PTSD & Addiction

Post-traumatic stress disorder (PTSD) and substance use disorders (SUD) are often co-occurring disorders, meaning they both occur in the same person at the same time. The presence of both disorders generally increases the severity of both conditions.

What Is Post-Traumatic Stress Disorder?

PTSD is a mental health disorder that can occur in people who have been through a very frightening, dangerous, or traumatic experience.

The condition is marked by continuous memories of the traumatic event, feelings of loneliness or guilt, and stress and fear, even when no danger is present. 

Is Addiction or Substance Abuse More Likely for Those With PTSD?

Yes, people with PTSD are over four times more likely to have a substance use disorder at some point during their lives when compared to the population as a whole.

Around 10 percent of the general adult population of the United States will have a substance use disorder during their lifetime. For people who have PTSD, however, the rate is far higher, with over 40 percent of people with PTSD also have a co-occurring substance use disorder.

How Are Post-Traumatic Stress Disorder & Addiction Related?

While there is no single reason that PTSD and substance use disorders have such high co-occurrence rates, some theories have been proposed.

One theory that may be supported by evidence is centered around the idea of self-medication. The central concept of the theory is that due to the uncomfortable symptoms caused by PTSD, people choose to take drugs in order to cope with their feelings or escape them.

According to a 2016 article based on PTSD research over years, this theory may be credible due to the fact that in many cases, substance use disorders develop after a patient is already suffering from PTSD. In addition to this, the article states that patients use PTSD to explain why they chose to take drugs, eventually leading to a substance use disorder. 

Another theory is instead based on occurrences in which a substance use disorder is present before PTSD is present. This theory proposes that drugs may expose a person to a higher chance of being involved in a traumatic event, which may then lead to the development of PTSD.

The existence of a co-occurring substance use disorder alongside PTSD may make both disorders more difficult to treat, and it may also cause symptoms of PTSD to worsen.

PTSD & Addiction in Veterans

PTSD is common among veterans, affecting about 23% of veterans who use healthcare through Veterans Affairs (VA). As for gender differences, about 10% of male veterans were diagnosed with PTSD while 19% of women had this psychiatric condition. Female veterans may be more likely to have PTSD due to sexual trauma experienced in the military, with about 33% of women reporting military sexual trauma.[13]

Moreover, veterans may experience PTSD and co-occurring addiction due to the challenges of coping with traumatic expereinces. Many veterans may self-medicate with drugs or alcohol in order to alleviate symptoms of PTSD, such as anxiety or insomnia. However, substance abuse can exacerbate PTSD symptoms and create a cycle of misuse, dependence, and withdrawal.

Here are some stats highlighting the rates of PTSD and addiction in veterans:[14]

• Veterans with PTSD and alcohol abuse tend to engage in binge drinking.
• Over 20% of veterans with PTSD also have a substance use disorder.
• Nearly 33% of veterans seeking treatment for addiction also has PTSD.
• About 10% of veterans from the Iraq and Afghanistan wars have a substance addiction.

Dual diagnosis treatment for both PTSD and substance use disorder can effectively address the symptoms of both conditions and help veterans achieve recovery and improve well-being and functioning.

Common Drugs Abused by People With PTSD

These substances are commonly misused by people with PTSD:

• Alcohol: One of the most common drugs misused by people who have PTSD is alcohol. Alcohol abuse is especially present in veterans suffering from PTSD. It makes up a large percentage of substance use disorders reported among the demographic.
  Despite attempts to self-medicate, according to the U.S. Department of Veterans Affairs, alcohol may worsen already uncomfortable and frustrating symptoms of PTSD. In addition, alcohol use may increase the time a person suffers from PTSD.
• Cocaine: Another drug that may be commonly abused by patients with PTSD is cocaine. According to a 2015 study, between 23 and 42 percent of people who abuse cocaine during their lifetime also suffer from PTSD.
• Prescription opioids: People with PTSD commonly abuse prescription opioids. A 2019 study found that people with PTSD were more likely to develop an opioid use disorder than people who did not have PTSD.

Treatment for PTSD & Co-Occurring Substance Use Disorder

Treatment for co-occurring PTSD and substance use disorder involves treating both disorders simultaneously. Care will often incorporate aspects of treatment for both issues.

Treatment for PTSD

For people who have PTSD, there are a variety of medications that can help with symptoms as well as different treatment options to address PTSD. Some of these are listed below:

• Antidepressants: Some common symptoms of PTSD take the form of sadness or apathy. Antidepressants can help alleviate some of these symptoms.
• Sleep medications: Some people with PTSD have trouble sleeping or suffer from nightmares due to PTSD. In these cases, sleep medication may be prescribed to help people maintain a good quality of sleep.
• Exposure therapy: This type of therapy functions by slowly exposing patients to recounting the event that caused their PTSD. Over time, this may help them to process the emotions that come with PTSD.
• Cognitive restructuring: This type of therapy aims to put the traumatic event in perspective for a person who might blame themselves for something they did not do. This allows people to view their trauma objectively or as it really happened.
• Eye movement desensitization and reprocessing: Also known as EMDR, this type of therapy requires a person to discuss their trauma while moving their eyes to follow a therapist’s finger. This may help change a patient’s view of a traumatic event.

Treatment for Co-Occurring Disorders

While there is no definitive treatment for co-occurring PTSD and substance use disorder, treatment generally involves a combination of medications and therapies that benefit both disorders. Here are some of the approaches used:

• COPE: One form of therapy which has shown promise in treating co-occurring PTSD and substance use disorder is Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure, also known as COPE.
  COPE functions by combining exposure therapy with cognitive behavioral therapy, a form of therapy commonly used to treat substance use disorders. While more research must be completed, COPE has shown promising results in multiple studies.
• Non-exposure therapies: Other forms of therapy that have shown some promise are non-exposure therapies, such as Seeking Safety or Transcend. These therapies are based on pre-written manuals, and they involve a set number of sessions.
  The therapies cover a wide variety of topics, such as tempering risky actions, how to set boundaries, how to distance yourself from emotional pain, and how to deal with triggers that push someone with a substance use disorder to use drugs.
  Both of these methods have had some success in initial trials, but further research is needed in order to determine their full effects on co-occurring PTSD and substance use disorders.
• Medications: In addition to therapeutic methods to treat co-occurring PTSD and substance use disorders, some medications have shown promise in treatment, especially when combined with therapy.
  Naltrexone, a drug that combats the effects of opioids, has shown some promise when used alongside the therapies that are commonly used for PTSD or substance use disorder treatment. While more research needs to be done before naltrexone sees widespread use, initial results were promising.
  A similar medication, disulfiram, which is generally used to treat alcohol use disorder, was shown to have similar effects as naltrexone, helping to decrease PTSD symptoms.
  Another drug that has shown promising results when used alongside therapy is prazosin, a medication generally used to regulate blood pressure. However, the drug may not function properly when combined with alcohol, and further research is required before it is accepted as an effective treatment.

The Need for Comprehensive Treatment

The most important part of treating PTSD and addiction is ensuring you choose a program that is equipped to care for dual diagnoses. If you only address PTSD or the addiction but not both, relapse is highly likely. 

Many addiction treatment programs cater to co-occurring disorders, identifying and treating all disorders and issues. They staff experts who are experienced in treating co-occurring disorders, helping clients to build a strong foundation for recovery on all fronts.

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More