Alcohol and Trauma

Basic Concepts and Definitions

Alcohol use, ranging from occasional to heavy drinking, is extremely common in the United States and in most Western countries. Alcohol use disorder (AUD) is either alcohol abuse or alcohol dependence. Alcohol abuse (AA) is a maladaptive and functionally impairing pattern of alcohol misuse and alcohol dependence (AD) is addiction to alcohol. Although AUD is disproportionately associated with trauma, it must be emphasized that every level of alcohol use, not simply intoxication and/or AUD, shows a direct association with trauma. Trauma can [Page 19]have acute and chronic sequelae, either physical and/or psychological in nature. Posttraumatic stress disorder (PTSD) is the psychological disorder occurring in an estimated 10% of individuals who have experienced trauma. PTSD is controversial, although not because multiple studies document that the propensity toward developing PTSD varies greatly among individuals even with a comparable trauma exposure, because this variation in individual vulnerability is the case for every psychopathological condition. The controversy revolves around diagnostic validity and whether PTSD is truly distinct from the many depressive and anxiety disorders with which it is associated pre-, co-, and postmorbidly. Forms of trauma highly correlated with alcohol over the lifetime include child maltreatment, assaultive violence, and military combat. The relationship between alcohol and trauma can be acute or chronic. Alcohol and trauma can co-occur or be separated in time. Lifetime comorbidity refers to cooccurrence of alcohol and trauma but not necessarily at the same time in an individual's life.

Conceptualizing Alcohol and Trauma Comorbidity

Certain forms of trauma, such as those occurring in natural disasters, bear no particular relationship to alcohol. It may be helpful to conceptualize that the trauma that does have a correlation with alcohol falls into two main, nonmutually exclusive, categories. The first category includes trauma resulting directly from alcohol use or trauma for which alcohol use, misuse, or AUD is undoubtedly a causative or aggravating factor. Related to this first category, the major role of alcohol misuse or AUD in multiple fatal and nonfatal injuries is well documented, particularly in data from motor vehicle accidents, which have provided the most exhaustive research findings thus far about alcohol and trauma in this first category. The causative role of alcohol is well demonstrated in policies, laws, and measures, which successfully curtail drinking and driving, and yield direct reductions in traffic-related trauma.

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