Alcohol Use and Abuse among PTSD Patients

Post-Traumatic Stress Disorder (PTSD) is a condition that occurs to individuals who have experience threatening life events like natural disaster, horrific accidents, and personal violent assault like rape among others. The condition entails a continued severe depression and anxiety for months and years long after the event. The condition usually coexists with alcohol use and abuse as individuals with the condition seek solace in alcohol (Anxiety and Depression Association of America). The thesis of this paper is that alcohol use and abuse among PTSD patients has damaging repercussions to their health condition and applications of behavior models to have been used to determine the health behavior. This paper discusses alcohol abuse among PTSD patients and in particular alcohol use and abuse and its significance. How the alcohol significantly affects health status in PTSD patients. How health models are applied to explain this health behavior. Comparison of health belief model and the social cognitive theory in application to the health behavior and the description of the model and theory.

Alcohol use, Abuse and its Significance

Alcohol intake is normally associated with relaxation, celebration or socialization and it cuts across age, gender and ethnicity. However on the flip side it causes adverse effects on the users especially the ones who eventually became addicts and those that have a health condition. Alcohol use may lead to heavy drinking, binge drinking and alcoholism.In the short term alcohol affects the brain’s communication with the rest of the body and in the long run leads to heart, liver and pancreatic problems. Ingeneral people react differently to alcohol and in particular Post-Traumatic Stress Disorder (PTSD) patients have a higher risk due to their predisposed health condition (Beidel, 2012).

Effects of Alcohol use and Abuse on Health Status of PTSD Patients

Alcohol use and abuse that occur after disasters are studied with mixed reactions. While others perceive it as a risk factor for mental illnessesafter disasters, others view it a copying mechanism triggered with poor mental health. Either way increased evidence of prevalence in alcohol use and abuse after disasters continue to pile by the day. Researchers have shown disaster effects of increased alcohol use, excessive consumption and increased prevalence of drinking after the Volendam Café Fire, Oklahoma City Booming and the September 11 terroristattack. Consequently alcoholwas associated with PTSD symptoms and grief (Cherry, 2009)

Alcohol use and abuse have a direct effect on the sleep cycle of PTSD patients. Problems with sleep are major concerns with PTSD patients even without alcohol in the picture and when combined with prolonged alcohol abuse even more confusing is the clinical picture. Consequently the effects on the sleep cycle are more powerful and long term (Galanter, 2012). Saladin, Brady, Dansy and Kilpatrick did acomparisonof twenty eight women with both PTSD and substance abuse to other twenty eight with only PTSD and their findings were that dual diagnosticsgroup had more symptoms of more sleep disturbance, avoidance and arousal and a greater traumatic event disorder than those with PTSD only. The group also had heightened depressive symptoms, higher rates of comorbid disorder axis one and two and other medicalproblems. Mueller and colleagues examined the alcohol dependency ration on 135 patients over the course of 10 years. Its findings were that those with alcohol dependency at the base line had a very low recovery rate from major depression compared to those with major depression alone. This clearly paints a very negative picture on the health of PTSD patients that abuse alcohol (Hersen& Beidel 46-47).

PTSD patients often develop comorbid disorders like alcoholism and drug abuse. Consequently there is a high possibility of brain changes in volume to be attributed to substance abuse rather than stress. Recent study measuring stress and alcohol consumption among ninety nine combat veterans with PTSD found out that alcoholic PTSD patients had hippocampi that were smaller than normal,in comparison to non-alcoholic PTSD patients. This is an indication that PTSD patients only suffer a trophy when enduring a double assault of trauma and alcoholism (Steen, 2009).

Comorbid disorders complicate treatment for patients withPTSD and also excebarate the condition itself. Therefore, patients with comorbid alcohol dependency and PTSD can do better if treated for both at the same time. Recent studied have shown reduced alcohol use and PTSD when administering both treatment at the same. This is a clear indication that a concurrent approach to those conditions is better than sequential treatment (Cloitre et al., 2012). Excessive alcohol intake makes treatment for PTSD even harder at the same time bringing serious problems like long term physical problems including diabetes, heart disease, liver disease and general physical pain (US department of Veterans Affairs, n.d).

