The relationship between PTSD and substance abuse is rooted in the use of substances to dampen or distract from the symptoms of PTSD. One of the hallmarks of PTSD is the efforts people make to avoid remembering, thinking about or feeling emotions related to the trauma they experienced. Substance use is a way people with PTSD can disrupt the brain’s normal functioning and temporarily block unwanted feelings.
Substances become less effective over time, causing people to use more of them to achieve the same effect as before. As people use substances more often to avoid the painful symptoms of withdrawal, PTSD symptoms also worsen. This can quickly lead to addiction.
Drug Abuse as a Hindrance to PTSD Treatment
Substance abuse hinders the treatment and recovery process for any mental health condition. PTSD can be particularly complicated by substance use because recovery from PTSD requires a person to reconnect with memories, thoughts and feelings that they have suppressed or avoided. Drugs can numb emotions and disrupt thinking and memory, making it difficult for people with PTSD to process trauma while actively using substances.
By prolonging the avoidance cycle of PTSD, substance use can make PTSD last longer. It can prevent exposure therapy and other common therapeutic interventions for PTSD from working. Substance use can also worsen PTSD symptoms through the ways it disrupts sleep and can make prescription psychiatric medications less effective.
Effects of Substance Abuse on PTSD Symptoms
People sometimes ask, “Can drugs cause PTSD?” The answer is that they cannot cause the condition but can increase the risk of PTSD by intensifying reckless and risk-taking behavior and exposing people to dangerous situations where they can be re-traumatized.
People who abuse alcohol or benzodiazepines often dissociate and end up in unexpected situations, including disturbing and violent ones. People who take large amounts of any substance, especially disorienting substances like alcohol and marijuana, can end up in places where they are less able to assert or defend themselves and where they have a higher risk of becoming victims of exploitation or harm.
Even when substance abuse does not lead to re-traumatization, it worsens the symptoms of PTSD. In addition to prolonging the avoidance cycle and blocking progress in treatment, drugs ultimately worsen depression, anxiety and trauma-related symptoms. Not only do many drugs directly cause these symptoms, but many others can also trigger them as residual effects.
Even in cases where substance use has not progressed to dependence, negative feelings alleviated by the substance return with greater intensity as it wears off. This can quickly lead to a vicious cycle of escalating drug use. This becomes even more of an issue when substance use progresses to addiction and includes acute withdrawal symptoms.
PTSD and Smoking
Research shows that people with PTSD smoke at higher rates when compared with the general population and that smoking is highly correlated with the disorder. This is a significant concern for two major reasons. The first is that the link between tobacco use and a wide range of health concerns, including heart disease and cancer, is so clearly established that doctors focus on smoking cessation before any other behavioral changes they encourage their patients to make.
The other is that smoking has been shown to worsen PTSD symptoms. The stimulant effects of nicotine not only intensify hyperarousal and avoidance symptoms but can also trigger intrusive symptoms. This is especially unfortunate because quitting smoking is even harder for people with psychiatric disorders. Smoking cessation rates are lower for people with PTSD.
PTSD and Alcohol
Alcohol is a popular drug of abuse because it is accessible, legal and socially accepted. In addition to these social aspects, alcohol is frequently chosen for its specific properties. Among the reasons that PTSD and alcohol use disorders are common comorbid conditions are the numbing effects of alcohol and its efficacy in blocking traumatic emotions and memories.
Unfortunately, alcohol use makes PTSD symptoms worse. While alcohol can temporarily blot out painful memories and feelings, these usually come back stronger after its effects wear off. Because alcohol is a depressant, it worsens depressive symptoms and affective symptoms of PTSD, such as emotional numbing and irritability.
Alcohol also disrupts sleep and can even trigger worse nightmares than those people with PTSD already experience. Heavy alcohol use can also cause dissociative episodes in which people engage in risky or self-destructive behavior or expose themselves to situations where they are vulnerable to re-traumatization.
PTSD and Marijuana
Marijuana is becoming increasingly socially accepted and more frequently sought as a source of relief for a large number of mental health disorders. Unfortunately, in addition to its calming effects, marijuana has dissociative properties that can amplify the dissociative symptoms of PTSD and facilitate emotional blunting and avoidance.
Research shows that the endocannabinoid system in the brain, or the natural brain-made equivalent of cannabis, plays a significant role in PTSD. In other words, marijuana and PTSD affect the same parts of the brain. This is one reason that marijuana can provide relief for PTSD, but it comes at a cost. As marijuana use increases and tolerance develops, these systems in the brain work even less well. In addition, heavy marijuana use can trigger paranoia and anxiety and worsen PTSD symptoms like hypervigilance and hyperarousal.
