Title : PTSD and alcohol use disorder: Breaking the cycle – A literature review and new framework
Abstract:
This paper presents a literature review, critical analysis, and theoretical framework proposal for understanding and treating the frequent co-occurrence of PTSD and Alcohol Use Disorder (AUD). Despite the high prevalence and severity of this comorbidity, current research primarily focuses on symptom management rather than prevention.
The literature review brings together current research on the common risk factors of these disorders, including their shared vulnerabilities such as genetic predisposition, early-life trauma, and neurobiological dysregulation. PTSD-related stress dysregulation, characterized by amygdala hyperactivity, impaired prefrontal control, and hippocampal dysfunction, increases reliance on alcohol as a coping mechanism. Prolonged alcohol use worsens PTSD symptoms by further significant impairing emotional regulation and cognitive flexibility, creating a cycle that complicates treatment and worsens prognosis. A critical analysis of existing treatment modalities reveals a significant gap in current research – most studies focus on management of symptoms rather than prevention.
Based on the literature review, this work presents an alternative perspective, viewing the reinforcement and interconnection of PTSD and AUD as a spiral cycle that progressively leads to worsening of the condition. The predictability of such reinforcement can be an opportunity for preventative intervention. Possible examples of this theoretical approach include Proactive patient screenings, education on the risks of self-medication, and preemptive behavioral and pharmacological strategies—including acamprosate, naltrexone, and semaglutide—may help prevent the full onset of AUD in high-risk PTSD patients, specifically predisposed to AUD but prior to the full onset of this problem.
By viewing this comorbidity as a progressive interconnected process and a single clinical entity, this model offers a foundation for future research and the development of prevention-focused treatment strategies.
