Is There a Relationship Between Complex Trauma and Alcohol Use Disorder?

CPTSD is a subtype of PTSD that develops in response to prolonged, repeated traumatic experiences, typically lasting months or years.

It often results from sustained exposure to trauma, such as childhood abuse or violence. This distinguishes it from the traditional diagnosis of PTSD, which can result from a single, time-limited traumatic event.

Evidence suggests that 1–8% of people in the larger population have CPTSD. In mental health settings, as many as 50% of people may have it.

Symptoms of CPTSD

CPTSD involves a range of symptoms beyond those typically associated with PTSD, like flashbacks and avoidance.

Symptoms of CPTSD include:

• emotional dysregulation
• negative self-concept
• persistent feelings of guilt or shame
• dissociation and depersonalization
• somatic symptoms, like headache, fatigue, or muscle pain
• poor focus or concentration
• mixed emotions toward the perpetrator
• persistent preoccupation with the abuser
• self-esteem difficulties
• difficulty with attachment and relationships

Causes of complex trauma

Complex trauma typically arises from prolonged and repetitive exposure to traumatic events.

Some common causes and sources of complex trauma include:

• childhood abuse
• childhood neglect
• domestic violence
• sexual abuse
• war and conflict
• human trafficking
• prisoner of war (POW) experience
• long-term bullying
• cult involvement
• chronic illness or medical trauma
• being a witness to ongoing trauma

A 2023 study suggests post-traumatic disorders are among the most common co-occurring diagnoses in people with substance use disorder (SUD).

People with both conditions often report experiences of repeated childhood sexual and physical abuse and have complex treatment needs.

Individuals with CPTSD may use substances like alcohol or drugs to cope with their emotional distress and psychological symptoms resulting from prolonged trauma exposure. This can lead to severe SUD, also called addiction.

One 2020 study explored the direct and indirect links between types of childhood trauma to PTSD and alcohol misuse.

Researchers found the following:

• PTSD and physical neglect were directly linked to less control over alcohol use.
• Emotional abuse was directly linked to more PTSD symptoms.
• Emotional abuse was indirectly linked to more alcohol-related problems through increased PTSD symptoms, less control over alcohol use, and increased alcohol use.
• Sexual abuse was indirectly linked to increased alcohol-related problems through increased PTSD symptoms, less control over alcohol use, and increased alcohol use, primarily in men.

Childhood trauma can increase the risk of developing alcohol use disorder (AUD) in adulthood.

One 2020 study found that people who experienced childhood trauma, particularly emotional and physical abuse, had a statistically higher lifetime rate of AUD.

The study only analyzed data from male participants, as no female participants met the diagnostic criteria for AUD.

According to the study, risk factors for AUD in males included:

• childhood physical abuse
• consumption of low-proof liquor (under 40% alcohol concentration)
• frequent drinking

Researchers are working to include studies with female participants with AUD.

Treatments that can address both complex trauma and AUD include the following:

• trauma-informed care, which is a holistic approach that recognizes trauma’s effects and creates a safe environment
• cognitive behavioral therapy (CBT)
• dialectical behavior therapy (DBT)
• eye movement desensitization and reprocessing (EMDR), which can help you process traumatic memories and reduce emotional stress
• motivational interviewing
• mindfulness-based stress reduction
• group therapy
• family therapy
• address dissociation
• 12-step programs, like Alcoholics Anonymous

According to a 2023 study involving female participants, dissociation increases suicidal behavior and is a mediator between childhood sexual abuse and suicidal behavior.

Treatment programs need to incorporate interventions that address these dissociative symptoms. Specific strategies may include grounding techniques and mindfulness.

One 2022 review investigated the effectiveness of psychological interventions, such as exposure-based therapy and CBT, for people with adverse childhood experiences at risk of PTSD and SUD.

The findings suggest that these interventions had a small positive effect on PTSD outcomes and didn’t significantly affect SUD outcomes.

In a 2015 study involving adolescents with psychiatric conditions and SUDs, those who received a two-session motivational interviewing intervention showed the following 6 months after discharge:

• delayed substance use
• reduced substance use, especially cannabis

They also had fewer rule-breaking behaviors at the 6-month follow-up.

Complex trauma and AUD are often intertwined, as childhood trauma increases the risk of developing AUD.

Addressing trauma through various therapeutic approaches, including trauma-focused therapy, EMDR, and motivational interviewing, can effectively reduce PTSD symptoms and substance misuse.

If you’re dealing with complex trauma and AUD, don’t hesitate to reach out to a mental health professional. They can provide specialized assessment and tailored treatment to address your unique needs and challenges.