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Post-traumatic Stress Disorder and Substance Abuse

Table of Contents

Post-traumatic stress disorder (PTSD) is a mental health condition characterized by intense, disturbing thoughts and feelings that may develop after someone has experienced or witnessed a life-threatening event, serious injury, or sexual assault.1 These types of events can overwhelm a person’s ability to cope, and examples include witnessing the death or injury of a loved one, military combat, a severe motor vehicle accident, and being physically or sexually assaulted.2

About 26–52% of people diagnosed with a lifetime prevalence of PTSD also meet the criteria for diagnosis of a substance use disorder.3 When an individual is diagnosed with a substance use disorder and a mental health disorder, this is called having a co-occurring disorder.4

Here, we will talk about PTSD, the experiences that can cause PTSD, signs and symptoms of PTSD, and treatments available for people suffering from PTSD and addiction. The good news is that both PTSD and substance use disorders (the clinical term for a drug or alcohol addiction) can be treated and managed. There are specialized treatment programs that can address both issues.


What is Post-Traumatic Stress Disorder (PTSD)?

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) identifies the criteria for a PTSD diagnosis as being exposed to death or the threat of death, serious injury, or sexual violence in one of the four following ways:1

  • Experiencing the trauma yourself.
  • Witnessing the traumatic event happening to others.
  • Finding out that the event happened to a close family member or friend.
  • Repeated exposure to traumatic events, e.g., first responders, medical personnel, and those in the military.

People with PTSD experience intrusive and disturbing thoughts and feelings related to the traumatic event long after it has ended. These thoughts and emotional disturbances are so distressing that they cause impairments in daily functioning. Nightmares and flashbacks may result in them “reliving” the event. They may experience intense sadness, anger, anxiety, or fear; they may feel a distance or detachment from other people; and they may avoid situations or people that remind them of the traumatic event or that trigger symptoms. Sometimes a strong negative reaction will be triggered suddenly by something ordinary, such as a loud noise or being touched accidentally.


What Are the Signs and Symptoms of PTSD?

Post-traumatic stress disorder is diagnosed by trained medical professionals, including physicians, psychiatrists, and therapists.1 They use criteria found in the DSM-5 to determine whether you have PTSD. Symptoms need to be present for at least 30 days and must cause significant distress or problems in daily functioning.1

Symptoms of PTSD include:1, 2

  • Recurrent thoughts and memories of the traumatic event that cause distress.
  • Recurrent scary dreams related to the event.
  • Experiencing flashbacks that feel like the trauma is happening again.
  • Experiencing triggers (sights, smells, sounds, news reports) that cause you to relive the event.
  • Avoiding situations that remind you of the event (crowds, driving, leaving the house, distracting yourself with work so you don’t think about the event).
  • Negative thoughts or feelings related to the traumatic experience (feeling guilt or shame about the event, feeling like the world is unsafe).
  • Feeling hyper-aware (can’t sleep, easily startled).
  • Difficulty controlling emotion.

Who Can Be Affected by PTSD?

Anyone can be affected by PTSD, regardless of their ethnicity, nationality, or culture, and at any age.5 PTSD affects approximately 4.7% of U.S. adults every year, and an estimated 6.1% will experience PTSD in their lifetime.

Events that can precipitate PTSD include, but aren’t limited to, natural or manmade disasters, war, being the victim of violence, witnessing violence, being involved in a severe car accident, the unexpected death of a loved one, sexual assault, or being repeatedly exposed to the details of such trauma of others (e.g., a police officer repeatedly exposed to details of child abuse).6

No one is immune, but certain populations experience PTSD at higher rates than others. One third to one half of rape survivors, military combat veterans, people held in captivity or internment due to ethnicity or for politically motivated reasons, and survivors of genocide will have PTSD. High rates of PTSD are also found in firefighters, emergency medical personnel, and police officers because their vocation increases the risk of exposure to traumatic events.7 Women are twice as likely as men to have PTSD, often as a result of being sexually assaulted.8 Latinos, African Americans, and American Indians are disproportionately affected and have higher rates of PTSD than non-Latino whites. Asian Americans have lower rates compared to non-Latino whites.


Co-Occurring Post-Traumatic Stress Disorder and Addiction

Experiencing trauma, as well as reliving it, causes a release of chemicals in the brain that are related to the acute stress that you are under.9 Sometimes, people turn to substances like alcohol, marijuana, or other drugs to help relieve this stress or to help them sleep, relax, or forget about the trauma. Over time, recurrent substance use contributes to changes in the brain and behavior and may lead to drug or alcohol dependence and addiction.10 Relying increasingly on psychoactive substances to alter your mood and cope with your PTSD symptoms can move you closer to developing a substance use disorder.10

When you suffer from PTSD or another mental health disorder and a substance use disorder, you are considered to have co-occurring disorders.3 Concurrent, integrated treatment for co-occurring disorders is increasingly being considered the standard of care, particularly when using both medications and psychosocial therapy (e.g., behavioral therapy, counseling, etc.).

