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Trauma or a life-threatening event can disrupt your world, creating great unrest in the mind and body. Long after the ordeal, you may experience flashbacks or nightmares, have trouble sleeping or develop health issues. The debilitating symptoms of post-traumatic stress disorder (PTSD) can be difficult to cope with, causing many victims to turn to alcohol or drugs for relief. As a result, treatment centers continue to see an increasing number of patients suffering from PTSD and addiction every year.

What is PTSD?

PTSD is a psychiatric disorder that can occur after experiencing or witnessing emotionally disturbing or life-threatening events.[1] The syndrome was first described in 1870 and most commonly seen in soldiers during times of stress, especially when fear was involved.[2]

An individual may find himself living in chronic fear, constantly replaying the experience or fighting to keep the memory of it at bay. Not everyone who has been through a traumatic event will develop PTSD and not everyone with the disorder has experienced trauma himself or herself. Some people develop the PTSD after a loved one suffers harm or undergoes profound stress. Because of socio-political developments in recent years and ongoing turmoil around the world, the prevalence of PTSD will likely increase sharply over the next 10 years, becoming among the most significant public health concerns of this century.[3]

A Growing Threat to the Population

In the United States, about seven or eight of every 100 people (or 7-8 percent of the population) will be diagnosed with PTSD at some point in their lives.[5] Diagnosis requires exposure to an event that involved or threatened violence, serious injury or death.

infographic about PTSD and addiction and how its linked in our brain
According to the National Institute of Mental Health (NIMH), in order to be formally diagnosed with PTSD, there must be a month-long occurrence of the following symptoms:
  • Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
  • Bad dreams
  • Frightening thoughts
  • Staying away from places, events or things that are reminders of the traumatic experience
  • Avoiding thoughts or feelings related to the traumatic event
  • Being easily startled
  • Feeling tense or “on edge”
  • Having difficulty sleeping
  • Having angry outbursts
  • Trouble remembering key features of the traumatic event
  • Negative thoughts about oneself or the world
  • Distorted feelings such as blame or guilt
  • Loss of interest in enjoyable activities
It is important to recognize these debilitating symptoms, because its co-occurring partner, addiction, can only compound them – not just for the suffering individual, but also on the people who care for and support him or her.

The Trauma of Addiction

The aftermath of a traumatic event can become a trying journey, filled with feelings of isolation and despair. When the brain is preoccupied with intense memories of hardships endured, it’s common to turn to drugs or alcohol for an escape. PTSD and addiction have long been linked, and over time, they have become a central focus of research studies and clinical trials. In fact, it’s been reported that 52 percent of men and 28 percent of women with PTSD also met lifetime criteria for alcohol dependence or drug abuse.[6]

infographic illustrating the connection between PTSD and substance abuse
For someone with PTSD, chronic drug or alcohol use leads to a “dual diagnosis,” which is the co-occurrence of a serious psychiatric disorder and an addictive disorder. In women, physical or mental abuse is one of the most common causes of PTSD and addiction. Research shows that a history of being abused increases the likelihood that she will fall victim to substance abuse. For example, one study revealed that 74 percent of women with addictions reported sexual abuse, 52 percent reported physical abuse and 72 percent reported emotional abuse.[7] In men, military combat is the major catalyst of PTSD and addiction, with one in three veterans seeking treatment for PTSD also requiring treatment for substance abuse.[8]

Drugs and alcohol tend to become numbing agents or tools of avoidance for those diagnosed with PTSD. In order to block out his thoughts, he seeks to detach himself from the activities and people that once provided joy and fulfillment. These mind-altering substances are used as an escape mechanism to alleviate the recurring memories and pain associated with the traumatic experience. The problem with this line of thought is that drugs and alcohol can actually make PTSD symptoms worse.

Compounding the Problem

Even people without PTSD get tempted by the high provided by alcohol or drugs. But for those diagnosed with PTSD, their effects only exacerbate symptoms and make it more difficult to cope with stress. He or she may believe that having a few drinks before bed will prevent nightmares and help them sleep easier. This may turn out to be true at first, but the habit only prolongs the cycle of avoidance found with PTSD, ultimately making it much more difficult to treat. Also, when someone withdraws from alcohol use, nightmares tend to return and increase.

The initial endorphin rush provided by alcohol or drugs is a pleasant distraction that’s easy to mistake for healing. But when the high wears off, the memories and pain return, and often, the symptoms intensify. Up to half of adults with both PTSD and drinking or drug problems experience at least one of the of the following issues when they try to stop:[9]

 

  • Increased anger and irritability
  • Depression or panic attacks
  • Decreased concentration or productivity
  • Addiction
  • Health issues
photo of a troubled looking young man curled up in the fetal position
It’s also common for those with PTSD to develop a “why not” mentality, which is the byproduct of a theory known as learned helplessness. For someone with PTSD, this thought process can be particularly destructive and end up blossoming into a full-blown substance abuse disorder. This was evidenced in the 1992 book “Trauma and Recovery,” which found that people who dealt with child physical abuse, partner violence, sexual slavery or long-term stress often became passive and withdrawn (due to learned helplessness), which led to self-harm or chronic substance abuse.

“Discovered by psychologist Martin Seligman in 1965, Learned Helplessness is a pattern of behavior taken on by someone who is exposed to situations he feels are out of his control. It can make a person feel powerless, causing him to think he has no control over what happens to him, leading to poor decision-making.”

Source: Neuropharmacology Journal

In addition to Learned Helplessness, drug and alcohol use makes it extremely difficult for PTSD sufferers to maintain meaningful relationships or function as productive members of society. Everyday life is disrupted, making it more difficult to hold a job or enjoy activities. For this reason, the dual diagnosis of PTSD and substance abuse often leads to broken homes, chronic unemployment, legal issues and poverty[11]. Getting the right treatment can make all the difference.