Application of Health Behavior Models in Explain Alcohol use and Abuse

The Health Behavior Model(HBM) underlying concept is that behavior is determined by personal believes and perceptions like a disease and strategies for reducing its prevalence. The theory has four main constructs that include perceived seriousness, susceptibility,benefits and barriers. However an addition has been made to this constructs that include cue to actions and self-efficacy. These are used either individual or together in explanation of a health behavior (Bartlet, n.d.). The construct of perceived seriousness entails an individual’s belief in seriousness or severity of an illness or disease. While based on medical information or knowledge it can come from personal beliefs about difficulties of disease or impacts it can have on the person’s life.For example flu is deemed as aminor ailment while asthma is view as a serious one (Tasman, 2013). If a person perceives his condition as very serious and that alcohol intake will worsen his condition based on medical information or knowledge, they will have to stop alcohol consumption. Perceived susceptibility is the most powerful in prompting adoption of healthier behaviors. In this case the greater the risk the greater an effort is made for a healthier lifestyle to decrease the risk. It prompts men having sexual relations with other men to get vaccination against hepatitis B and use condoms to decrease susceptibility to HIV infection. The main concept behind this construct is prevention. Stretcher and Rosen-stock assert that when this construct is combined with that of perceived seriousness it results to perceived threat (Steen, 2009). In this case if a person perceives a health risk in regard to alcohol consumption that results into a health threat they will have to make adjustments for the benefit of their health. The construct of perceived benefits entails personal value or usefulness of a new behavior in reducing risk of a developing disease. New behaviors are adopted by people in the belief that they will reduce the risks of developing a disease (Mandell, 2007).

In this light, if an individual beliefs that lack of alcohol consumption will increase their chances of quick recovery they will stop taking alcohol or reduce the intake. For a person to adopt a new behavior a person must belief that there are benefits to the behavior change. A perceived barrier to change involves an individual’s evaluation of obstacles in the way of adopting a new behavior. They are the most significant in determining behavior change. In this case a person outweighs the benefits of the new behavior with the consequences of the old ones (Mandell, 2007). A personwill have to evaluate whether continued alcohol consumption has greater consequences for their health than lack of it inorder to come to a consensus about the intake. Cue actions involve events, people or things that influence individuals to change their behaviors. Self-efficacy is an individual on belief in making ability to do something. No one does new things unless they are certain they can (Mandell, 2007). If a person watches a story on television about another talking about his experience with alcohol and how it affected him, this may influence his alcohol intake behavior to reduce to a minimal intake or none at all. On the other hand if the patient believes that they can reduce alcohol consumption or stop its intake completely, they will be more confident in taking the step.

The Planned Behavior Theory assumes cognitive behavior to behavioral intentions and has components that include: behavioral beliefs likes the likelihood of an action may promotemornegate behavior, evaluation outcomes are also avoided in terms of desire or negative consequences. Behavioral attitudes that define of the sum of an individual’srelevant and likely hood related to behavioral beliefs. Normative includebeliefs of what behaviors are expected by others, degree of an individual’scomplying with others expectation. Subjective norms are multiplicative sums of the two sets of normative beliefs. Behavioral intentions are derived from a combination of behavioral attitude and subjective norms (Taylor, 2008).

Specific to alcohol, positive attitude towards drinking correlate with drinking behaviors. In peer behavior is associated with binge drinking behaviors. Attitude towards drinking and perceived norms about drinking of fellow group members predict intentions to engage in the behavior. Lack of behavioral control predicts drinking behavior (Taylor, 2008). The trans-theoretical model has components that include: the following constructs the five or six stages of change that are pre-contemplation where an individual has no intention of changing his behavior in the near future. Contemplation where the individual is considering changing their behavior in the next six month. Preparation where change is planned within the next month. Maintenance where the health behavior has been maintained for at least six months. Termination where change in behavior is seen after period of time (Taylor, 2008).

