People with PTSD are more likely to have issues with substance use than the general population.1, 2 PTSD occurs in some people after they have been exposed to trauma and can have long-lasting negative effects if it isn’t treated.
In the U.S., approximately 8 million adults live with PTSD each year.3 Women are more likely to develop PTSD (10%) than men (4%).3
Read on to learn more about PTSD’s risk factors, signs, and symptoms, how PTSD and substance abuse affect each other, as well as the importance of treating PTSD and substance use disorders (SUDs) at the same time.
What is Post Traumatic Stress Disorder?
When dealing with traumatic events, fear is a normal response. Afterward, people may experience strong emotions and react in different ways to process the situation. While many people recover from the shock of trauma, others don’t. Fear and stress can linger and make them feel like they are still in danger when they aren’t.2
Certain intrusive symptoms (e.g., distressing memories of the original trauma) can interfere with an individual’s ability to function in some areas of their lives and are just part of the criteria used for the diagnosis of PTSD.
PTSD can develop after exposure to certain traumas, either actual or threatened; these can include: 1, 3, 4
- Assault of any kind.
- Bad car accidents.
- Being a prisoner of war or actively engaged in war.
- Being held hostage.
- Disasters that are natural or man-made.
- Seeing someone else be hurt or killed.
- Sexual violence.
- Terrorist attack.
- Waking up during surgery.
Exposure to trauma doesn’t have to be firsthand to develop PTSD.1 People who are regularly exposed indirectly to traumatic events, such as police officers or first responders, can also develop PTSD.1
Symptoms of PTSD usually start within the first 90 days of experiencing trauma, but in some cases don’t begin for months or even years after the trauma has occurred.4 To be diagnosed with PTSD, the following issues must be present for at least 1 month:1, 2
- At least 1 symptom involving re-experiencing the event
- At least 1 symptom involving avoidance or attempts to avoid trauma-associated distress
- At least 2 symptoms involving arousal and reactivity associated with the traumatic event
- At least 2 symptoms affecting mood and thoughts
These symptom clusters will be explained later in this article.
Risk Factors for Developing PTSD
While it is impossible to identify who will develop PTSD after experiencing trauma, certain risk factors can increase the likelihood. These include:1, 2
- How severe the threat is perceived to be, with more severe threats increasing the risk of developing PTSD. Ongoing exposure to continued threats, such as during wartime, increases the risk. Additional stressors, such as financial issues or loss of housing, can also make PTSD more likely.
- Females are more likely to develop PTSD than males. Younger adults are more likely to develop PTSD than older adults when exposed to trauma.
- Previous mental health disorders, either in childhood or adulthood, or a history of substance use.
- Social factors can play a role. These can include lower socioeconomic status, lower levels of education, experiencing family dysfunction, coming from a broken home or one in which a parent has passed away, belonging to a minority group, having low levels of social support, or having a family history of mental illness.
Signs and Symptoms of PTSD
The diagnosis of PTSD is made based on 4 clusters of signs and symptoms that must be each present for at least 1 month and cause substantial issues in a person’s ability to function socially, at work, at school, or in other areas of functioning. The clusters and their corresponding symptoms are:1, 2
- At least 1 symptom related to a re-experiencing of the original trauma or traumatic event, including:
- Persistent, uncontrollable, and disturbing memories.
- Persistent, upsetting dreams.
- Physical reactions to thoughts or reminders.
- Terrifying thoughts.
- At least 1 avoidance symptom relating to the occurrence, including:
- Avoiding/trying to avoid memories, thoughts, or feelings.
- Avoiding/trying to avoid things that remind you of the event or bring up. thoughts, feelings, or memories tied to the trauma, such as people, places, things, events, conversations, or situations.
- At least 2 symptoms reflecting a change in arousal and reactivity, including:
- Angry or irritable behavior without proper cause, which may be verbal or physical outbursts toward people or objects, and can be aggressive.
- Difficulty concentrating.
- Excessive vigilance, or being overly aware of your surroundings at all times.
- Feeling jumpy or easily startled.
- Problems with sleep, either falling asleep, staying asleep, or sleeping restlessly.
- Self-destructive or irresponsible behavior.
- At least 2 negative changes in thoughts and moods surrounding the traumatic event, including:
- Dissociative amnesia or being unable to recall important parts of the event.
- Distorted thoughts about the cause or consequences of the traumatic incident, including blaming yourself or others.
- Feeling detached or withdrawn from other people.
- Lingering negative feelings, such as fear, anger, guilt, shame, or horror.
- Loss of interest in participating in activities or hobbies that used to be important.
- Ongoing difficulty in experiencing good feelings like happiness, satisfaction, or love.
- Recurring and amplified negative beliefs about yourself, others, or the world in general, such as “I can’t trust anyone,” “I’m a terrible person,” or “the world is a very dangerous place.”