Replacing Bad Memories with Good Treatment

Often, individuals with a dual diagnosis of PTSD and addiction don’t fully understand their disorder and may not deem it necessary to seek treatment. They may learn to live with the nightmares or become accustomed to a life of solitude. This is why it is so crucial for friends and family recognize the symptoms and encourage the individual to seek treatment from professionally trained psychotherapists, medical experts and counselors.

Evidence shows that people enjoy improved PTSD and substance use disorder symptoms when provided a treatment program that addresses both conditions.[12] This can involve any of the following (alone or in combination): [13], [14], [15]

photo of a patient lying on a couch undergoing cognitive behavioral therapy

Cognitive Behavioral Therapy (CBT)

Certain thoughts about a traumatic event can cause stress or worsen symptoms. CBT is a form of psychotherapy helps an individual understand and change his thought processes by identifying the thoughts that cause fear or sadness and replacing them with more accurate thoughts. Along the way, he will learn to identify and correct problematic behavior to stop substance abuse and to address a range of other problems that often co-occur with PTSD.

photo of young female patient in therapy suffering emotion pain

Exposure Therapy

People with PTSD tend to fear and avoid the thoughts or emotions that remind them of traumatic events. During exposure therapy, the individual is urged to revisit these memories in order to not feel overwhelmed by them. By talking about the details and confronting situations he or she has been avoiding, PTSD symptoms and substance abuse begin to decrease.

photo of patients during a group therapy session

Group Therapy

Shared experiences can have a profound effect on one’s recovery from the dual diagnosis of PTSD and substance abuse. By hearing from others who have been through trauma, the individual is likely to feel more comfortable discussing their own experience. Together, they can learn how to deal with the pain, anger and guilt, and better cope with their symptoms.

photo of a mom, dad and child during family therapy

Family Therapy

PTSD and substance abuse has many victims – including family members. The symptoms can make one difficult to live with, taking a toll even the most tight-knit families. Attending family therapy sessions can help improve understanding and communication, making it easier for family members to offer help and for the victim to accept it.

photo of a open bottle of prescription medication pills

Medication

While psychotherapy is invaluable in working through the hardships of PTSD and addiction, medication has also proven to be effective. Certain antidepressants, including selective serotonin reuptake inhibitors (SSRIs), have been shown to help alleviate depression, anxiety, sleeplessness and other symptoms related to the disorder.

Recent Research Advances in PTSD and Addiction

Research studies have reported encouraging results for both CBT and exposure therapy. One study of community addiction treatment programs found that CBT was more effective than individual addiction counseling in reducing PTSD symptoms.[16] As for exposure therapy, it’s important to note that until recently, it was rarely employed in addiction treatment centers despite its efficacy in the treatment of PTSD. However, the program Concurrent Treatment of PTSD and Substance Use Disorders with Prolonged Exposure (known as COPE) has gained momentum using imaginal and in vivo exposure with relapse-prevention therapy and psychoeducation to improve PTSD and substance use outcomes.[17]

Taking Control

Whether you’re suffering with PTSD or witnessing the struggle of a loved one, taking the first step toward getting treatment may be difficult. What’s worse, sometimes the victim fails to see that she has a problem. The grip of addiction can be so powerful that he or she is simply not sober long enough to think logically about the situation and recognize the need for treatment. As a relative or friend of someone struggling with PTSD and addiction, you have the power to help.

  • Start by asking questions and avoiding statements.
  • Show concern and empathy rather than sympathy or criticism.
  • Don’t rush things. Bide your time and wait for the right moments.
  • Remember, people do better when they make their own decision about seeking treatment. Suggest and support, rather than beg or order.
  • During conversations, try not to directly disagree with the person, but do not lie or pretend you agree.
  • Point out any inconsistencies in statements in a way that doesn’t spark resistance.
  • Don’t wait for rock bottom. While many people struggling with addiction have a rock-bottom experience, it is not necessary to hit it in order to get help.

If you’ve been diagnosed with PTSD and are struggling with addiction, there are some smaller steps you can take before entering into a full-fledged treatment program. Start by:

  • Seeking support from friends and family, and confiding in those with whom you feel comfortable
  • Finding a support group
  • Writing about your feelings
  • Developing a positive coping strategy, such as exercising when you’re tempted to drink or use drugs
  • Setting realistic goals for yourself
  • Realizing symptoms improve gradually, not immediately
  • Speaking with your doctor about treatment options

PTSD is difficult enough without the life-altering complications of addiction. While it may seem manageable to work through the struggle on your own, in most cases, seeking professional help is the only way to ensure a lasting recovery. Behavioral Wellness and Recovery can help. Specializing in substance abuse, mental illness and dual diagnosis, our experts combine traditional and holistic methods for a comprehensive approach to addiction treatment. Discover what we can do by calling 800-683-4457 today.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297500/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1569621/
[3] http://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp
[4] http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp
[5] http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp
[6] http://www.ptsd.va.gov/professional/newsletters/research-quarterly/V7N4.pdf
[7] http://www.stephaniecovington.com/assets/files/Covington%20SARC.pdf
[8] http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp
[9] http://www.ptsd.va.gov/public/problems/ptsd-alcohol-use.asp
[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433056/
[11] https://www.samhsa.gov/disorders/co-occurring
[12]http://www.ptsd.va.gov/public/problems/ptsd_substance_abuse_veterans.asp
[13] https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral
[14] http://www.ptsd.va.gov/public/family/effects-ptsd-family.asp
[15] http://www.ptsd.va.gov/public/treatment/therapy-med/medications-for-ptsd.asp
[16] https://www.ncbi.nlm.nih.gov/pubmed/22383864
[17] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646384/