Another construct is the ten processes of change subdivided into experiential and behavioral that includes: consciousness raising where a new awareness is made for a problem. Dramatic relief whereby there is emotional expression and effective change.Environmental re-evaluation where the problem is seen in the context of an individual’s physical and social world. Self re-evaluation that entails intellectual and emotional acceptance of changed values. Social and self-liberation that involves heightening awareness of alternative lifestyles negating the problem and developing a strengthened personal commitment and ability to change. Counter conditioning which entails adopting alternative behaviors. Forming healthy relationships. Reinforcement management and stimulus control (Taylor, 2008). Decisional balance that involves ways in which people weigh costs and benefits. Self efficacy that is predicted to raise an individual’s moves towards the action and maintenance stages. Temptation reflects the intensity of the urge to engage in undesired behavior as a result of physical addiction and conditioning (Taylor, 2008).

The transtheoretical model in relation to alcohol use and abuseentails binge drinking which is a health behavior practices by college students. The theory dissects the likely hood of a person seeking help for negative behavior. However many drinkers will not seek help as they do not believe their behaviors to be harmful and this is an obstacle to behavior change. The theory functions as an effective model in presenting necessary stages needed for change (Taylor, 2008). Social cognitive theory posits that learning occurs in a social context within a dynamic and reciprocal interaction the individual, environment and behavior. This explains how people acquire and maintain behavioral pattern. It has the following constructs: reciprocal determinism, behavioral capability that refers to an individual’s actual capability in performing a behavior via essential knowledge and skills. Observational learning that asserts people can witness a behavior conducted by others then replicates the same. Reinforcement is also another construct that refers to internal and external responses to an individual’s behaviors affecting the probity of discontinuing or carrying on of the behavior. Expectation involving an individual’s consequences of a behavior. Self-efficacy that entails the individual’s capacity confidence in his ability to perform a certain behavior (LaMorte, 2016).

Social cognitive theory in relation to alcohol use and abusein reducing alcohol consumption is dependent on an individual’s self-efficacy level and level of outcome expectancy. A person will not be more inclined to not consume alcohol if he considers that social approval and healthier lifestyle is obtained by not consuming alcohol. A person who wants to consume less alcohol but lacks skills to cope with stress is less likely to stop the consumption even if he is motivated (LaMorte, 2016).

The transactional model of coping sees coping as a conscious process that varies with demands of a given situation. Copying as an attempt by an individual to regulate emotions regardless of effectiveness. Extraversion is where by an individual takes the situation as challenging rather than threatening and adopt fewer maladaptive and avoidance strategies. Thehigh E individuals have few stressors generally and when stressors present themselves they do not react strongly. As per the tension reduction hypothesis alcohol allow for relief of temporary stressors reinforcing faulty strategies. Patients with alcohol codependency score temptation subscale to alcohol abstinence. The more psychiatric disorder a person experiences the more they are inclined to drinking more so in situations triggering negative effect. The higher the patient’ssymptoms, the more importance areplaced on alcohol intake (Cloitre, 2012).

Comparison of Health Belief Model and Social Cognitive Theory in Relation to Alcoholism

The Health Behavior Model (HBM) is underlying concept is that behavior is determined by personal believes and perceptions a disease and strategies for reducing its prevalence (Bartlet, n.d). Social cognitive theory posits that learning occurs in a social context within a dynamic and reciprocal interaction the individual, environment and behavior. This explains how people acquire and maintain behavioral pattern (Cameroon, 2012).

The health model behavior model has theory has four main constructs that include perceived seriousness, susceptibility, benefits and barriers that are all based perception in order to direct ones behavior (International society for Trauma Stress, 2009). The social cognitive theory constructs entail reciprocal determinism, behavioral capability, observational learning, reinforcements, expectation and self-efficacy all based on the learning of a new behavior influenced by environment (Galanter, 2012). While the health behavior model has preventative components that include the construct of perceived seriousness entails an individual’s belief in seriousness or severity of an illness or disease.The construct of perceived benefits entails personal value or usefulness of a new behavior in reducing risk of a developing disease. The construct of perceived benefits entails personal value or usefulness of a new behavior in reducing risk of a developing disease. A perceived barrier to change involves an individual’s evaluation of obstacles in the way of adopting a new behavior (Steen, 2009).

