After a traumatic event, people often report using alcohol to relieve their symptoms of anxiety, irritability, and depression. Alcohol may relieve these symptoms because drinking compensates for deficiencies in endorphin activity following a traumatic experience. Within minutes of exposure to a traumatic event there is an increase in the level of endorphins in the brain. During the time of the trauma, endorphin levels remain elevated and help numb the emotional and physical pain of the trauma. However, after the trauma is over, endorphin levels gradually decrease and this may lead to a period of endorphin withdrawal that can last from hours to days. This period of endorphin withdrawal may produce emotional distress and contribute to other symptoms of posttraumatic stress disorder (PTSD). Because alcohol use increases endorphin activity, drinking following trauma may be used to compensate this endorphin withdrawal and thus avoid the associated emotional distress. This model has important implications for the treatment of PTSD and alcoholism.

Margaret was raised in a chaotic environment, experiencing extensive physical abuse first by her alcoholic parents, then later in an abusive relationship. During one particularly disturbing event, she recalled being severely beaten, then locked in a closet, bleeding, for several hours. She also recalled sexual abuse by her intoxicated father from the ages of 8 to 14. When Margaret was 16 she was involuntarily hospitalized following a suicide attempt, and subsequently became involved in a sexual relationship with a male patient who forced her to participate in group, sadomasochistic sex several times during a 6-month period. Following this experience, Margaret began abusing a variety of substances, primarily alcohol. When she presented for treatment at age 38, she had undergone at least 10 prior treatment attempts for alcohol dependence. She reported drinking up to a case of beer daily, which she said she used primarily to help her sleep and to suppress nightmares of the sexual abuse, and also in response to the trauma reminders she frequently experienced in daily life. When abstinent from alcohol, Margaret reported extremely vivid and disturbing nightmares, profound agitation and jumpiness, and acute reactivity to a variety of environmental cues that reminded her of her traumatic experiences.

Unfortunately, this example is far too common, as people like Margaret, after an experience of sexual or physical victimization, turn to alcohol to relieve symptoms of anxiety, irritability, and depression. In this paper we present a new model to help explain how trauma's effects on psychological distress may influence alcohol consumption.

The experience of psychological trauma (experiencing or witnessing an event involving actual or threatened death or serious injury of self or others does not necessarily lead to long-term emotional distress or alcohol abuse. Rather, the likelihood of experiencing adverse consequences is related to the victim's ability to cope with the trauma. Consider the following two hypothetical examples. Barbara and Jan both attend a seminar on crime prevention. On her way home, Barbara encounters a man who points a gun to her head and demands her money. Caught off guard, Barbara freezes in terror, forgetting everything she has just learned in the class about how to protect herself; the assailant takes her pocketbook and runs off with $50 and all of Barbara's credit cards. Although Barbara avoided physical harm, she was left with the feeling that she had no control over the outcome of the incident (she experienced uncontrollable trauma) and, as a result, experienced feelings of terror and helplessness. Compare Barbara's situation to Jan's. On her way home from the same crime prevention class, Jan encounters another man who points a gun at her head and demands her money. Jan is also afraid but manages to keep her wits, and recalling one of the strategies she just learned in the class, she throws her pocketbook past the gunman down the street. The assailant runs after the pocketbook, and Jan runs in the opposite direction. In comparison to Barbara, Jan experienced controllable trauma, because she took direct action that influenced the outcome of the incident and provided the means for her own escape. Both women experienced similar emotions and tangible loss as a result of the incident, and both escaped unharmed, but Barbara felt a pervasive sense of helplessness after the crime and felt that her self-defense class had been in vain, whereas Jan felt a sense of control over the trauma because of her swift action that enabled her to escape. As a result, Barbara experienced more severe posttraumatic symptoms than did Jan

To understand how trauma can lead to emotional distress and affect alcohol consumption, it is important to understand the biochemical changes that occur during and after an experience of uncontrollable trauma. During uncontrollable trauma, an increase in endogenous opioids (endorphins) helps to numb the pain of the trauma. Following the trauma, however, a rebound endorphin withdrawal can contribute to the symptoms of emotional distress observed after a traumatic event as well as an increased desire to drink alcohol. The endorphin compensation hypothesis assumes that people use alcohol following a traumatic experience in an attempt to relieve the endorphin deficiency. According to this hypothesis, this use of alcohol creates a vicious cycle in which more alcohol is needed to prevent subsequent endorphin withdrawal symptoms. Chronic exposure to this addictive cycle can lead to alcohol addiction. Special populations, such as women, may be at particular risk for trauma-induced, co-occurring alcoholism and psychopathology. This model has important implications for the treatment of trauma-induced psychological distress and alcohol addiction.

Posttraumatic Stress Disorder

extremely traumatic event, such as witnessing a death, having one's life threatened, or enduring serious injury, may develop a set of symptoms known as posttraumatic stress disorder (PTSD). PTSD is diagnosed in people who are exposed to a potentially life-threatening trauma, during which they experience an acute sense of intense fear, horror, or helplessness. People afflicted with PTSD experience symptoms from the following three clusters:

A reexperience of the event through nightmares, flashbacks, and so forth. Active and passive avoidance of the event. Active avoidance occurs when sufferers make a point of avoiding situations, places, and people who remind them of the trauma. Passive avoidance, or numbing of responsiveness, is the body's way of avoiding the event through feelings of detachment or estrangement from the external world.

Generalized hyperarousal, or increased arousal. Sufferers may experience difficulty falling asleep or staying asleep, outbursts of anger, and exaggerated startle responses. Margaret experienced symptoms from all three clusters. For example, she reexperienced her sexual abuse through frequent nightmares and intrusive, distressing thoughts and images of the event whenever she encountered men who physically resembled her father or when she was in closed spaces, such as closets or basements. Emotionally, she alternated between feeling apathetic, numb, and alienated from others and feeling "on edge," hypervigilant, and anxious. She avoided numerous situations reminiscent of her earlier experiences, including her childhood home and movies and news items involving child abuse. She also avoided discussing her abuse history with others and attempted to suppress her own memories of what happened. She felt unable to control many of these PTSD symptoms except by drinking alcohol, but even alcohol provided only temporary relief.

Tags: Alcoholism, Stress

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