The effects of co-occurring PTSD-SUD can be incredibly troubling. Due to the anxiety and stress caused by PTSD, many patients wouldn’t seek help and end up self-medicating with alcohol or medications with a proper prescription. This is what usually leads to SUD for people with PTSD, and the statistics back that up.
Let’s look at what goes into creating this tandem of conditions, which can be incredibly debilitating in the long term.
What is PTSD?
Post-traumatic stress disorder is a psychological condition that results from exposure to a traumatic event, whether the individual experiences or witnesses the trauma. Much of its occurrence leaves the individual feeling powerless or out of control, which can lead to developing stress and/or anxiety disorder.
This condition is commonly associated with armed conflicts, workplace violence, natural hazards, sexual assaults, and childhood abuse. People who develop PTSD as a result of these experiences may end up having nightmares and flashbacks as a result of emergencies that have not been completely settled in their minds.
For example, a soldier who was captured as a prisoner of war has had his ability to fight taken away from him. He may have flashbacks to his experience as a result of uncertain dread and outrage. A child who has been horribly mistreated by a parent or relative may grow up living with intrusive feelings of weakness and vengeance.
Symptoms of PTSD include recurrent nightmares, flashbacks, avoidance of things identified with the traumatic event, extreme tension, restlessness, forceful conduct, lashing out, and furious upheavals. These symptoms can be triggered whenever the individual is reminded of traumatic events, which can be constant, making the condition agonizing.
These behavioral symptoms typically fall under one of three general categories—reliving the trauma, avoiding situations that remind of trauma, and irritability and anxiety due to hyperarousal. Individuals who experience these symptoms a month after a major traumatic event may be described as having PTSD.
How Can PTSD Lead to SUD?
Substance use disorder can be a result of the patient coping with their lingering trauma. The substance helps them take their minds off their trauma temporarily, and they develop a dependence on a said substance in order to function in their day-to-day life.
According to the National Center for PTSD at the US Department of Veteran Affairs, a significant number of PTSD patients tend to develop SUD. For instance, around 60% to 80% of Vietnam War veterans who seek treatment for PTSD require additional treatment for substance abuse. Meanwhile, they found that sexual abuse is a leading cause of addiction in women.
The prevalence of 52% of males and 28% of females with PTSD developing SUD down the line coincide with lifetime models for liquor misuse or reliance in the 1995 Public Comorbidity Study in the Documents of General Psychiatry. As for opioid abuse, statistics in a similar report show 35% of males and 27% of females with PTSD developing this form of SUD also coincide with the models.
Much of this is due to endorphin withdrawal, which has an impact on the use of alcohol or drugs to curtail PTSD. When someone gets into a horrible accident or encounters a traumatic episode, their brain produces endorphins, which help numb pain and relieve stress.
In the aftermath, more of those endorphins will be needed in order to adapt to the pressure caused by remembering that traumatic experience. If the individual hasn’t completely come to terms with it, the trauma continues to haunt them and they go for either seek treatment or find a quick source of endorphins.
Endorphin withdrawal in the aftermath of the traumatic event can cause anxiety, depression, distress, and body pain. That can compel the individual to seek out alcohol or drugs to deal with those symptoms in the short term.
There is still much to be done in order to truly understand how to treat co-occurring post-traumatic stress disorder (PTSD) and substance use disorders (SUD). Around half of the people who are looking for SUD treatment exhibit symptoms of PTSD as well. On the other hand, people with co-occurring PTSD-SUD tend to get poorer treatment outcomes compared to those with either one of those conditions alone.
That signifies a problem in how co-occurring PTSD-SUD is both diagnosed and addressed. Most of the time, they’re treated as separate conditions, which is understandable for the most part. However, they prop each other up, so it stands to reason that they must be diagnosed and treated as one condition. As of now, there isn’t enough empirical evidence to determine the best course of treatment for people with this co-occurring condition.
As of now, most studies have focused on three categories of treatment—non-exposure-based psychosocial treatments, exposure-based psychosocial treatments, and medical trials. What has shown the most potential so far are exposure-based psychosocial treatments. There is still much research to be done to get more data on what will be most effective and reliable in the real-world treatment of PTSD patients.