The house is quiet and you already know what will get you to sleep. Maybe two fingers of something. Maybe half a pill from a prescription somebody wrote long ago. It works fast.
That is the problem. Self-medicating PTSD is not weakness; it is what happens when someone finds something that quiets a symptom nothing else has touched.
The bill arrives around 3 a.m., and again the next day.
You are not unusual. The VA’s National Center for PTSD reports that over 4 out of 10 U.S. adults with PTSD (45%) also have problems with drug or alcohol use.
If you are in crisis, call or text 988 (Suicide & Crisis Lifeline).
SAMHSA National Helpline: 1-800-662-HELP (4357) – free, confidential, 24/7, in English and Spanish, for treatment referral and information.
If someone may be overdosing, call 911. Naloxone reverses opioid overdose and is available without a prescription in Texas.
Stopping alcohol or benzodiazepines suddenly can be dangerous. Talk with a clinician before you stop, and go to an emergency room if you develop shaking, confusion, or seizures.
Our Fort Worth office is 817-659-7344.
What self-medicating PTSD with alcohol does to the second half of the night
“Almost everyone who has PTSD also has trouble sleeping,” the National Center for PTSD says, and the same page notes that over time drug and alcohol use “can also have negative effects on sleep quality.” A 2014 review in the Handbook of Clinical Neurology explains the trade: a drink before bed gets you to sleep faster and deepens sleep early while suppressing REM, then the night turns over into wakefulness and lighter sleep. Those findings come from sleep laboratories, not PTSD samples.
Then comes the day, the hours meant to repair you missing, the startle and short fuse running on nothing. In someone who drinks most nights, part of that is the alcohol leaving. NIAAA lists trouble sleeping, shakiness, restlessness, sweating, a racing heart and feeling low among withdrawal symptoms that appear as alcohol wears off, overlapping PTSD’s arousal symptoms almost item for item. Mornings like that, most mornings, mean the body has adapted, and stopping unsupervised is then unsafe.
Sleep does not snap back the week the drinking stops. The same review reports disturbed sleep with increased wakefulness after stopping, and that sleep problems predict a return to drinking. Expect the rough stretch, and tell a clinician.
The VA’s sleep page is harder: “Using marijuana, alcohol and street drugs to manage PTSD or sleep problems is related to a higher risk of thoughts about suicide and suicide attempts.” That is an association. If your nights include thoughts of not being here, call or text 988.
Why benzodiazepines are not recommended for PTSD
The 2023 VA/DoD Clinical Practice Guideline for PTSD is direct: “We recommend against benzodiazepines for the treatment of PTSD.” The rating is Strong against, the most negative it issues, and it calls the class “associated with misuse, decreased effectiveness of recommended PTSD treatments, and cognitive changes,” on evidence it rates very low. Nobody here is telling you to stop a prescribed medication; this is a rating about a drug class.
Stopping abruptly can be dangerous. The FDA’s 2020 class-wide boxed warning states that physical dependence can occur “even as prescribed,” and that stopping abruptly or cutting the dose too quickly “can result in withdrawal reactions, including seizures, which can be life-threatening.”
A drink some nights, a pill some nights, both on the bad ones: that is the dangerous combination. The FDA is blunt: “Do not drink alcohol with benzodiazepines. Alcohol can increase the risk of serious and life-threatening side effects.” Misuse “can result in overdose or death, especially when benzodiazepines are combined with other medicines, such as opioid pain relievers, alcohol, or illicit drugs.” Both slow breathing. If both are part of your nights, tell a clinician. It changes what is safe next.
This article gives no taper, and be skeptical of anything online that does; that belongs with your prescriber. Shaking, confusion or a seizure means an emergency room. Alcohol is the same: NIAAA calls its withdrawal “a potentially life-threatening process” and says people with severe alcohol use disorder “may need medical help” to stop.
Do you have to be sober before anyone will treat the PTSD?
No. That question keeps people out of an office for years.
Recommendation 34 of the 2023 VA/DoD guideline suggests that a co-occurring substance use disorder should not preclude its trauma-focused treatments, and that comorbidities should not delay treatment. It rates that Weak for, on low confidence. The National Center for PTSD is blunter: “Research shows that treating PTSD and substance use at the same time works to treat both conditions.”
