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PTSD and Substance Abuse

General Overview of PTSD

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), PTSD occurs when a person is exposed to a catastrophic, violent, or accidental event that involves a threat of death, severe injury, or sexual violation.

This can include the person:

  • Being the direct victim of the event
  • Witnessing such an event
  • Discovering that a family member or loved one has experienced such an event
  • Experiencing firsthand, repeated exposure to the details of such an event
  • The result of this exposure is that the person feels a great deal of distress about the event, to the degree that it impairs the person’s interpersonal relationships, ability to work or accomplish daily tasks, and other functional abilities.

People with PTSD may have flashbacks or otherwise continually re-experience the trauma of the event. They may feel continual guilt or blame, and they may become aggressive or violent in response to situations that remind them of the event or that would cause little or no stress in people not affected by PTSD.

PTSD and Substance Abuse

Sometimes, people with PTSD use alcohol or drugs to help them handle the painful emotions and responses that arise from their mental health disorder – a behavior referred to as self-medicating. As explained in research from the journal Genes, Brain and Behavior, extreme stress can lead to changes in brain chemistry that contribute to drug-seeking behaviors. These behaviors can, over time, lead to drug abuse and addiction.

In addition, these changes in the brain can make it difficult to treat PTSD that co-occurs with substance abuse.

The physical changes in the brain’s response systems can make it harder to make lasting behavioral changes that help the person avoid relapse into addiction.

Risk of Substance Abuse for People with PTSD

There is a high risk of substance abuse for people who have PTSD. According to the U.S. Department of Veteran Affairs National Center for PTSD, alcohol abuse is often found in people who have experienced this type of trauma. Statistics cited include:

  • Up to 75 percent of people who have survived abuse or violent trauma report drinking problems.
  • About a third of people who have survived severe illness, injury, or catastrophe report drinking problems.
  • Both women and men who have survived sexual abuse report more problems with drinking than others.

Alcohol is not the only substance implicated in addiction or abuse problems for those struggling with PTSD. People who are experiencing this disorder may abuse or develop dependence on any type of drug that they believe helps to soothe the feelings of anxiety, fear, and panic.

Recognizing Co-occurring PTSD and Substance Abuse

According to the American Psychiatric Association, the following are signs that someone is experiencing PTSD in relation to a traumatic event:

If the person has experienced trauma and is demonstrating these behaviors, PTSD may be present. In addition, if the person seems to be using drugs or alcohol more frequently and showing symptoms of substance abuse, an addiction may have developed. According to the National Institute on Drug Abuse, signs of substance abuse include:

  • Decreased interest in hobbies; spending more time alone or using the substance
  • Changes in appetite or sleep habits
  • Extreme mood swings
  • Inability to keep up with work, school, or other responsibilities due to substance use
  • Relationship problems
  • Drinking or using more of the substance than intended or desired

A mental health professional can diagnose both PTSD and substance abuse. In particular, experts in substance abuse who have experience working with co-occurring disorders can provide the most help in managing these disorders together.

Most Commonly Abused Drugs with PTSD

People who experience PTSD are most likely to use drugs that inhibit the brain’s stress control mechanism – also known as the fight-or-flight response. This is the system that is involved in the stress, fear, and anxiety response, and the system that is overstimulated with PTSD. The substances that depress this system and therefore are likely to be abused by those with PTSD include:

Alcohol abuse and PTSD are often co-occurring. In one study from Recent Developments in Alcoholism, it was reported that between 60 and 80 percent of military veterans who seek help for PTSD also have alcohol use disorders.

Opiate drug abuse is often found to occur with PTSD as well. According to a study in the Journal of Addictive Diseases, withdrawal from opiate drugs can also mimic certain symptoms of PTSD, such as hypervigilance and jumpiness.

Treatment Options

Treating PTSD and substance abuseTreating PTSD and substance abuse requires addressing both conditions at the same time. Because the symptoms of PTSD make it challenging to recover from substance abuse and avoid relapse, therapy must address both issues simultaneously. Therapy will likely involve processing the traumatic events that led to PTSD as well as addressing the underlying reasons that led to substance abuse. Most often, the same issues led to the development of both disorders. Research in Clinical Psychology has shown that integrated treatment that provides exposure therapy for PTSD and Cognitive Behavioral Therapy for substance abuse is promising for those with these co-occurring conditions.

This type of integrated treatment is most helpful when provided in a focused, inpatient treatment program by professionals experienced in treating co-occurring disorders. This care includes the following elements:

  • Medically supported withdrawal from the substances of abuse, if necessary
  • Trauma-focused Cognitive Behavioral Therapy to help the person manage PTSD symptoms as well as avoid relapse into substance abuse
  • Medications, if appropriate, to manage withdrawal symptoms and mitigate relapse
  • Family therapy to repair relationships that were damaged by symptoms from both disorders
  • Continued support, therapy, and reinforcement after treatment to help the person maintain management of both disorders

With integrated treatment under this type of program, the person can learn to manage the triggers and challenges of both PTSD and substance abuse. With effective treatment, full recovery is possible.

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