Co-Occurring Disorders: PTSD and Substance Abuse
PTSD and SUDs commonly co-occur in the same person.4, 5 Nearly half of Americans who seek treatment for addiction also meet the diagnostic criteria for PTSD, which is a rate more than 5 times as common as that found in the general population.6
People with PTSD were 2 to 4 times more likely to develop SUDs than people without PTSD.5 Among people with PTSD, almost half (46.4%) met the diagnostic criteria for an SUD.5 This issue is particularly prominent among veterans: Nearly one-third who seek treatment for an SUD are also diagnosed with PTSD.8
Many theorize that people with PTSD may use substances to self-medicate their symptoms.5, 6 The types of substance(s) used could be a reflection of which symptoms are most prominent or distressing at the time.5 p3 PTSD has been linked to the use of various substances, including alcohol, marijuana, cocaine, opioids, marijuana, amphetamines, and benzodiazepines.5, 6, 7
Treating PTSD and Substance Abuse Co-currently
Since PTSD and SUDs can influence each other, many see benefit to treating both disorders at the same time using an integrated behavioral treatment approach.5, 6 Having both PTSD and addiction can worsen or complicate the course of each condition, so treating both in an integrated manner can be helpful.7
This also allows you to work on the managing PTSD-related issues earlier in treatment, potentially improving one’s focus on their recovery efforts.5
Certain distressing PTSD symptoms might make you want to use substances to feel better, even though using substances could ultimately make your symptoms worse.7 On their own, either disorder has the potential to cause problems in other areas of your life, such as at work, school, or home; the impact could be even more problematic when you are dealing with both PTSD and SUDs.
Substance use might lead to legal troubles, for instance, if you are driving under the influence or caught using illegal substances, and such an outcome could potentially worsen PTSD symptoms. It can also feel somewhat overwhelming or isolating to struggle with both of these diagnoses, especially given that not every provider is trained to treat both of these issues.
When it comes to treatment, there are various available settings and levels of care that may be sought based on your individual needs.
This stage of care commonly involves the management of substance withdrawal while under medical supervision.9 As part of a medical detoxification protocol, medical staff can provide medications to make withdrawal easier and monitor patients for any complications.9
This is a facility where you stay for about 4 weeks (or more, if needed) while receiving counseling and therapy (both individual and group), as well as addiction education, relapse prevention skills, and aftercare planning prior to program completion.9 If you have family members or a significant other who wants to be involved in your treatment, they may be able to attend a family program or family therapy sessions to learn how to support you in your recovery.
While living at home, you attend therapeutic programming, including regularly scheduled individual and group therapy sessions, several times a week.9 When appropriate, outpatient recovery programs allow you to handle your daily responsibilities while receiving relatively less time-intensive treatment services; this type of treatment is ideal for people who have strong support networks or have completed inpatient treatment.
Relapse prevention and sobriety maintenance are key, long after the initial treatment period. To these ends, aftercare efforts may vary, but often include regularly scheduled sessions with a therapist or other mental health professional, ongoing participation with peer support or self-help meetings, and/or sober living arrangements. This will be discussed as part of your discharge plan when you complete treatment.
Various forms of cognitive-behavioral therapy (CBT) have been investigated for their effectiveness at treating PTSD and SUDs.5, 6:
This PTSD treatment approach can be incorporated into a residential SUD treatment plan.5 It focuses on education about PTSD and learning relaxation skills, then using those skills to confront your trauma-related fears in a safe environment so that you can overcome your reaction to the trauma.6
This is a non-exposure type of therapy that focuses on how thoughts and feelings affect behaviors and prioritizes your feelings of safety.5 In 24 sessions, you learn to foresee dangerous situations, avoid relapse triggers, establish boundaries, and learn how to deal with anger and emotions.5, 6
Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure
This is a combination of prolonged exposure for PTSD, using education, relaxation techniques, and exposure to trauma-related fears in increments, along with CBT techniques to develop coping skills, identify and deal with substance cravings, and prepare for and deal with situations that place you at high risk for relapse.5
While medications won’t cure PTSD or SUDs, they can assist in the treatment process. Some medications that can be used in the recovery process include:
- Sertraline (Zoloft), which is approved to treat PTSD and can reduce certain symptoms such as hyperarousal or re-experiencing.5, 6
- Disulfiram (Antabuse), which can make it unpleasant to drink alcohol, may reduce continued drinking behavior and prolong abstinence. Interestingly, one study found that disulfiram therapy was associated with fewer PTSD symptoms, though other groups (including non-disulfiram ones) in the study demonstrated similarly significant decreases in symptom severity.5, 6
- Naltrexone, which can reduce drinking behavior and discourage continued opioid use. In the aforementioned study, the naltrexone experimental group also saw a reduction in PTSD symptoms, though the effects weren’t as robust as they were with the disulfiram group.5, 6
It may feel hopeless when you’re dealing with PTSD and an SUD. However, research into effective treatment strategies is ongoing and, currently, several therapeutic options are available. Treatment centers like Oxford can help you get started. Recovery is possible.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th). Arlington, VA: American Psychiatric Publishing.
- National Institute of Mental Health. (2019). Post-traumatic stress disorder.
- S. Department of Veterans Affairs. (2018). How common is PTSD in adults?
- National Alliance on Mental Illness. (2015).
- McCauley, J.L., Killeen, T., Gros, D.F., Brady, K.T., & Back, S.E. (2012). Posttraumatic stress disorder and co-occurring substance use disorders: Advances in assessment and treatment. Journal of Clinical Psychology, 19(3), 1-27.
- Berenz, E.C. & Coffey, S.F. (2012). Treatment of co-occurring posttraumatic stress disorder and substance use disorders. Current Psychiatry Reports, 14(5), 469-477.
- S. Department of Veterans Affairs. (2019). PTSD and problems with alcohol use.
- S. Department of Veterans Affairs. (2019). PTSD and substance abuse in veterans.
- National Institute on Drug Abuse. (2012). Principles of drug addiction treatment: A research-based guide (3rd edition).