Trauma psychiatry is only in its infancy, partly because of resource limitations and poor local constructs for PTSD hindering treatment seeking 39. The nation’s specialized psychiatry and addiction treatment facilities are concentrated in the major cities and serve patients from across the country. Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. Lee and colleagues investigate childhood stress as a predictor for PTSD and AUD in Early Life Stress as a Predictor of Co-Occurring Alcohol Use Disorder and Post-Traumatic Stress Disorder. They review both human and preclinical models of these disorders and examine potential biologic, genetic, and epigenetic mechanisms.
PTSD Memory Loss: The Link Between Trauma and Blackouts
In Functional and Psychiatric Correlates of Comorbid Post-Traumatic Stress Disorder and Alcohol Use Disorder, Straus and colleagues present the DSM-5 definitions for PTSD and AUD and discuss models for functional relationships between the disorders. They also examine risk factors and their associations with co-occurring disorders. Smith and Cottler, in The Epidemiology of Post-Traumatic Stress Disorder and Alcohol Use Disorder, describe the changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM) definitions of AUD and PTSD. They review key surveys that have measured these disorders, the possible relationships between the two disorders, the risk factors, and which populations are at risk. Understanding the role of dissociation in PTSD blackouts is crucial for developing effective treatment strategies. Therapies that focus on increasing awareness of dissociative tendencies and developing skills to remain grounded in the present moment can be particularly helpful in managing and reducing the frequency of blackouts.
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Arousal and reactivity symptoms include:
Trauma exposure and posttraumatic stress disorder (PTSD) are common among college students, and PTSD frequently co-occurs with other mental health disorders (American Psychiatric Association, 2013). One study found that in a large sample of undergraduate college students, 85% reported experiencing a past Criterion A traumatic event, and over the course of two months 21% had experienced another Criterion A trauma (Frazier et al., 2009). While prevalence estimates of PTSD among college students have varied, studies have shown that approximately 6 to 12% of students with a history of trauma have sufficient symptoms of PTSD to elicit a diagnosis (Bernat et al., 1998; Frazier et al., 2009). 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.
Our brains wipe these memories, which is called active or adaptive forgetting. Emotional events can boost our recollection — namely for specific items in a memory. Use of alcohol/other drugs to cope with stress was measured using the alcohol/drug use coping items from the Brief COPE (Carver, 1997). This measure has been used in previous studies of military/Veteran coping (Romero et al., 2020), and the substance use subscale demonstrated strong internal consistency in this sample (α ≥.85). Specifically, participants indicated how often in the last year they were “unable to remember what happened the night before because you had been drinking.” Response options ranged from 0 (never) to 4 (daily or almost daily). From my discussions with people who have experienced blackouts, the amnesia has nearly instantaneous onset and ending.
- I once asked a group of alcoholics in rehab how many had experienced a blackout in the first years of their drinking.
- Future adequately sampled studies should account for confounders of inflammatory mediators in blood, and the comparison group should include a healthy control as well as isolated disorders.
- Children who are victimized have very little control over the traumatic event and may experience severe emotional distress as a result.
One survivor described it as “feeling like a ghost in my own life, present but not really there.” Another recounted the fear and confusion of coming to awareness in unfamiliar surroundings, unsure of what had transpired during the lost time. Unfortunately, there may not be much you can do during a PTSD blackout because you won’t have control of your mind or body at the time. Someone in the room with you may be able to talk you out of the blackout by helping you get grounded – answering questions about the present day, reminding you where you are, telling you who you are with, etc.
Duration and Frequency of PTSD Blackouts
Participants rated how often they were “feeling down, depressed, or hopeless” and had “little interest or pleasure in doing things” on a scale from 0 (not at all) to 3 (nearly every day). Responses were summed to create a total score, with total scores ranging from 0–6. This scale has demonstrated validity in identifying symptoms of depression in primary care settings, with scores ≥3 considered a positive screen for depression (Kroenke et al., 2009). The experience can be compared to snapping photos only to discover later that there was no film in the camera. The difference with a blackout is that, not only are there no pictures in the camera, but your mind has absolutely no memory of having taken the pictures. Twin studies show that if one twin is prone to blackouts, the other is much more likely to also be prone if they are identical, rather than fraternal.
A few studies from Nepal have reported the prevalence of PTSD among vulnerable groups, such as tortured refugees (14%), former child soldiers (55%), and victims of political violence (14%) 34 and human trafficking (30%) 35. In a sample of patients admitted for treatment and rehabilitation of drinking problems in eight different institutions in Nepal, we reported sociodemographic, drinking-related and neuroimmune correlates of comorbid depression 36,37,38. We identified positive associations between inflammatory cytokines and lifetime MD, but not recent symptoms of depression, in the AUD sample 20. In this study, we hypothesized that AUD patients exposed to potentially life threatening trauma, and those with PTSD comorbidity have an aggravated drinking problem as well as dysregulated neuroimmune function. Thus, we set out to investigate the prevalence of PTSD, and its socio-demographic and AUD-related correlates in a treatment sample of AUD in Nepal. Specifically, we examined the relationship between AUD-PTSD comorbidity and serum levels of CRP, inflammatory cytokines, tryptophan metabolism parameters, and BDNF.
Poststress Alcohol Consumption
Starting with alcohol detox, we can help you safely quit alcohol without the fear of relapsing. And from there, we can help you with recovery from residential alcohol treatment to ongoing, outpatient support. At Heroes’ Mile, you get a personalized care plan that uses compassionate, research-based therapies administered by veterans. Blacking out happens when you drink enough that your brain stops creating and storing new memories. Blackout drinking actually causes a type of amnesia called anterograde amnesia. When you’re blackout drunk, your hippocampus—the area of your brain in charge of memories—stops working properly.
Support from loved ones, understanding from the broader community, and ongoing research into trauma and its effects on the brain all contribute to improved outcomes for those affected by PTSD blackouts. Educating loved ones and the broader community about the nature of PTSD blackouts can help reduce stigma and improve support systems for those affected. It’s important to emphasize that blackouts are not a choice or a sign of weakness, but rather a complex symptom of a serious mental health condition that requires compassion and professional support.
For example, in a study with rats we found very modest increases in alcohol consumption on days when shocks were administered but dramatic increases in alcohol preference on subsequent days (Volpicelli et al. 1990). We termed this the “ happy hour effect” and have noted that even among social drinkers, alcohol consumption increases following, but not during, exposure to stress. These results were the opposite of what we expected based on a tension-reduction theory of alcohol use. If one uses alcohol solely to reduce anxiety, alcohol consumption should increase during times of stress rather than after the stress. A positive history of traumatic events was reported by 139 participants (74%).
