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PTSD and Substance Abuse – The Two Go Hand-in-Hand

PTSD and substance abuse go hand-in-hand. This is because many people with PTSD use drugs and alcohol to cope. Understanding post-traumatic stress and learning how to treat the symptoms without the use of mood or mind-altering substances is essential to treating this debilitating condition.

What is PTSD?

Post-traumatic Stress Disorder (PTSD) is a mental health problem that develops as the result of a trauma or serious injury. PTSD is a psychiatric disorder, although it does not necessarily represent a lifelong diagnosis. While PTSD is often associated with combat-related veterans who develop the condition after combat, PTSD also affects millions of Americans off the battlefield. PTSD is just what its name suggests – a stress disorder brought on post-trauma. PTSD happens after a traumatic experience. It can result from sexual assault, injury, a car accident, an extreme weather event like an earthquake, or any other traumatic experience that causes the brain to experience sudden and extreme stress. It is the high level of stress brought that lies at the root of PTSD. PTSD is often associated with the “fight or flight” syndrome because the body and brain respond to post-traumatic stress with the same physiological response as they would in a life or death situation.

What are the Symptoms of PTSD?

PTSD can occur years after a trauma takes place, although symptoms usually happen a short time afterward. The severity and duration of PTSD symptoms varies from person to person. PTSD can last for weeks, months, or years. It can lie dormant for several years and return unexpectedly – as is often the case with childhood sexual abuse survivors. The kind of event that triggers PTSD is usually life-changing. It is a catastrophic event that occurs so far outside of the normal functioning of the brain, the brain is overwhelmed by the stress of trying to “figure it out.” Fear, anxiety, sleep disturbance, depression, a super-heightened state of awareness, difficulty socializing, and the loss of interest in daily activities are just a few of the symptoms that accompany PTSD. Having negative beliefs, feelings, and attitudes after a traumatic event is common. Trauma can change a person’s beliefs about people, life, and even their own spirituality. Someone with PTSD may suddenly believe that life has no real purpose or meaning and that events are just random and uncontrollable. More specifically, the National Institute on Health recognizes four symptoms when identifying PTSD:

  • At least one re-experiencing symptom
  • At least one avoidance symptom
  • At least two arousal and reactivity symptoms
  • At least two cognition and mood symptoms

Here’s a deeper explanation:

  1. Reliving or re-experiencing the event. This may come in the forms of nightmares or sleep disturbances, or they may come as “flashbacks.” The mind manufactures images, scenarios, and sounds that cause the person with PTSD to seemingly “relive” the event. This results in increased heartrate, difficulty breathing, panic, and disassociation.
  2. Avoiding situations. Many people who experience post-traumatic stress will avoid events, places, and activities that remind him or her of the trauma. For instance, if someone is in a car accident, he or she may refuse to drive after the event. Avoiding can also take the form of refusing to talk about the presence of PTSD.
  3. Hyperarousal and reactivity. Someone with PTSD may feel on edge, as if he or she always needs to be on the lookout for an imminent threat. Those who suffer from PTSD may become very reactive, agitated, or even hostile. People with PTSD also get startled easily and respond anxiously to loud noises or sudden movements.
  4. Cognition and mood symptoms. PTSD can distort thinking in a number of significant ways. In extreme cases, an individual with PTSD may become paranoid and think “the world is out to get them.” PTSD can cause mood swings, depression, an increased or decreased need for sleep, loss of appetite, and other symptoms that make it challenging to manage the responsibilities of daily living.

PTSD and Veterans

It is not surprising that PTSD is particularly common among veterans who have served in a combat zone. Spending any length of time fighting a dangerous war will most definitely result in trauma and we know that trauma leads to PTSD. It is usually not until months or years after leaving a combat zone that most veterans begin to experience the symptoms of PTSD. Providing specialized care for veterans who suffer from PTSD is important. Although the symptoms of PTSD are typically the same for veterans and civilians, veterans seem to thrive in a supportive, therapeutic environment with other veterans. This is not only attributed to the unique camaraderie veterans share, but it is also believed the peer support offered in veterans-focused groups is unparalleled. Thankfully, in more recent times, the nation has risen to the occasion in terms of supporting our nation’s veterans in their continued need for PTSD treatment. Veterans can now receive specialized care for PTSD through their local VA medical center and get ongoing assistance through programs like the Wounded Warrior Project and the VA National Center for PTSD.

PTSD and Non-Combat Related Trauma

While veterans experience combat-related PTSD, others experience non-combat related PTSD. All too often, those who experience PTSD from a childhood incident or the death of a loved one don’t recognize PTSD when it occurs. This is because many are misinformed about the nature of post-traumatic stress. To be clear, you do not have to be a combat veteran to experience PTSD. If you have survived, witnessed, or experienced a traumatic event that has caused an upset to your life, you will most likely experience the symptoms of Post-traumatic Stress Disorder. It is easy to fall into the misguided notion that “I can’t have PTSD….. I didn’t go to war!” This mindset is based on misinformation. PTSD is just as real for those who have suffered a non-combat related trauma as it is for veterans.