Substance use disorders and PTSD frequently co-occur and there is a strong association between both disorders. There is a strong correlation between PTSD and substance abuse among military veterans and first responders.11

People who experience trauma in childhood are particularly at risk of developing PTSD and substance abuse issues.12 The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma as “an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.”13 People are 7–10 times more likely to develop a substance use disorder if they experienced multiple traumas as a child.12 Women who experienced a sexual assault in childhood are 3 times more likely to develop a problem with drugs or alcohol.12

There are several reasons PTSD and substance addiction seem to occur together:

  • Reducing or avoiding symptoms of PTSD. People may use substances to help alleviate anxiety and other symptoms of PTSD, or to avoid dealing with or reliving trauma. Although some substances may temporarily reduce symptoms of PTSD, they can also worsen symptoms in the long run or contribute to the development of a SUD.
  • Epigenetic factors. Environmental factors like acute stress, trauma, and exposure to drugs or alcohol can affect genetic factors in a way that changes the way our brain works and how our body responds, ultimately impacting behavior.14
  • Genetic predisposition. Between 40–60% of a person’s risk of developing a substance use disorder is genetics. The use of substances to manage PTSD can increase the likelihood of developing an addiction in someone whose genetic makeup puts them more at risk to developing a substance use disorder.14

PTSD and Substance Abuse Among Veterans

Military veterans who saw combat are at a heightened risk for co-occurring PTSD and substance use disorders. The Veterans Administration reports that 55% of veterans of the Iraq or Afghanistan wars who were diagnosed with a substance use disorder also have a co-occurring PTSD or depressive disorder.15 Many veterans were repeatedly exposed to situations where they feared for their safety or witnessed traumatic events.3 Sexual assault while in the military can also contribute to PTSD.3 Overall, 11–20% of veterans experience PTSD after deployment.16

Veterans with co-occurring PTSD and addictions need treatment providers that are skilled in treating both disorders. The US Department of Veterans Affairs can assist you in finding resources. They operate the National Center for PTSD and a crisis line for veterans.17 American Addiction Centers can also assist you in locating treatment providers who specialize in working with people with PTSD and substance use disorders.


Treating PTSD and Addiction

Treatment for PTSD and addiction may comprise a variety of interventions which may be delivered in either an inpatient and outpatient treatment setting.4 Your provider will conduct an assessment of your needs and develop an individualized treatment plan with you. Integrated treatment for PTSD and addiction occurs along a continuum.4 What treatment you receive depends on several factors, including the severity of your issues, previous treatment attempts, and your insurance status.4 PTSD and addiction may be treated by:

  • Detox. The first course of action when addressing PTSD and substance abuse issues is to detox. The purpose of detox is to clear your body of substances and manage any withdrawal symptoms.4
  • Rehab treatment. Inpatient or outpatient drug rehab programs that specialize in co-occurring disorders can help you address your substance abuse issue and your PTSD simultaneously and provide a safe place for you to begin your recovery journey.4 Treatment can occur in a variety of settings, including acute care centers, hospitals, clinics, halfway houses, community mental health centers, private psychotherapist’s or doctor’s office, or in group counseling arrangements. For around-the-clock care and support, you may opt to go to an inpatient treatment program. Those requiring less intensive support may choose to attend an outpatient treatment program for a certain number of days a week or be involved in psychotherapy and medication management services with your provider.
  • Mutual-help groups. A component of outpatient care, programs like Alcoholics Anonymous, Narcotics Anonymous, and SMART Recovery offer peer support from people who are experiencing similar challenges with substance use.4
  • Medications. Your physician may prescribe medications to help with your PTSD symptoms or substance use disorder. Common medications prescribed to manage PTSD symptoms include antidepressants like fluoxetine (Prozac), citalopram (Celexa), sertraline (Zoloft), paroxetine (Paxil), and venlafaxine (Effexor).18, 19 Your physician may also prescribe benzodiazepines to help you manage your anxiety. These may include clonazepam, alprazolam, or lorazepam.19 Additionally, your doctor may prescribe you medication to help address your substance use issue, particularly medications that may help you ease cravings or reduce your desire to use certain substances, such as opioids or alcohol.3
  • Psychotherapy. Several types of therapy are available to treat PTSD. They usually occur along with behavioral treatments you may be receiving to address your substance use issue. These therapies are:20
    • Cognitive-behavioral therapy (CBT). This focuses on helping you pay attention to your thoughts, feelings, and behaviors. CBT also helps you develop skills to address negative beliefs or overwhelming thoughts.
    • Cognitive processing therapy (CPT). This is where you learn to manage your thoughts and feelings regarding the trauma.
    • Prolonged exposure therapy (PE). In this, you repeatedly process the traumatic event until it is no longer distressing.
    • Eye movement desensitization and reprocessing (EMDR). This involves focusing on sound, lights, or movements while you process the trauma. It helps to desensitize you to the traumatic event.

Getting help for both PTSD and addiction is an important step in reclaiming your life from being ruled by substance abuse and reliving traumatic experiences. If you or someone you know has been struggling with PTSD and addiction issues, American Addiction Centers can help you find the treatment you need. Deciding to pursue treatment is the first step toward recovery. Don’t wait to take it.

Call 1-888-744-0069 Our admissions navigators are available to help 24/7 to discuss PTSD and co-occurring addiction treatment.

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NREMT
Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series of in-depth articles on Community Paramedicine programs across the country that go beyond transporting patients to emergency rooms and connects specific patients, such as repeat system users, the homeless and others with behavioral health issues and substance use disorders, to definitive long-term care and treatment. In his current capacity as Medical Editor for American Addiction Centers, Ryan works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.
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