Everyone experiences stress and stressful events. Many individuals who go through situations associated with trauma do not necessarily develop serious mental disorders, but some do experience severe psychological reactions.
Post-traumatic stress disorder (PTSD) occurs in some people who experience traumatizing events. People with PTSD develop various dysfunctional behaviors, reactions, and symptoms that affect their ability to function. Being depressed after losing a loved one may not be a sign of PTSD, unless medical professionals determine that the length or intensity of a person’s bereavement is dysfunctional.
More than 19 million U.S. residents aged 12 or older had some kind of addiction or substance abuse disorder in 2017, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). About 50% of individuals who seek treatment for substance use also have post-traumatic stress disorder. People who have co-occurring PTSD and substance use disorder (SUD) have poorer outcomes of treatment than those who do not have such comorbidity (the presence of two or more conditions at the same time).
Individuals suffering from PTSD are more likely to have substance abuse and addiction disorders. Post-traumatic stress disorder may be caused by various kinds of trauma. It may occur after people witness or experience physical or sexual assault, fight or live in a war zone, or become involved in car accidents.
For people who have concurrent substance abuse and PTSD, their addiction problems may have started after their mental disorders took hold. Or, the post-traumatic stress disorder may have started after an accident or violent event that occurred when the individuals were intoxicated.
Past theories suggested that people suffering from these concurrent conditions first needed treatment for their addiction, and then for their PTSD. Modern studies suggest that receiving treatment for drug or alcohol abuse and PTSD at the same time may produce better results. The integrated treatment approach is thus recommended to treat both disorders in tandem.
Co-Occurring Substance Abuse Disorders and PTSD
Although addiction or substance abuse go hand-in-hand with PTSD, the relationship between these two disorders is complex and difficult to define. Trauma may contribute to substance abuse and addiction. For example, people who suffered abuse in their childhoods may struggle with drug or alcohol addiction in adulthood.
Often, PTSD relates to self-medicating behaviors. People with PTSD may indulge in excessive alcohol consumption or use drugs to avoid feeling the emotional pain associated with their mental disorder or to detach from emotions they find overwhelming. If they already abuse alcohol or drugs, people may be more likely to develop PTSD.
Researchers noted that studies have found that “individuals with a pre-existing alcohol use disorder (37.5 %) or SUD (41.5 %) met criteria for PTSD at higher rates following the Oklahoma City bombing than those without prior SUD.” (SUD stands for substance use disorder.)
People who abuse drugs or alcohol are at a higher risk of experiencing trauma. Drinking alcohol or taking illegal substances lowers inhibitions. Misusing substances also makes individuals more likely to become involved in risky behaviors, such as driving under the influence of drugs or alcohol or practicing unsafe sex.
Individuals who abuse substances have a higher risk of harming themselves or experiencing and witnessing traumatizing events. Addiction may cause cognitive and emotional impairment that may lower their ability to cope with the effects of distressing experiences, thus leading to conditions such as post-traumatic stress disorder.
How Does Addiction Relate to PTSD?
According to the journal Alcohol Research & Health, many people with PTSD turn to alcohol abuse to boost the endorphins naturally produced by the brain. The mood-boosting effects that arise from the use of alcohol are only short-lived, however.
With an increased intake of alcohol, people may become chemically dependent, meaning they will need more alcohol to produce the same numbing effects. With time, dependence turns into addiction. Addiction is characterized by habitual use of the substance, increased tolerance, and persistent abuse of alcohol or drugs despite their devastating effects.
Dependence on substances is often described as a form of self-regulation. It may not be different from self-injury or other kinds of impulsive behaviors related to trauma. Addiction may occur when individuals try to block intrusive memories, disconnect from anxiety, and end hypervigilance.
When drugs or alcohol are used to help manage symptoms of PTSD, the symptoms of the mental disorder only worsen. As depressants of the central nervous system (CNS), opioid drugs and alcohol may worsen anxiety and depression and interfere with an individual’s sleep patterns.
People may mistakenly think that treating trauma is going to stop their drug or alcohol abuse, but it is likely that their addiction will continue to persist. That’s because substances such as alcohol and drugs hijack the reward system of the brain. Individuals develop tolerance, meaning they need more of the drug or alcohol to create the same effects they once produced.
Such complex interactions mean that addiction issues need to be addressed alongside post-traumatic stress disorder and other mental illnesses. Successful recoveries require people to understand the trauma symptoms they have been attempting to treat by drugging or drinking.
Trauma symptoms may increase once people enter sobriety. People will need to have coping strategies to manage PTSD triggers if they appear. Relapse prevention plans should help patients devise methods to manage PTSD triggers and symptoms in addition to addiction.
Signs That an Individual May Be Abusing Drugs
People who are abusing alcohol or drugs may have various symptoms, such as:
- Desire to use substances to feel normal
- Inability to stop using substances, even when they desire to quit
- Withdrawal symptoms such as nausea, muscle pain, lethargy, and anxiety when they attempt to stop using the substance
- Difficulties meeting school, work, and social obligations because they are using substances
- Use of large amounts substances to get drunk or high
Signs That a Person May Have PTSD
An individual suffering from PTSD may have various symptoms. They may be:
- Reliving traumatizing events
- Experiencing problems expressing feelings or feeling positive emotions
- Avoiding activities or locations that remind them of trauma-inducing events
- Engaging in self-destructive and impulsive behaviors
- Feeling hopeless, in despair, constantly on edge, or extremely alert