PTSD and substance use disorders (SUDs) go hand in hand in a vicious cycle. Understanding how they work together is key to treatment and recovery. This article will look at the relationship between PTSD and addiction, why they co-occur, and evidence-based ways to break the cycle and heal.

Understanding PTSD

PTSD is a mental health condition that develops after a traumatic event, such as combat, natural disasters, accidents, or personal assaults. Symptoms can include intrusive memories, avoidance of triggers, negative changes in thinking and mood, and heightened reactions like irritability or hypervigilance^[1].

Who is affected by PTSD?

While anyone can develop PTSD, some groups are more at risk. Military personnel and veterans, first responders, survivors of abuse or violence, and people exposed to life-threatening events are most vulnerable. According to the National Center for PTSD, 7-8% of the US population will experience PTSD at some point in their lives^[1]. It can impact daily living, relationships, and overall well-being.

PTSD and Substance Use Disorders

Why are they related?

People with PTSD may turn to alcohol or drugs to manage their symptoms. This self-medication can numb feelings of anxiety, fear, and hyperarousal for a short time but often leads to a substance use disorder^[2]. The relief is short-lived, and substance use can make PTSD symptoms worse over time, creating a vicious cycle.

The Vicious Cycle

As tolerance to substances builds, people may need to use more to get the same effect and increase the risk of addiction^[3]. Substance use can make PTSD symptoms worse, leading to more distress and more reliance on substances for relief. Hard to break without professional help.

Statistics

Research shows a high co-occurrence between PTSD and substance use disorders:

• 46.4% of people with lifetime PTSD also have a substance use disorder^[4]
• 20% of veterans returning from Iraq and Afghanistan have PTSD, and nearly one-third of those also have SUDs^[5]
• Adolescents with PTSD are more likely to develop substance abuse problems, 59% may develop a SUD^[6]

Treatment Challenges

Dual Diagnosis

When PTSD and substance use disorders co-occur, it’s called a dual diagnosis or co-occurring disorder. Treating both at the same time is important but tricky:

• Symptom Overlap: Symptoms of PTSD and SUDs overlap, making diagnosis and treatment planning harder.
• Increased Severity: Co-occurring disorders are more severe, have a higher risk of relapse, and have poorer treatment outcomes if not addressed^[7].

Barriers to Getting Help

The stigma around mental health and addiction can stop people from getting help. Shame and fear of being judged or being seen as weak can stop people from reaching out. Lack of awareness about the connection between PTSD and addiction can lead to underdiagnosis and undertreatment.

Paths to Recovery

Integrated Treatment Approaches

Recovery requires both PTSD and substance use disorders to be treated at the same time. Integrated treatment models have better outcomes than treating each condition separately^[8]. Integrated treatment includes:

1. Trauma-Informed: Recognizes trauma and prioritizes safety, empowerment, and healing.
2. Cognitive-behavioral therapy (CBT): Helps individuals identify and change negative thought patterns and behaviors associated with both PTSD and SUDs.
3. Eye Movement Desensitization and Reprocessing (EMDR): Processes traumatic memories and reduces their emotional charge^[9].
4. Medication-Assisted Treatment (MAT): Uses medication to manage withdrawal symptoms, reduce cravings, and treat PTSD symptoms when appropriate.
5. Peer Support Groups: Provides community and understanding among others who have gone through similar experiences.

Detox and Medical Support

Medical detox may be required to manage withdrawal symptoms from substances. This should be done under the care of medical professionals for safety and comfort.

Building Coping Skills

Developing healthy coping skills is key to managing PTSD without using substances. These may include:

1. Mindfulness and Relaxation Techniques: Like meditation, deep breathing or yoga to reduce stress and increase being present.
2. Creative Therapies: Art, music or writing to express and heal.
3. Physical Activity: Exercise can improve mood and reduce anxiety and overall health.

Support Networks

Family and Friends

Support from loved ones is a big part of recovery. Family therapy can address relationship dynamics, improve communication and educate family members about PTSD and addiction.

Professional Help

Working with a team of mental health professionals ensures you get the best care. Psychiatrists, psychologists, counselors and social workers can provide specific treatment and support.

You are not alone. Help is available. For confidential support and information on treatment options:

SAMHSA National Helpline: 1-800-662-HELP (4357)

Crisis Text Line: Text HOME to 741741

Overcoming Obstacles to Treatment

Reducing Stigma

Education is the key to reducing stigma. Educating about PTSD and addiction as medical conditions can help people seek help without shame.

Access to Care

Access to affordable, evidence-based treatment programs is crucial. This means expanding insurance coverage, more mental health services, and community-based resources.

Conclusion

Breaking the cycle of addiction and PTSD is hard but possible with the right support and treatment. Integrated trauma-informed treatment that addresses both conditions at the same time is the best way to achieve long-term recovery. If you or someone you know is struggling with PTSD and substance use, seeking help is the bravest and most important step to healing.

Resources

• National Institute on Drug Abuse: www.drugabuse.gov
• Substance Abuse and Mental Health Services Administration (SAMHSA): www.samhsa.gov
• National Center for PTSD: www.ptsd.va.gov
• Veterans Crisis Line: 1-800-273-8255 (Press 1)

References

1. U.S. Department of Veterans Affairs. (2019). How Common is PTSD in Adults? Retrieved from https://www.ptsd.va.gov/understand/common/common_adults.asp
2. Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231-244.
3. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.)
4. Kessler, R. C., et al. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048-1060.
5. Seal, K. H., et al. (2009). Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001–2010: Implications for screening, diagnosis, and treatment. Drug and Alcohol Dependence, 116(1-3), 93-101.
6. Clark, D. B., et al. (1997). Traumas and other adverse life events in adolescents with alcohol abuse and dependence. Journal of the American Academy of Child & Adolescent Psychiatry, 36(12), 1744-1751.
7. Najavits, L. M., et al. (1998). “Seeking Safety”: Outcome of a new cognitive-behavioral psychotherapy for women with posttraumatic stress disorder and substance dependence. Journal of Traumatic Stress, 11(3), 437-456.
8. Brady, K. T., Back, S. E., & Coffey, S. F. (2004). Substance abuse and posttraumatic stress disorder. Current Directions in Psychological Science, 13(5), 206-209.
9. Shapiro, F. (2017). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). Guilford Press.

Disclaimer

The information provided in this article is for educational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider for personalized care. If you are experiencing a mental health crisis or need immediate assistance, please contact a mental health professional or emergency services.

Acknowledgments

We extend our gratitude to mental health professionals and researchers whose work continues to shed light on the complexities of PTSD and addiction, guiding individuals toward effective treatments and hope for recovery.

If you found this article helpful, please consider sharing it with others who may benefit from this information.

Authored By

Shebna N Osanmoh I, PMHNP-BC

October 14, 2024

Shebna N Osanmoh is a board-certified Psychiatric Mental Health Nurse Practitioner with extensive experience across the mental health spectrum. Holding a Master’s in Psychiatric/Mental Health Nursing from Walden University, Shebna provides compassionate, culturally sensitive care for a wide range of mental health conditions, emphasizing holistic and individualized treatment approaches to support patients in their wellness journey.