People suffering from post-traumatic stress disorder (PTSD) commonly abuse substances as a form of self-medication. Over time, alcohol or drug abuse can lead to dependence and a co-occurring mental health/substance use disorder.
What Is PTSD?
Post-traumatic stress disorder (PTSD) is a mental health disorder caused by exposure to a disturbing or distressing event, such as having your life threatened, experiencing sexual violence or suffering a severe injury.It can lead to significant impairment in the lives of those affected. 1
The person doesn’t have to directly experience the event, though this is often the case. He or she can also witness the event, learn of the trauma that occurred to a family member or a close friend, or witness other unpleasant elements of the event (such as blood, dead bodies or hearing intimate details surrounding abuse). 1
PTSD has many different symptoms and can manifest in a number of different ways.
People can have different experiences. Some may have more fearful re-experiencing symptoms, while others may struggle more with depressive moods, negative thinking, or social relationships.
- Psychological distress when exposed to cues that relate to the event.
- Significant physical responses to cues that relate to the event.
- Dissociative reactions or flashbacks in which the person relives the event.
- Repeated dreams about the trauma.
- Persistent and involuntary dreadful memories of the event. 1
- Avoidance of external factors (such as locations, conversations, people or activities) that remind the person of the traumatic event and cause terrifying thoughts, feelings or memories.
- Avoidance of painful memories, thoughts or feelings associated with the trauma. 1
Negative Mood and Thought Changes
- Amnesia surrounding components of the traumatic event.
- Negative thoughts or beliefs about the world, others or oneself.
- Distorted thinking that leads to blaming oneself for the event.
- Chronic negative state of emotions (such as shame, anger, guilt or fear).
- Lack of interest in hobbies or activities.
- Feeling estranged or detached from other people.
- Consistently unable to feel positive emotions. 1
- Irritability and anger, typically expressed as aggression.
- Self-destructive behaviors.
- Hypervigilance or hyperarousal (increased anxiety and detection of threats).
- Exaggerated response to being startled.
- Concentration difficulties.
- Sleep problems. 1
For a person to receive a formal diagnosis of PTSD, he or she must display at least one of the intrusion symptoms, one of the avoidance symptoms, at least two of the negative mood and thought changes and at least two of the reactive symptoms for more than a month. 1
People who have experienced trauma may turn to drugs or alcohol to escape memories, soothe emotional pain or feel a sense of control. However, a therapeutic approach is often necessary to truly heal the pain of the event.
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PTSD and Addiction
People with PTSD may use drugs to fall asleep, avoid memories, or numb emotions.
Trauma can negatively impact the brain in countless ways.
A normal stress response involves activation of the hypothalamic-pituitary-adrenal (HPA) axis – a network connecting the brain and body through hormonal messages – as well as the hippocampus, amygdala and medial prefrontal cortex in the brain. 9 Stress activates the release of cortisol and norepinephrine, which increase arousal and help us take necessary action.
After a normal stressful situation, we are able to “turn off” this stress response. In traumatic stress, however, these processes remain stuck “on,” causing prolonged release of cortisol and norepinephrine.
People with PTSD can remain chronically hyperaroused in this state, or alternatively “shut down” their nervous system, both leading to many of the symptoms described above. PTSD can also create lasting problems with learning and memory, immune system function, psychological wellbeing (e.g., anxiety, depression), and relationships and other social responsibilities. 1, 9
Use of Drugs and Alcohol to Cope
Because of the profound distress and impairment in the lives of those affected by PTSD, many people abuse drugs or alcohol to cope.
Below are some reasons why victims of trauma often abuse substances: 10, 11, 12
- To fall asleep due to the sleep dysfunction caused by PTSD.
- To avoid traumatic memories or dreams.
- To forget about their problems.
- To deal with mood disturbances associated with PTSD.
- To numb themselves from extreme emotions.
Abusing drugs or alcohol can actually exacerbate these problems over time and decrease functioning across many areas of life. Proper treatment can help people with PTSD to recover in a healthy and positive way.
Signs and Symptoms of Substance Abuse
If someone has post-traumatic stress disorder and is abusing drugs or alcohol to cope with the emotional distress or pain, he or she is at risk of developing an addiction.
Below are some signs and symptoms that may indicate an addiction: 1
- Using more of the substance than intended or over a longer period of time.
- Having difficulty cutting down on using or quitting.
- Experiencing strong cravings to use the substance .
- Using the substance to the point that it interferes with home, school or work responsibilities.
- Persistently using the substance despite interpersonal difficulties that are caused or worsened by the substance.
- Abandoning significant activities or hobbies in favor of substance use.
- Habitually using the substance in dangerous situations, such as driving a vehicle.
- Continuing to abuse the substance regardless of physical and psychological consequences.
- Requiring increased doses of the substance to feel the desired effects or feeling less of a “buzz” or “high” when using the same amount (tolerance).
- Experiencing withdrawal symptoms with cessation of use or using the substance to prevent or alleviate withdrawal symptoms.
PTSD and Substance Abuse Treatment
If you suffer from an addiction to drugs or alcohol and post-traumatic stress disorder, seek out a recovery center that specializes in treating people with a dual diagnosis. These recovery centers can develop treatment plans that address both the PTSD and the addiction at the same time, which can help prevent relapse.
Some rehabs are more experienced in treating those with PTSD than others, so ask about the staff’s experience before choosing the program. All recovery programs are different, so your choice will depend on your individual needs.
Below are different types of treatment programs:
- Inpatient treatment: These facilities require that you live on-site for the duration of your treatment. You can separate yourself from triggers to use, as well as trauma-related triggers. Services offered include therapy and counseling, detox, medical maintenance, psychiatric and medical treatment, and aftercare planning.
- Outpatient treatment: You can live at home and still meet your responsibilities at school or work while receiving treatment for PTSD and addiction. Outpatient treatment can include different recovery services such as relapse prevention, education classes, therapy and counseling and support groups.
- Group counseling: A mental health professional will facilitate group therapy sessions focused on different goals, such as improving social skills or developing coping strategies, while also sharing stories related to addiction and trauma.
- Individual therapy: You work one-on-one with a therapist to address issues related to PTSD and addiction and correct problematic behaviors and thought patterns.
- Holistic and complementary treatments: Alternative treatments for PTSD and addiction include equine therapy 8, meditation 7, yoga 7, acupuncture, 7 and relaxation techniques. 7
Therapies Used to Treat Post-Traumautic Stress Disorder and Addiction
- Prolonged exposure: Prolonged exposure therapy is used for those suffering from PTSD. It focuses on re-experiencing the trauma-inducing event through thoughts and memories. The therapist works to reduce the distress and pain the person experiences due to the traumatic event. 2
- Eye movement desensitization and reprocessing: Eye movement desensitization and reprocessing (EMDR) re-engages the person in the traumatic event while employing an eye tracking technique that is designed to reorganize the brain’s processing of the traumatic event. 3
- Cognitive behavioral therapy (CBT): CBT focuses on the relationship between your thoughts, feelings and behaviors while working to fix maladaptive patterns of behavior and thought. The therapist will teach and build on positive coping skills to be used in place of drug or alcohol abuse.
Certain factors can increase someone’s risk of developing post-traumatic stress disorder. These include: 1
- Experiencing a traumatic event.
- History of other mental health disorders.
- History of emotional problems.
- Low socioeconomic status.
- Family dysfunction.
- Parental death or separation.
- Lower intelligence.
- Negative coping strategies.
Conversely, a strong support system can be a protective factor against PTSD and decrease the risk of developing it. 1
Risk Factors for Addiction
Some early risk factors for substance abuse, such as behavioral problems, can be treated once they are identified. Treatment can reduce the chances of later complications.
Risk factors for substance abuse include: 5,6
- Aggressive behavior as a child.
- Lack of parental supervision.
- Availability of drugs.
- Substance use.
- Poor social skills.
- Academic failure.
- Drug-using peers.
Some protective factors that can reduce the risk of substance abuse include: 5
- A strong parent-child bond.
- Academic success.
- Anti-drug policies.
- Strong neighborhood attachment.
Parents should be aware of the childhood risk factors so that they can work to create a nurturing and communicative relationship with their children while educating them about the dangers of drugs and associating with peers who use drugs.
PTSD and Addiction Statistics and Facts
An estimated 50% of people seeking treatment for an addiction also have PTSD.
- An estimated 50% of people seeking treatment for an addiction also have PTSD. 4
- People in the United States have an estimated 9% chance of developing PTSD throughout their lifetime. 1
- The prevalence of PTSD is highest among rape victims, genocide survivors, military personnel and people imprisoned for political or ethnic reasons. 1
- PTSD is also common among military veterans, police officers, firefighters and emergency medical personnel. 1
- People with PTSD and a co-occurring substance addiction tend to relapse more quickly than those with an isolated addiction. 4
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. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Association.
. U.S. Department of Veterans Affairs. PTSD: National Center for PTSD. Prolonged Exposure Therapy
. EMDR Institute. What Is EMDR?
. Berenz, E., and Coffey, S. (2012). Treatment of Co-occurring Posttraumatic Stress Disorder and Substance Use Disorders. Current Psychiatry Reports 14.5: 469-77.
. National Institute on Drug Abuse. (2003). What Are Risk Factors and Protective Factors?
. National Institute on Drug Abuse. (2003). What Are the Early Signs of Risk That May Predict Later Drug Abuse?
. Strauss, J., and Lang, A. (2012). Complementary and Alternative Treatments for PTSD PTSD Research Quarterly 23.2: 1050-835.
. Cramer, T. (2014). Reining in PTSD with Equestrian Therapy Veterans Health Administration.
. Bremner, J. D. (2006). Traumatic stress: Effects on the brain. Dialogues in Clinical Neuroscience, 8(4), 445-461.
. PTSD: National Center for PTSD. PTSD and Substance Abuse in Veterans
. Khoury, L., Tang, Y. L., Bradley, B., Cubells, J. F., & Ressler, K. J. (2010). Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population. Depression and Anxiety Depress. Anxiety, 27(12), 1077-1086. doi:10.1002/da.20751
. The National Child Traumatic Stress Network. (2008). Making the Connection: Trauma and Substance Abuse