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PTSD and Addiction

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Medically reviewed: 06/26/2018
Last updated: 05/15/2019
Author: Addictions.com Medical Review

Reading Time: 4 minutes

What is Post-Traumatic Stress Disorder?

Post-traumatic stress disorder, or PTSD, is a mental illness that stems from experiencing or witnessing a frightening, dangerous, shocking, or otherwise traumatic event. The fight, flight, or freeze response that occurs during these types of events is meant to help the individual quickly react to protect themselves, but sometimes the central nervous system gets stuck in a highly reactive mode after a trauma, causing the sufferer to feel stress, fear, and anxiety even when they are no longer under threat.

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PTSD was once considered an anxiety disorder, but has been re-classified by the DSM-5 as a “Trauma and Stressor-related Disorder.” Anyone who has experienced or witnessed a traumatic event, such as war, physical or sexual assault, a natural disaster, death, or an accident, will be mentally and emotionally affected, and will likely have difficulty adjusting afterward.

However, if the stress and fear related symptoms get worse over time instead of better, or last for months or even years after the traumatic event, and start interfering with normal daily functioning, then the person most likely has PTSD. In some cases, those who only experienced the threat of harm, or who learned about the event secondhand, can be diagnosed with this disorder. PSTD is not measured by the severity of the trauma, but by the individual’s reaction to the trauma, and their difficulty is healing afterward.

What Are the Signs and Symptoms of PTSD?

An individual must exhibit certain signs and symptoms to be diagnosed with PTSD. These can include:

  • Re-experiencing
    • Flashbacks
    • Bad dreams
    • Frightening thoughts
    • Abnormal reactions to situations that remind you of the event
    • Distressing memories
  • Avoidance
    • Staying away from places or things that remind the individual of the event
    • Avoiding thinking of talking about the event
  • Reactivity
    • Angry outbursts
    • Problems sleeping
    • Being startled easily
    • Feeling tense or on edge
    • Difficulty concentrating
    • Self-destructive behavior
  • Mood and Mental Changes
    • Trouble remembering parts of the traumatic event
    • Issues with memory in general
    • Difficulty feeling positive emotions
    • Irritability and aggression
    • Emotional detachment from family and friends
    • Negative thoughts about oneself
    • Suicidal thoughts
    • Loss of interest in activities they used to enjoy
    • Feelings of guilt or blame

How Does PTSD Interact with Addiction?

Many individuals with PTSD self-medicate their symptoms with drugs and alcohol so that the disorder is often co-occurring with substance use disorder. When an individual is dealing with a dual diagnosis of PTSD and addiction, both issues will require targeted treatment. This is especially an issue among veterans. Almost 1 out of every 3 veterans seeking treatment for substance use disorders also have PTSD. However, there is also a strong relationship between these two disorders in civilian populations as well.

If an individual has difficulty or is unable to cope with emotions like fear, guilt, anxiety, or shame, that alone can be enough to lead to substance abuse, when there is a trauma triggering an extreme level of negative emotions, the risk of an individual turning to drugs or alcohol is greatly increased. Any substance that allows the person with PTSD to disconnect emotionally will have the potential for abuse.

People who start with substance use problems are more likely to experience PTSD after a traumatic event, as well as to cope with the issue by abusing drugs or alcohol. There is a serious correlation between these two disorders that can start with either problem and intensify into two comorbid disorders requiring professional treatment.

How is PTSD and Addiction Treated?

Co-occurring disorders like post-traumatic stress disorder and addiction must be treated simultaneously in a professional setting. Patients need to work towards overcoming both issues at the same time so that one will not impede the progress of another. For example, if the individual’s PTSD goes untreated while they are being treated for addiction, they will be much more likely to relapse back to drug abuse because their PTSD is still causing them all the same issues.

Inpatient therapy is the ideal starting point for a dual diagnosis of PTSD and substance use disorder, because it allows for greater control of symptoms, and provides around the clock support. Both substance use withdrawal symptoms and psychotherapy can provoke strong emotional responses in patients. Without qualified, continuous support, the patient will run too great a risk of self-harm, or even suicide.

Medications and behavioral therapies can be used to treat both PTSD and substance use disorders. Cognitive-behavioral therapy can be especially beneficial for the treatment of both issues. This form of therapy helps patients learn how to recognize triggers for their substance abuse as well as how to cope with their trauma in safe, rewarding ways.

Cognitive Behavioral Therapy approaches that may be useful for PTSD include:

  • Cognitive restructuring: This approach helps patients sort through and better understand their bad memories. Sometimes the patient may not remember the entire event, or they may remember it differently than how it happened. Often patients feel shame or guilt about some aspect of the trauma that is not their fault. Therapists can help patients re-examine what happened and learn to see the trauma in a healthier, more realistic way.
  • Exposure therapy: This form of therapy helps people control their fear and stress responses by gradually exposing them to the things they fear safely. Therapists may begin by having the patient visualize or write about the experience, then build up to visiting the place where the trauma occurred or re-experiencing some aspect of the experience, such as having an individual who was traumatized in a car crash drive in a parking lot.

There is no one-size-fits-all treatment for PTSD or addiction. Individuals should discuss their options with treatment providers, and speak up if a certain approach seems particularly helpful or unhelpful.

Most importantly, post-traumatic stress disorder is a complicated issue that should be treated by qualified and experienced specialists at a dual diagnosis facility, not by a treatment center that only employs addiction counselors.