According to the National Intimate Partner and Sexual Violence Survey (NIPSVS), nearly 1 in 4 women and 1 in 7 men have experienced severe violence at the hands of an intimate partner.
In many cases, this violence results in the victim developing post-traumatic stress syndrome, or PTSD – a condition in which intense fear and apprehension related to a traumatic event continue for a month or more past the event itself, making it difficult for the victim to function in day-to-day life.
In addition, PTSD is highly correlated to substance abuse and addiction. When a person who has been a victim of domestic violence experiences co-occurring PTSD and substance use disorder, specialized treatment is needed to provide the level of safety and empowerment that are more likely to lead to long-term recovery from both disorders.
Domestic Violence and PTSD
NIPSVS shows that approximately 22.3 percent of women and 4.7 percent of men who have experienced domestic violence, rape, or stalking by an intimate partner exhibit at least some symptoms of PTSD; this represents more than 31.8 million people. The symptoms of PTSD that were measured by the survey were experienced for a month or more, and include:
- Nightmares or flashbacks
- Wanting to avoid anything that reminds the victim of the violence
- Hypervigilance and anxiety
- Feeling disconnected, numb, or disinterested in activities
Especially if the individual is still living with the partner or unable to avoid that person, these symptoms can become overwhelming and the person may feel a sense of never being able to be safe. These overwhelming feelings can lead to the individual trying to take excessive measures to drown or numb those feelings.
Prevalence of Substance Abuse in People with PTSD
Per a study from Current Opinion in Psychiatry, between 21 and 43 percent of people with PTSD also experience some form of substance use disorder. Additionally, studies show that PTSD has a strong effect on the development of substance use disorders. This is often based on the idea of self-medication – the individual trying to eliminate depression, fear, anxiety, and other symptoms of PTSD by using substances that diminish them.
As would be expected from this data, people who have developed PTSD are highly likely to develop substance use disorders. Often, these people are more likely to use hard drugs or multiple drugs; however, alcohol and marijuana may also be used. The point is that this substance abuse often becomes heavy and chronic, leading to addiction.
Complications in PTSD and Substance Abuse Treatment
People who experience co-occurring substance abuse and PTSD have specific treatment challenges; often, it is difficult to achieve recovery from one disorder without treating the other. This is because each disorder feeds the other. Substance abuse makes it more likely that a person will experience trauma, according to the National Center for PTSD, because people who are under the influence of alcohol or drugs may have a harder time dealing with the stress response.
At the same time, the self-medication theory indicates that the tendency toward substance abuse will continue as long as PTSD symptoms continue. This creates a spiral that keeps a person stuck in the symptoms of PTSD and substance abuse unless both disorders are treated.
Special Treatment Needs
Because of these problems, people who have PTSD and substance abuse need customized treatment plans that integrate therapies for both disorders. However, this can be a challenge in people who have experienced the fundamental loss of trust that can come with domestic violence.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), this creates a need to address specific treatment needs that may not be as important for people struggling with substance abuse who are not dealing with PTSD or domestic violence. These needs include:
- Safety issues
- Physical health issues
- Relationship issues
- Decision-making skills
The therapies recommended for this population, then, are most likely to have positive outcomes if they address these needs, in turn empowering the people who are struggling with domestic violence, PTSD, and substance abuse to take the steps toward recovery.
The primary need for people who have PTSD from domestic violence events is safety. Without achieving separation from the perpetrators of the abuse, these individuals may not be able to move past their trauma and take in the lessons of treatment.
However, as described by SAMHSA, this can be a challenge, because the very nature of the relationship between domestic violence and PTSD is that the person does not feel safe. It is when the person felt safe – with someone who was supposedly trusted – that the trauma occurred.
As a result, substance abuse treatment for this individual needs to take into account the need to rebuild trust and feel safe before other therapies will be able to take hold.
- Cognitive Behavioral Therapies
Therapies that are beneficial for both substance abuse and PTSD treatment include trauma-focused Cognitive Behavioral Therapies that can help the individual learn to understand the triggers for both disorders, and then develop and apply alternative behaviors and tools that help manage these issues in an integrated manner.
One example of this type of treatment is Seeking Safety, described in an issue of Addictive Behaviors. This therapy endeavors to combine treatment for PTSD and substance use disorders specifically for people who have experienced domestic abuse. It has resulted in better treatment outcomes for both conditions, as well as lower reports of intimate partner violence.
This type of therapy can not only help the person make more positive choices related to substance abuse and similar coping behaviors for PTSD, but it can also give the person tools for making more beneficial decisions regarding relationships, paving the way for a life that feels safer and more hopeful.
An important goal of all therapies involved in treating co-occurring PTSD and substance use disorders in people who have experienced domestic violence is to make these individuals feel empowered in their own lives. By helping to develop an experience of control over their own choices, these therapies can allow this population to move forward into treatment, and to avoid decisions that lead to continued domestic violence in the future.
In turn, this can help people who have experienced domestic violence feel more able to maintain sobriety and manage the symptoms of PTSD for the long-term, enabling them to develop healthier relationships and a more positive future.