Post-Traumatic Stress Disorder and Alcohol Consumption: Biological Mechanisms of Stress Resilience to Subsequent Alcohol Consumption Quilla C. Flanagan-Burt,* Celia Middleton,* and Junghyup Suh

https://arcr.niaaa.nih.gov/volume/46/1/post-traumatic-stress-disorder-and-alcohol-consumption-biological-mechanisms-stress?utm_source=arcr-email&utm_medium=email&utm_campaign=suh-2026-02&utm_content=arcr-listserv PURPOSE: Resilience is crucial in mitigating the risk of stress-related health issues. Although many people can adapt to adverse stress or trauma, stress exposure can increase the risk of health issues, including obesity, cardiovascular disease, and digestive illnesses. Some individuals may even develop debilitating conditions, such as post-traumatic stress disorder (PTSD). People with PTSD often struggle to adapt, sometimes turning to alcohol to cope, which can lead to alcohol use disorder (AUD), characterized by excessive alcohol-seeking and dependence. Understanding the biological underpinnings of resilience, therefore, is a key to preventing both PTSD and AUD. Recent research has uncovered the neurobiological traits that protect against the development of stress-induced alcohol dependence. Studies have shown that proactive coping and a lack of stress-related symptoms are associated with resilience. Preclinical studies, especially in rodents, have provided deeper insights into how stress impacts alcohol-seeking behaviors. Research has shown that resilience involves adaptive changes at the molecular, cellular, neural circuit, and systems levels. This review aims to integrate this research to better understand what makes people vulnerable to stress and alcohol consumption, highlighting aspects frequently overlooked in clinical models.