PTSD, Alcohol, and Avoidance: Why Drinking Can Feel Helpful at First
One of the reasons alcohol can become such a powerful coping strategy for PTSD is that, at least initially, it may feel like it works. Someone drinks and notices that their anxiety decreases, their thoughts slow down, or they feel less emotionally overwhelmed. They may feel less vigilant, more comfortable socially, or simply able to stop thinking for a while. For a nervous system that has spent the day tense and on alert, that relief can feel significant. The problem is that temporary relief is not the same as recovery. The National Center for PTSD notes that some people use alcohol specifically to relax or manage thoughts and feelings they would rather avoid.
I sometimes compare this kind of avoidance to holding a beach ball underwater. Imagine standing in a swimming pool and pushing a large beach ball beneath the surface. At first, it works. The ball is out of sight. But it hasn't disappeared. You have to keep using energy to hold it down, and the harder you push, the more forcefully it wants to come back to the surface. Trauma-related thoughts, emotions, memories, and physical sensations can work in a similar way. Alcohol may temporarily help push those experiences below the surface, but it doesn't resolve what is underneath them.
Over time, something that initially seemed to increase functioning by helping a person turn down PTSD symptoms can begin to interfere with functioning. A person may increasingly rely on alcohol to transition from work to home, manage anxiety, tolerate social situations, quiet intrusive thoughts, or escape uncomfortable emotions. At the same time, alcohol can contribute to problems that overlap with PTSD. For example, although someone may drink to help themselves sleep, alcohol can make sleep less restful, and substance use can increase irritability and avoidance of emotions. The coping strategy that once felt helpful can gradually become part of the problem.
There is also a powerful learning process occurring. Each time anxiety, tension, or trauma-related emotions arise and alcohol makes them temporarily quieter, the brain has another opportunity to associate drinking with relief. The pattern can become: trauma trigger → increasing tension → uncomfortable thoughts or emotions → alcohol → temporary relief → continued avoidance → symptoms return. Research in treatment-seeking veterans has found an association between PTSD avoidance symptoms and alcohol craving, supporting the importance of examining alcohol use within the larger pattern of trauma-related avoidance.
Eventually, keeping that beach ball underwater can require more and more energy. Recovery involves gradually learning that we don't have to keep pushing it down. We can notice the anxiety, memory, sadness, anger, physical tension, or urge to escape and develop other ways of responding to it. This doesn't mean enjoying painful emotions or simply enduring them. It means learning that an uncomfortable internal experience can be present without immediately needing to make it disappear.
The goal of trauma treatment, then, isn't simply to take away a coping strategy. It's to help someone develop new ways of regulating their nervous system, tolerating difficult internal experiences, and responding to trauma reminders without automatically escaping them. Little by little, the person learns: I can feel this and still be okay. I can choose what I do next. Eventually, recovery becomes less about getting better at holding the beach ball underwater and more about realizing you don't have to keep holding it down at all.