PTSD and Substance Abuse

Statistics indicate that substance abuse and PTSD go hand-in-hand, prompting a dual-diagnosis from a mental health care professional. Although there is a well-known connection between veterans, PTSD, and substance abuse; substance abuse is also common among those who experience non-combat related PTSD. This is not surprising. Post-traumatic stress is so debilitating, those who suffer with this condition often turn to drugs, alcohol, and prescription medications to cope. Many people who battle PTSD also battle a problem with substance abuse. In fact, addiction experts are now asserting that PTSD and substance abuse are very common co-existing disorders. Research indicates those who suffer from PTSD are abusing a number of different substances. While many with post-traumatic stress turn to alcohol, others are use street drugs like heroin and cocaine, and some abuse pain medication. No matter what the drug of choice is for the individual with PTSD, addiction always leads to dark and hopeless places. Intoxicating substances seem to offer some comfort from PTSD, but this comfort is fleeting and comes with negative consequences. Those who turn to drugs and alcohol usually develop an addiction and subsequently experience legal difficulties, family problems, issues with work and school, and other negative experiences that accompany substance abuse. Here are some fast facts about PTSD and substance abuse for both veterans and civilians:

  • Up to 75 percent of all people who have experienced a serious trauma have reported alcohol abuse.
  • Alcohol abuse affects 52 percent of men with PTSD and 28 percent of women.
  • Drug abuse affects 35 percent of men with PTSD and 27 percent of women.
  • About 8 million adults report to having PTSD annually.
  • Among all veterans receiving VA care for PTSD, 27 percent also have a substance abuse problem.


“Dual-diagnosis” is medical terminology used to describe someone who has a mental health diagnosis and a substance abuse problem. Dual diagnosis represents the presence of two co-occurring disorders – one addictive and one psychiatric. Someone who suffers with PTSD and a drug or alcohol problem is considered to have a dual-diagnosis. He or she is diagnosed with PTSD and substance abuse. It is important to recognize that dual-diagnosis is not limited to PTSD. For instance, someone can have bi-polar and a substance abuse problem and be considered dual-diagnosis. However; it is essential to make the distinction that when someone does have PTSD and a problem with addiction, he or she falls into the dual-diagnosis category. Typically, PTSD cannot be effectively treated until the cycle of addiction has been arrested. This usually means someone with an addiction to drugs, alcohol, or prescription medication must first detox and receive treatment before addressing the symptoms and causes of PTSD.

Living with a Loved One Who Has PTSD

PTSD doesn’t just affect the individual with the disorder. It affects the whole family. That is why it is important for spouses and family members to get support when trying to care for someone with PTSD. Unfortunately, PTSD can incapacitate a person to the degree that become are unable to work and are required to live on disability or government assistance. This can lower the self-worth of the person struggling with PTSD and cause depression or suicidal thoughts. PTSD also changes the family dynamic and causes a shift in roles. For instance, a combat veteran may be medically discharged from the military and need their spouse to be the sole breadwinner. Or, a mother may have experienced a sexual assault and become unable to care for her children. Many with PTSD feel as though they cannot carry on healthy relationships with the people they love and care about the most. This causes a sense of isolation and abandonment for spouses, parents, friends, and co-workers who have daily interactions with the person diagnosed with PTSD. Learning new routines, ways of communicating, and treatment-related activities are positive ways for families to learn to live with PTSD. Help for PTSD is available.

Treatment for Post-traumatic Stress Disorder

Therapy and medication are currently the most popular treatments for PTSD. Usually, the two are used in conjunction with one another.  Psychotherapy, or individual counseling, involves meeting with a qualified therapist. Medication helps heal the areas of the brain effected by PTSD. There are different types of therapy for individuals struggling with PTSD. Current medical research suggests that Cognitive Behavioral Therapy (CBT) is the most effective treatment for PTSD. Two types of CBT are very popular – cognitive therapy and exposure therapy. Cognitive Processing Therapy (CPT) teaches individuals the skills they need to change how they think about the trauma, which ultimately changes the way they feel about the trauma. Prolonged Exposure (PE) therapy requires the individual to talk about the trauma repeatedly until memories from the experience are no longer traumatic. Another kind of therapy used to treat PTSD is Eye Movement Desensitization and Reprocessing (EMDR). This involves focusing on sounds or movements while reliving the trauma. This helps the brain work through the traumatic experience and form new reactions to the memory. This type of therapy is designed to reorient a person’s reaction to a trauma so it becomes grounded in the reality that the trauma is a past event with no influence over the present moment.

Medication and PTSD

In addition to various types of therapy, there are a number of medications offered to help ease the symptoms of PTSD. Many people report that medication has been life-changing in terms of reducing the effect of PTSD symptoms. SSRIs (selective serotonin reuptake inhibitors) and serotonin-norepinephrine reuptake inhibitors are used to treat depression and PTSD. Anti-anxiety medications are also common for treating PTSD. Although medications are highly effective for treating PTSD symptoms, most mental health professionals recommend medications be closely supervised by a physician and taken in addition to regular, ongoing therapy. Although medication and therapy are effective for PTSD treatment, recovery is a long and often slow process.

Substance Abuse Treatment and PTSD

Treating PTSD and substance abuse can become a complicated endeavor if an individual is suffering from these co-existing disorders. PTSD alone is a complex psychological disorder that requires specialized, ongoing care. Dual-diagnosis makes matters much more difficult. This is why addiction treatment is paramount to the successful treatment of PTSD. Someone who truly wants to experience relief from PTSD will first have to address his or her substance abuse problem. This may require detox, inpatient treatment, or 12-Step meetings. Do you think you might have an addiction to drugs, alcohol, or prescription medication? Take this addiction quiz and find out where you stand. Do you have experience with PTSD and substance abuse? Please leave your comments here: