Post-traumatic stress disorder (PTSD) can deeply affect how a person thinks, feels, and responds to the world around them. For many, substance use becomes a way to cope with the lasting impact of trauma, especially when those experiences have not been fully processed.
PTSD is one of the most powerful and under-recognized contributors to substance abuse in the US. For many people, substance abuse only came after the trauma, not before. Understanding this connection and treating both conditions at the same time is a core part of trauma-informed, dual diagnosis care at All In Solutions.
What Is Post-Traumatic Stress Disorder?
PTSD is a psychiatric disorder that occurs when someone is exposed to a traumatic event, such as the death of a loved one, a life-threatening situation, a natural disaster, a serious injury, or sexual violence, whether experienced directly, witnessed, or affecting someone close to them.[1]
PTSD has historically been associated with combat veterans. However, ongoing research has confirmed that PTSD can develop in people other than combat veterans and from many different sources, including childhood abuse, sexual assault, domestic violence, medical trauma, accidents, and community violence.[2]
PTSD is characterized by four symptom clusters that last for more than one month following the traumatic event and significantly impact normal functioning: re-experiencing, avoidance, negative cognitive and affective alterations, and hyperarousal.[3]
Symptoms of PTSD
Re-Experiencing: Re-experiencing symptoms involve reliving the traumatic experience in the present and include:
- Intrusive memories, such as having flashbacks or distressing dreams related to the event.
- Psychological or physiological distress when exposed to internal or external cues related to the traumatic event.
- A sense of “reliving” the traumatic experience as if it were occurring again.
Avoidance: Avoidance symptoms involve trying to avoid or escape from the pain of re-experiencing, and include:
- Avoiding thinking about, feeling, or recalling memories of the traumatic event.
- Avoiding people, places, activities, and situations that trigger memories of the traumatic experience.
- Emotionally detaching from others
Negative Alterations in Cognition and Mood
- Persistent negative beliefs about yourself, the world, or others.
- Persistent feelings of guilt, shame, or blame related to the trauma.
- Decreased interest in previously enjoyed activities.
- Feelings of detachment or estrangement from family and friends.
- Inability to experience positive emotions.
Hyperarousal
- Hypervigilance and an exaggerated startle response
- Difficulty concentrating and sleeping
- Irritability, angry outbursts, or reckless behavior
- Physiological reactivity to trauma-related stimuli
The Connection Between PTSD and Substance Abuse
Studies show that between 30 and 60% of people who seek help for substance use disorder also meet the criteria for an associated diagnosis of PTSD.[4] Those with PTSD are also between two to four times more likely to have a substance use disorder when compared to people without PTSD.[5] The rates of occurrence among veterans are even higher.[6]
The primary reason for the relationship between PTSD and substance abuse is self-medication. Alcohol and drugs such as opioids, benzodiazepines, and cannabis help temporarily relieve symptoms like hyperarousal, numb emotional pain, and temporarily suppress flashbacks and intrusive thoughts. But while substances can provide temporary relief in the short term, the neurochemical effects of chronic substance abuse ultimately worsen the symptoms of PTSD, increase emotional reactivity, and make the trauma hard to process.[7]
The Connection Between Childhood Trauma and Drug Addiction
Adverse childhood experiences, which include physical, sexual, or emotional abuse, neglect, household dysfunction, and exposure to domestic violence, have been found to be a strong predictor of drug use and substance disorders in adults. Studies have shown that the higher the number of adverse childhood experiences, the greater the likelihood of addiction, mental health conditions, or dying at a young age.[8] Experiences of childhood trauma also negatively affect neurological development in ways that make the child more susceptible to developing PTSD and addiction as an adult.[9]
Many clients in addiction treatment facilities suffer from unresolved traumatic experiences from childhood, which may have contributed to their substance use. For many of them, the substance use was always about something else. Finding and treating that underlying cause is what can make lasting recovery possible.
When to Seek Help for PTSD and Addiction
PTSD needs professional intervention if trauma-related symptoms are impairing your daily functioning, relationships, or ability to maintain employment, regardless of how long ago the trauma occurred.
When PTSD co-occurs with substance use, looking for treatment programs that provide integrated therapeutic interventions is extremely important. Studies show that sequential treatment (treatment that focuses on one disorder at a time) consistently produces worse outcomes compared to integrated treatment that addresses both conditions simultaneously.
Evidence-Based Treatments for PTSD and Co-Occurring Addiction
EMDR (Eye Movement Desensitization and Reprocessing): EMDR is a form of evidence-based psychotherapy that was established specifically for trauma processing. This intervention uses bilateral stimulation (most commonly eye movements) to facilitate the reprocessing of trauma experiences, reduce their negative emotional charge, and integrate the trauma experiences within the normal autobiographical memory. The World Health Organization, the Department of Veterans Affairs, and the Substance Abuse and Mental Health Services Administration (SAMHSA) all recognize EMDR as an effective treatment for PTSD.[10]
Prolonged Exposure Therapy: Prolonged exposure therapy is a trauma-focused cognitive behavioral therapy (CBT) intervention designed for clients to systematically address and confront trauma memories, feelings, and situations they have been avoiding. By continually approaching the feared trauma memory or situation with no negative consequence, the brain is able to recognize that the event no longer poses a threat. This reduces the intensity of re-experiencing and avoidance symptoms. Research from many controlled trials has established prolonged exposure therapy as one of the most effective therapeutic methods for treating PTSD.[11]
Trauma-Focused CBT: Trauma-focused cognitive behavioral therapy addresses the distorted beliefs about the self, others, and the world that PTSD generates: shame, self-blame, a sense that nowhere is safe and no one can be trusted. Within a trauma-informed framework, the therapist assists the client in identifying trauma-based distortions and developing cognitive flexibility to support emotional recovery that is needed to remain in sobriety.
Holistic Treatment for PTSD: Holistic approaches used to treat PTSD, including yoga therapy, mindfulness practices, art therapy, and somatic therapies, enhance evidence-based clinical treatment by addressing how trauma is stored in the body and not only in the mind. There is an abundance of research that supports the use of holistic mind-body approaches in treating PTSD.[12] All In Solutions incorporates these holistic modalities into individualized trauma-informed care.
