off. It quiets racing thoughts, makes it easier to fall asleep, and numbs painful memories, at least for a while. That is why PTSD and alcohol or drug problems so often show up together. If this sounds familiar, you are not alone, and there is no shame in it. It is still worth knowing why it tends to make things harder over time.
Why self-medicating backfires
The relief is real, but it's short. Over weeks and months, drinking to cope tends to make PTSD worse in a few specific ways.
- Sleep gets worse. Alcohol may knock you out, but it breaks up deeper sleep later in the night, so you wake up more tired and more on edge.
- Anxiety rebounds. As the alcohol wears off, the body swings toward restlessness and worry, often by the next morning.
- Avoidance grows. Numbing a memory is a way of avoiding it, and avoidance is one of the things that keeps PTSD going.
- Mood and anger get harder to manage. Alcohol is a depressant, and it loosens control over angry or impulsive reactions.
- Risk goes up in a crisis. Alcohol and drugs make it more likely that someone will act on suicidal thoughts.
Signs it may be becoming a problem
- Drinking or using to get to sleep or to cope with memories
- Needing more to get the same effect
- Trying to cut back without success
- Drinking getting in the way of work, relationships, or health
- People close to you saying they are worried
Treatment can address both
For years, people were often told to get sober before treating their trauma. That is changing. The 2023 VA/DoD guideline states that having a substance use disorder should not prevent someone from receiving the recommended PTSD treatments, and many programs now treat both at the same time.
Options include trauma-focused therapies such as Cognitive Processing Therapy and Prolonged Exposure, programs that combine PTSD and substance use treatment, and medicines for alcohol use disorder, such as naltrexone, that a doctor can prescribe.
Small steps you can take now
- Track how much and when you drink for one week
- Swap one drink for another coping skill, such as a walk, a call, or grounding
- Keep alcohol out of the house if it is hard to resist
- Tell your doctor honestly what you are using, so they can help safely
- Do not stop heavy daily drinking suddenly on your own. Withdrawal can be dangerous, so talk with a doctor first.
Where to get help
The SAMHSA National Helpline (800-662-4357) offers free, confidential treatment referrals 24/7. Veterans can get care for both PTSD and substance use through the VA. See more options on our get help page.
If you are in crisis, call or text 988. Veterans can dial 988 and press 1.
PTSD Info articles are for education only and are not a substitute for professional medical advice, diagnosis, or treatment. If you are in crisis, call or text 988 (Veterans press 1), or call 911 in an emergency.