The social cognitive theory has the following constructs reciprocal determinism that entails dynamic and reciprocal interaction of the person with, environment and behavior. Behavioral capability that refers to an individual’s actual capability in performing a behavior via essential knowledge and skills. An individual must know what to do and how to do it to be successful at this. Observational learning that asserts people can witness a behavior conducted by others then replicates the same. If such is performed successful then its imitation will be successful.

Reinforcement construct that refers to internal and external responses to an individual’s behaviors affecting the probity of discontinuing or carrying on of the behavior. the can be positive or negative. Expectation involving and individual’s consequences of a behavior. With regard to alcohol use and abuse the health behavior model is applied in a preventive form in that if the risks of consuming alcohol are greater than the benefits of not consuming, a person will be inclined to stop the consumption (Tasman, 2013). With social cognitive theory a person’s efficacy eventually determine their ability to cope with stress instead of finding comfort in alcohol (Mandell et al., 2007). Both models have self-efficacy as one of their constructs which is an individual’s confidence in their ability to do something. Both the models are applied in explaining a health behavior.

Conclusion

In conclusion, drawing from the discussion above it is clear that alcohol dependency poses health risks even without a predisposed medical condition. It is also clear that far more adverse effects are registered in individuals with a predisposed medical condition who consume alcohol. PTSD patients in particular have higher risks that come with alcohol intake as opposed to patients who does not indulge in alcohol.

References

America, a. a. (2016). understanding the facts:post traumatic stress disorder PTSD. Retrieved may 10, 2017, from adda.org: www.adaa.org/understanding-anxiety/posttraumatic-stress-disorderptsd. Bartlet, J.A. (n.d.). health belief model. Retrieved may 10, 2017, from jblearning.com: http://www.jblearning.com/samples/0763743836/chapter%204.pdf

Beidel, M. H. (2012). adult psychopathy and diagnisis. hoboken: john willey and sons.

Cameroon.T.M. (2012, february 7). “Have a drink, you’ll feel better.” Predictors of Daily Alcohol Consumption Among Extraverts: The Mediational Role of Coping. Retrieved may 10, 2017, from ncbi: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3378784/

Cherry, K. (2009). perspective on natural disasters:coping with katrina ,rita and other storms. baouton rouge: springer science and business media.

Cloitre, M., Courtois, C. A., Ford, J. D., Green, B. L., Alexander, P., Briere, J., & Van der Hart, O. (2012). The ISTSS expert consensus treatment guidelines for complex PTSD in adults. Retrieved November, 5, 2012.

Galanter, M. (2012). rural development in alchoholism volume 6. newyork: spriner science and business media. International society for Trauma Stress. (2009). Effective Treatments for PTSD: Practice Guidelines from the International society for Edna B. Foa, T. M. (2009). Effective Treatments for PTSD: Practice Guidelines from the International society for trauma stress . newyork: guilford press.

LaMorte, W. (2016, april 28). the social cognitive theory. Retrieved may 10, 2017, from sphweb: http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories5.html

Mandell, L. A., Wunderink, R. G., Anzueto, A., Bartlett, J. G., Campbell, G. D., Dean, N. C., ... & Torres, A. (2007). Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clinical infectious diseases, 44(Supplement 2), S27-S72.

Steen, R. (2009). Human Intelligence and Medical Illness: Assessing the Flynn Effect . newyork: springer science and business media.

Tasman, M. A. (2013, september 6). mentaldisorders:diagnosys ,etiology and treatment. Retrieved may 10, 2017, from psychtreatment: www.psychetreatment.com/alcohol-use-and-abuse.htm

Taylor, P. M. (2008). A Review of the use of the Health Belief Model (HBM), the Theory of Reasoned Action (TRA), the Theory of Planned Behaviour (TPB) and the Trans-Theoretical Model (TTM), to study and predict health related behaviour change. Retrieved may 10, 2017, from warwick: http://www2.warwick.ac.uk/fac/med/study/ugr/mbchb/phase1_08/semester2/healthpsychology/nice-doh_draft_review_of_health_behaviour_theories.pdf

The US department of Veterans Affairs. (n.d.). PTSD and problems with alcohol use. Retrieved may 10, 2017, from ptsd.va.gov: https://www.ptsd.va.gov/public/problems/ptsd-alcohol-use.asp