More than 5.2 million Americans suffer from post-traumatic stress disorder. Also, a disproportionate number of persons with PTSD (compared to the general population) struggle with substance use disorder. Data shows that an average of 7.8% of Americans will suffer from PTSD at some point during their lives. And as many as 30% of veterans will struggle with PTSD. Yet, post-traumatic stress disorder often goes untreated, sometimes for years, despite contributing to vulnerabilities to substance use disorder.
For the millions of Americans struggling with PTSD, it’s important to understand the link between PTSD and addiction. With an estimated 38.5% of addicts in treatment showing some signs of PTSD, the two disorders are intrinsically linked, both because PTSD increases risks of Substance Use disorder (SUD), and vice versa. Patients use drugs and alcohol as coping mechanisms, are more prone to risk-taking behaviors, and persons with addictions are more likely to be exposed to traumatic experiences. Here, it’s crucial that patients seek out appropriate care to treat the symptoms of SUD as well as PTSD, to ensure a full recovery.
What is PTSD?
PTSD is a stress disorder that develops in response to a traumatic event or series of events. These events can range from car accidents to abuse to military service, but typically include life-threatening moments in which the individual feels helpless and unable to cope.
Common triggers include abuse, physical assault, sexual assault, accidents, falling, natural disasters, fires, or exposure to war zones.
Today an estimated 80% of all individuals will experience a traumatic event in their lifetime, triggering an adrenal response to create a state of high alert. In PTSD, the stress response means that reaction doesn’t simply go away, it sticks around, sometimes for decades. The results range from minor panic to debilitating responses and the inability to function.
Post-traumatic stress disorder is typically heavily linked to military service, but not necessarily so. About 30% of veterans versus 7.5% of the general population struggle with PTSD, but anyone can experience a traumatic event.
The DSM-5 Diagnostic Manual of Mental Disorders lists 8 common criteria for identifying PTSD:
- Direct or indirect threats of death, sexual violence, injury, or disability resulted in the reaction
- They experience intrusive memories, dreams, flashbacks, or emotions
- They avoid trauma-inducing stimuli
- Thy express unusual irritability, reckless behavior, concentration, sleeping patterns and alertness or vigilance
- Symptoms last for <1 month
- Symptoms cause significant distress and social or occupational impairment
- Symptoms are independent of substance use of any kind
If you suspect that you or a loved one is experiencing PTSD, it’s important to see a doctor. If you’re seeking treatment for a substance use disorder, it’s also important to disclose trauma to your medical providers, because it will affect treatment.
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Addiction and PTSD
PTSD is undeniably linked to substance use disorder. The Department of Veterans Affairs shows that veterans with PTSD are more than twice as likely to abuse a substance. And, with 38% of persons in treatment suffering from PTSD, trauma and substance abuse are definitely connected. However, that link is not as clear-cut as a direct cause and effect. Instead, the two intertwine, with PTSD increasing vulnerability to substance abuse and dependence and substance use disorder increasing vulnerability to PTSD. This is exacerbated by various factors such as the individual, their social and economic situation, their mental health and opportunities to seek help.
Many drugs also cause PTSD-like symptoms, which is why the DSM-5 criterion explicitly state that symptoms must remain after cessation of substance abuse.
ACE – The younger individuals are exposed to trauma, the more likely they are to develop a substance use disorder as a result. The ACE study documents the experiences of 70,000+ children over several decades, showing how adverse childhood experiences like trauma result in a range of vulnerabilities to health problems including addiction. Children under 16 who have experienced a traumatic event are likely to experience changes in the adrenal reaction in the brain, resulting in an increased likelihood to abuse drugs and alcohol, take risk behaviors, to exhibit seeking behaviors, and be in social and economic conditions resulting in substance use disorder.
Mood Swings – Negative emotions including loneliness, sadness, and even exhaustion contribute to drug use and relapse. Each of these are normal symptoms of PTSD, and many individuals will resort to self-medicating to escape from or tolerate moods, to cope with sadness, and otherwise manage emotional ups and downs. People who frequently feel bad are significantly more likely to resort to substance use which greatly increases the likelihood of addiction. Substances ranging from alcohol to opioids are often used to cope with anxiety, panic, depression and sadness. Unfortunately, the two exacerbate each other, with many substances contributing to the same symptoms the user is trying to fix. This results in a negative cycle of taking drugs or alcohol to feel better, feeling worse and taking more drugs or alcohol to feel better.
Risk-Seeking – Persons with PTSD are highly likely to engage in thrill-seeking behavior, typically for the same reasons they seek out drugs and alcohol. Risk-seeking servers as a temporary distraction from feelings of depression, isolation, panic and flashbacks, giving a brief respite to the disorder. Unfortunately, risk-seeking behavior frequently leads to drug usage.
While self-medication is common, it’s important to note that many of the medications used to treat PTSD also contribute to addiction. If your loved one has been treated for PTSD or anxiety in the past, they likely received a benzodiazepine prescription. Today, we know that benzos are highly addictive and shouldn’t normally be prescribed for more than about 5 weeks without an intensive risk management and evaluation schedule (REMS). Unfortunately, many people have and still do have benzodiazepine prescriptions for drugs like Valium and Xanax that they have had for years. Continuing this medication for any duration of time will result in an addiction and sometimes to migrating to other, stronger drugs.
PTSD and Substance Use
Persons who use substances are more likely to put themselves in harm’s way. Someone with a substance use disorder is at significantly higher risk of vehicular accidents, arrest, assault, sexual assault and exposure to acts of violence including domestic abuse. This is especially true for addicts who surround themselves with other abusers, who are likely to turn to violence when hit by mood swings. Factors including substances impacting reckless behavior, motor controls, and inhibition also mean that substance abusers are more likely to engage in dangerous activities and more likely to put themselves in danger during those activities.
This means that while PTSD increases vulnerability to addiction, addiction also greatly increases the chances of someone having PTSD.
Getting Dual Diagnosis Treatment
PTSD is a mental health disorder that must be treated alongside a substance use disorder. This is important, because if you treat one first and then the other, the other will simply cause the first to re-occur. PTSD typically causes resistance to treatment and group therapy and increases risk of relapse if not treated. But, substance use disorder makes it difficult or impossible to treat PTSD.
A rehabilitation facility offering dual diagnosis treatment is one that is offering to treat PTSD alongside substance use disorder. Most facilities will take a dual-track approach, combining behavioral therapy approaches to tackle the most important factors first (such as risk to life, behaviors impeding treatment, cravings, etc.) so that the patient can recover as quickly as possible, while getting treatment for both problems.
PTSD is a severe mental health disorder. If you suspect that you or a loved one is struggling, even without a substance use disorder, it’s important to seek out help. If substances are involved, there is help.
If you or your loved-one is seeking help for substance addiction, call us at (714) 443-8218 and look into our recovery programs. Our programs and recovery center helps clients by providing them with detox, family intervention, and long-term Outpatient or residential treatment if necessary.
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