Key takeaway
You are awake when you should be asleep, or you drank so you could sleep, and what happened will not stay in the past. If the fear has lasted more than a month and gets in the way of life, tell a clinician about the trauma and the using. If you are in danger tonight, call 911 or 988.
Last updated: Mon Oct 05 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
You are awake when you should be asleep, or you drank so you could sleep, and the thing that happened will not stay in the past.
If you are in immediate danger, if someone is seizing, or if someone will not wake, call 911. If the night will not end, call or text 988. You do not have to decide whether this is PTSD before you ask for help.
Tell someone what happened, and what you use
When you can, tell a clinician both. Fear right after danger is the body's alarm. NIMH says most people come down from that first wave. PTSD is the name when the symptoms last longer than a month, get in the way of work or relationships, and are not better explained by a medicine, by substance use, or by another illness. A psychiatrist, psychologist, or clinical social worker is who makes that call.
You do not have to have been the person in the crash or the assault. Hearing that someone close to you was hurt can be enough. If the event was during military service, the veterans guide and the military sexual trauma guide are the pages that stay with that history. The wider overlap is the trauma guide.
Do not run the hard part alone at the kitchen table
Exposure therapy is gradual work with a professional, done in a way that stays safe. It is not a worksheet you run at 2 a.m., and it is not a drive back to the place. If a clinician offers it, ask about their training, and ask what they do if your drinking or drug use goes up in those same weeks.
People with PTSD often also have depression, an anxiety disorder, or a substance problem. NIDA says it is usually better to treat those together, because people carrying both typically have a harder time staying in care when the plan only names one. Together does not mean a trauma hour on the first night of withdrawal. It means neither problem is postponed until the other is declared finished. The dual-diagnosis guide is how to ask. If the feeling might be panic rather than a memory, the anxiety guide is the closer read.
The care that helps is talk therapy, with medicine when a prescriber who has treated PTSD says it belongs. The FDA has approved two SSRI antidepressants for PTSD. Do not borrow someone else's. If opioids are part of this, do not stop methadone, buprenorphine, or naltrexone to look drug-free. The medication guide covers those medicines.
Staying off alcohol, and staying near people you trust, is part of taking care of yourself. It is not a home detox. If drinking has been heavy and daily, a sudden stop can be life-threatening. Read the withdrawal guide before you treat "just quit" as the plan for the fear.
Ask a program who screens for PTSD and for substance use, and who is on call at night.
FindTreatment.gov can narrow a search. Call and ask whether they actually treat both. Call or text (800) 653-9376 if you want help finding a program that can sit with the trauma and the substance use in one plan.
Additional Resources
Sources cited on this page:
- NIMH: Post-traumatic stress disorder
- NIDA: Co-occurring disorders and health conditions
- NIAAA: Understanding Alcohol Use Disorder
- SAMHSA FindTreatment.gov
- 988 Suicide & Crisis Lifeline
- SmarterRecovery about page (referral disclosure)
Common Questions
Does a frightening event mean I have PTSD?
No. Fear after danger is a normal alarm, and most people come down from that first wave. PTSD is the name for symptoms that last longer than a month, get in the way of work or relationships, and are not explained by medicine, substance use, or another illness. A mental health professional makes that call.
Why do PTSD and substance use show up in the same person?
They often do. People with PTSD often also have depression, an anxiety disorder, or a substance use problem. Drinking or using can take the edge off for a short time and still make the fear worse. That pattern is common. It is not a treatment, and it is not true of every person.
Should the substance use be treated first and the PTSD later?
Usually it is better to keep both in the plan from the start. Together does not mean a trauma-processing hour on the first night of withdrawal. It means both problems have someone trained for them, and neither one is postponed until the other is declared finished.
Can I use an exposure exercise I found online?
No. Exposure therapy is gradual work with a professional, done in a way that stays safe. Do not replay the worst memory on purpose, and do not drive back to the place because a worksheet said to. If a clinician offers it, ask about their training and what they do if your using goes up in those same weeks.
What if stopping alcohol or a medicine makes the fear worse?
Tell a clinician before you stop. Avoiding alcohol is a reasonable health step, and it is not a home detox. If drinking has been heavy and daily, a sudden stop can be life-threatening. Call 911 for a seizure, collapse, or trouble breathing. Call or text 988 for a mental health crisis.