The guideline is more careful about which half improves, calling the evidence “mixed as to whether PTSD treatment plus SUD treatment is more effective than SUD treatment alone.” The PTSD side is better supported: reason to start rather than wait, not a promise that treating the PTSD fixes the drinking.
Concurrent care can mean two providers in parallel or one program doing both; the guideline reviewed both. The National Institute on Drug Abuse says that when conditions co-occur, “it is usually better to treat these health issues at the same time rather than separately.” If it is one program, ask what is in it: the protocol with the most evidence keeps trauma-focused work inside, and programs that leave it out “did not improve PTSD symptoms in individuals with a SUD more than SUD treatment alone.”
It comes up at the first visit, usually as an apology. What gets asked is narrower than you expect: how much, how often, how long, and what happens on the nights you skip it. That last answer often decides whether the next step is an appointment or a referral for medically supervised withdrawal, which this office does not provide. A referral is not a rejection.
The alcohol side has its own medications: NIAAA lists three the FDA has approved to help people stop or reduce drinking, naltrexone, acamprosate and disulfiram. Whether any fits you is worth asking a clinician about.
What treatments for PTSD actually have evidence behind them
The best-supported treatments are talk therapies. The VA/DoD guideline gives its strongest rating to individual, manualized trauma-focused psychotherapy: Cognitive Processing Therapy, Eye Movement Desensitization and Reprocessing, and Prolonged Exposure. They ask you to approach what you have been steering around, the tension in self-medication.
What the guideline reports is an association, rated very low, between benzodiazepines and “decreased effectiveness of recommended PTSD treatments.” The worry about alcohol is a clinical inference, not a finding from that evidence: therapy that asks you to stay with a feeling can be undercut by anything that blunts it on arrival. A reason to raise this with whoever treats you, not to wait until you have stopped.
Those therapies are delivered by trained psychotherapists, not here. What we do offer is PRISM, a GrayMatters Health device FDA-cleared as an adjunctive treatment for symptoms associated with PTSD in adults, used, in the FDA’s words, “together with other pharmacological and/or non-pharmacological interventions.” Alongside that therapy, not instead of it. Its clearance study was single-arm and open-label with no control group. It does nothing for drinking.
What we are, and what we are not
We are an outpatient adult psychiatry office in southwest Fort Worth. There is no addiction program here, no detox or withdrawal management, no residential treatment, no partial hospitalization or intensive outpatient program, and no 24/7 substance use service. The SAMHSA National Helpline (1-800-662-HELP) answers around the clock for referrals.
What is here: Dr. Diana Ghelber treats addiction as part of general adult psychiatric care and is certified to provide buprenorphine treatment for opioid use disorder, which addresses opioids specifically and does nothing for alcohol or benzodiazepines.
A PTSD evaluation looks at sleep, medications, what you use and when, and the question underneath: how much is trauma, how much is the substance. Heavy drinking can produce low mood, anxiety and broken sleep on its own, and those often lift with time away from it. Telling them apart is why a clinician may want to see your symptoms with less alcohol in the picture before prescribing, if anything. That is not a refusal to treat the PTSD. It also means depression gets assessed rather than assumed.
Frequently asked questions
Is it dangerous to drink while taking a benzodiazepine?
Yes. The FDA is direct: “Do not drink alcohol with benzodiazepines. Alcohol can increase the risk of serious and life-threatening side effects.” Both slow breathing, and combining them, or either with an opioid, has caused severe respiratory depression and death. Tell your prescriber what you actually drink.
Do I have to be sober before a clinician will treat my PTSD?
Not as a rule. The 2023 VA/DoD guideline suggests a co-occurring substance use disorder should not preclude trauma-focused PTSD treatment, and the National Center for PTSD says treating both at once works for both. Two caveats: it is rated Weak for, and concurrent does not mean unsupervised.
What happens if I stop a benzodiazepine or heavy drinking suddenly?
It can be dangerous, so do not improvise. The FDA warns that stopping benzodiazepines abruptly “can result in withdrawal reactions, including seizures, which can be life-threatening,” and NIAAA calls alcohol withdrawal “a potentially life-threatening process.” Talk with a clinician first. Shaking, confusion, or a seizure means an emergency.
Do I have to go somewhere else for the alcohol part?
For some of it, yes. This is an outpatient adult psychiatry practice with no addiction program, detox, residential treatment, intensive outpatient program, or 24/7 substance use service. Dr. Ghelber treats addiction within general adult psychiatric care and is a certified provider of buprenorphine treatment for opioid use disorder. Referrals: 1-800-662-HELP.
The bottom line
If you found something that shuts the nights down, it works, and that is what makes it hard to put down. What quiets arousal fastest also fragments the second half of the night and blunts the feeling trauma-focused treatment depends on. You do not have to be sober before anyone takes the PTSD seriously. What you must not do is stop alcohol or a benzodiazepine abruptly on your own, or drink on top of one. This is not a character problem. It is treatable.
Talk with us
If you are in Fort Worth or the surrounding North Texas area and what you have read here sounds familiar, we would be glad to talk it through with you. The Institute for Advanced Psychiatry is an outpatient practice at 6800 Harris Parkway, Suite 100, treating adults 18 and older. You can request an appointment or call 817-659-7344.
If you are in crisis or thinking about harming yourself, please do not wait for an appointment. Call or text 988 to reach the Suicide & Crisis Lifeline, available 24/7, or go to your nearest emergency room.
If you are in crisis, call or text 988 (Suicide & Crisis Lifeline).
SAMHSA National Helpline: 1-800-662-HELP (4357) – free, confidential, 24/7, in English and Spanish, for treatment referral and information.
If someone may be overdosing, call 911. Naloxone reverses opioid overdose and is available without a prescription in Texas.
Stopping alcohol or benzodiazepines suddenly can be dangerous. Talk with a clinician before you stop, and go to an emergency room if you develop shaking, confusion, or seizures.
Sources
- U.S. Department of Veterans Affairs, National Center for PTSD. “PTSD and Substance Use.” Accessed 2026-09-03. https://www.ptsd.va.gov/understand/related/substance_misuse.asp
- U.S. Department of Veterans Affairs, National Center for PTSD. “Sleep Problems (Understand PTSD: Related Problems).” Accessed 2026-09-03. https://www.ptsd.va.gov/understand/related/sleep_problems.asp
- U.S. Department of Veterans Affairs and U.S. Department of Defense. “VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder, Version 4.0.” 2023. https://www.healthquality.va.gov/guidelines/MH/ptsd/
- Colrain IM, Nicholas CL, Baker FC. “Alcohol and the Sleeping Brain.” Handbook of Clinical Neurology. 2014;125:415-431. https://pmc.ncbi.nlm.nih.gov/articles/PMC5821259/
- National Institute on Drug Abuse. “Co-Occurring Disorders and Health Conditions.” Accessed 2026-09-03. https://nida.nih.gov/research-topics/co-occurring-disorders-health-conditions
- U.S. Food and Drug Administration. “FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class.” September 23, 2020. https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class
- National Institute on Alcohol Abuse and Alcoholism. “Understanding Alcohol Use Disorder.” Updated January 2025. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder
- U.S. Food and Drug Administration, CDRH 510(k) Premarket Notification Database. “510(k) K222101 – Prism, GrayMatters Health, Ltd.” Cleared March 17, 2023. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?ID=K222101
- Substance Abuse and Mental Health Services Administration. “SAMHSA’s National Helpline.” Accessed 2026-09-03. https://www.samhsa.gov/find-help/helplines/national-helpline
Medical disclaimer
This article is for general education and is not medical advice, a diagnosis, or a treatment recommendation for any individual. Reading it does not create a physician-patient relationship. Treatment decisions, including whether any medication or procedure is appropriate for you, should be made with a qualified clinician who knows your history. Do not start, stop, or change a psychiatric medication without talking to your prescriber. If you are experiencing a medical or mental health emergency, call 911 or 988.