PTSD and Stimulants
It might seem unusual for people with PTSD to choose to use stimulants. Rather than calming the mind, they cause agitation that can worsen anxiety and PTSD symptoms. However, they also cause people to feel more powerful and confident, effects which can counteract the feelings of helplessness that are often part of PTSD.
These effects tend to be short-lived, however. Powerful stimulants carry risks that are similar but more intense than those that accompany nicotine, including increased agitation and hypervigilance. Stimulant abuse is also linked to increased rates and symptoms of depression.
The six most commonly abused types of stimulants are:
- MDMA (Ecstasy)
- Prescription stimulant drugs like Adderall
- Synthetic stimulant drugs like “bath salts“
While stimulants can temporarily make people feel euphoric, they typically trigger secondary anxiety and depression, especially in high doses. These and other effects can intensify the full range of PTSD symptoms, especially intrusive thoughts, avoidance and hypervigilance.
Statistics on PTSD and Drug Abuse
PTSD and substance abuse statistics show significant relationships between these conditions:
- Around 33 percent of veterans seeking substance abuse treatment have comorbid PTSD.
- About 50 percent of people in inpatient substance abuse treatment also have PTSD.
- Nearly 80 percent of women seeking substance abuse treatment have lifetime histories of sexual or physical assault.
- People who abuse opiates and cocaine report higher rates of exposure to trauma than users of other substances.
- People with PTSD are at least two times more likely than the general population to have an alcohol use disorder.
Due to the strong link between PTSD and addiction, it is important to screen for and treat comorbid substance use disorders when treating people for PTSD.
PTSD and Substance Abuse in Veterans
While PTSD and substance abuse are strongly linked in the general population, the relationship between PTSD and substance abuse in veterans is even stronger. Research has shown that as many as 75 percent of veterans with PTSD have a co-occurring substance use disorder.
Combat trauma can be especially severe, which can intensify efforts to avoid or numb the memories, thoughts and feelings associated with it. Binge drinking is especially common among veterans with co-occurring conditions as a way to combat the resurgence of bad memories. This has made providing treatment for these co-occurring disorders a priority for the U.S. Department of Veterans’ Affairs (VA) and other providers that serve veterans.
Treatment for PTSD with Co-Occurring Substance Use Disorders
While there is no single best treatment for comorbid PTSD and substance use disorders, research has shown that successful dual-diagnosis treatment uses an integrated approach.
Integrated Treatment Approaches
Using an integrated treatment approach means coordinating mental health and substance use disorder treatment, often by providing them through the same organization.
In general, integrated programs are more effective for any dually diagnosed clients but have yielded special outcomes for people with PTSD and substance use disorders. One is that they have dispelled the traditional “Pandora’s Box” hypothesis that addressing trauma-related material in the early stages of substance use treatment jeopardizes the recovery. Instead, they have shown that addressing trauma early in treatment improves recovery rates for both disorders.
As dually diagnosed patients establish periods of abstinence from substance use, they have to learn new ways to cope with PTSD symptoms, which may initially seem to get worse. Already being in active treatment for PTSD means a person can have access to additional resources and coping skills to manage PTSD symptoms. This helps prevent people from experiencing a recurrence of substance use while continuing to work on recovery from PTSD.
Treatments that work for uncomplicated PTSD have also been shown to be effective for comorbid PTSD and substance use disorders. These include individual or group cognitive behavioral therapy (CBT), cognitive processing therapy (CPT) and prolonged exposure therapy (PET). Pharmacotherapy can also be helpful in reducing PTSD symptoms and preventing people who are in treatment for PTSD from resuming substance use.
One intervention developed specifically for people with dually diagnosed PTSD and substance use disorders is Seeking Safety. This systematic, manual-based intervention addresses several issues, including decreasing high-risk behavior, setting boundaries, managing emotions and coping with triggers to use substances.
Another program developed for clients with PTSD and substance use disorders is Transcend, which combines approaches from psychodynamic therapy, CBT and twelve-step treatment programs. Research has shown that both Seeking Safety and Transcend effectively treat co-occurring PTSD and substance use disorders.
With locations across the United States, The Recovery Village offers many different integrated treatment options for people with co-occurring disorders. Contact a representative at The Recovery Village today to learn how you or a loved one can start to heal from addiction and trauma.