PTSD and Addiction

About 3.5% of Americans are diagnosed with post-traumatic stress disorder (PTSD) each year, and roughly 1 in 11 are diagnosed at some point in their lives.¹ In southern Nevada, the number of PTSD-related emergency department visits increased from 402 in 2009 to 3,718 in 2017, the latest year for which we have data.²

PTSD and substance abuse are often closely linked; people with PTSD are 2 to 4 times more likely to also have a substance use disorder (SUD).³ About 80% of people with PTSD have another mental health diagnosis, which includes SUDs.⁴ If a person has both an SUD and a mental health disorder, this is called co-occurring disorders, or dual diagnosis.

What Is PTSD?

Post-traumatic stress disorder (PTSD) is a mental health disorder that can develop in a person who has been exposed to a scary, life-threatening, or shocking event, such as war, serious accidents, sexual violence, or natural disasters.^{5, 6} Exposure to the traumatic event can be first-hand or indirect, such as learning about the violent death of a friend.¹

Anyone can develop PTSD after a traumatic event.¹ Symptoms can be draining and harm a person’s wellbeing and ability to function in everyday life. Many people who go through trauma recover from their symptoms, but if they don’t, they are at risk of PTSD. They may feel stressed and anxious for long periods of time, although their symptoms can come and go.^{1, 5}

Common PTSD Symptoms

Some of the common symptoms of PTSD include:¹

• Reliving the event through flashbacks, intrusive thoughts, or distressing dreams. You might feel as though the event is actually happening to you again.
• Avoiding things that remind you of the event. This might include staying away from people or places, or avoiding your thoughts and feelings by staying busy or actively trying not to think about it.
• Hyperarousal and hyperreactivity. This means you constantly feel “on edge,” like you have to watch out for people or things that could cause you harm, or that you act out of proportion to certain situations, such as having angry outbursts or feeling suspicious of others.
• Thought and mood changes. People with PTSD might have increased negative thoughts and feelings about themselves and the world, feel unable to remember certain details of the trauma, have less interest in things they used to enjoy, or feel blame and guilt.

PTSD in Veterans and First Responders

The unique nature of veteran and first responder jobs may put them at higher risk of PTSD. Witnessing horrible, life-threatening events, being exposed to combat, and seeing others suffering can all increase the risk of PTSD. Other unique factors military members face that can increase their chances of PTSD include the politics around the war, the war’s location, their specific job in the war, and the type of enemy they face.⁷ The National Center for PTSD puts PTSD rates at anywhere from 11 to 30 out of every 100 veterans (11 to 30%), depending on their service era—or which specific war they encountered during their time of service.⁷

First responders also face unique job-related stresses that make PTSD more likely. This can include continued exposure to trauma, irregular or long work hours, sleep problems, the physical demands of the job and, in the case of emergency medical services, a lack of resources and funding.⁸

Veterans and first responders may also deal with high levels of stigma surrounding their use of mental health services, increasing the chances that their symptoms go unnoticed or untreated. Unfortunately, most people with PTSD don’t receive the treatment that they need to feel better.^{8, 9}

How Are Addiction and PTSD Related?

Substance abuse and PTSD are closely linked. For people with PTSD, the lifetime risk of developing a substance use disorder (SUD) is between 36% and 52%.⁶ And for people with SUDs, the lifetime risk of developing PTSD is between 26% and 52%.⁶

The reasons the two disorders are so closely linked aren’t fully known. One theory is the “self-medication” theory, which suggests that people who have PTSD may turn to drugs or alcohol to ease their symptoms of stress, anxiety, depression, and other problems.^{3, 10} There’s quite a bit of evidence to support this particular model, as many studies suggest that PTSD most often develops before the co-occurring SUD and that substances are used mainly to manage PTSD symptoms in this group of people.^{3, 10}

But there are other reasons people with PTSD may develop addictions. Some studies have pointed to certain personality traits, such as impulsive behavior, anxiety, and high sensitivity to stress, as influencing both PTSD and SUD.¹¹ Other studies point to possible genetic and environmental factors as well as previous exposure to trauma.³

No matter the cause, co-occurring addiction and PTSD can worsen each other. And compared to people with only one of the two disorders, co-occurring PTSD and substance abuse is associated with:^{3, 6}

• Higher treatment costs and longer treatment durations.
• Worse treatment outcomes and faster relapse (return to drug use after a period of not using).
• Increased long-term medical issues.
• More social and legal problems.
• Higher risk of violence, suicidal thoughts and behaviors, and death.

That said, recovery from co-occurring PTSD and addiction is possible, and it’s never too late to start.

How to Treat Addiction and Trauma

Integrated treatment for co-occurring disorders, co-occurring disorder treatment, and dual diagnosis treatment are all terms that mean the same thing. This type of care involves treating SUD and PTSD (or other mental health disorders) at the same time and is the current standard of care.^6,12

Integrated treatment will often include a combination of prescription medicines and behavioral therapy. Behavioral therapy can help you identify PTSD triggers and learn how to cope with them, while medicines can help manage your symptoms. Possible therapies used to treat PTSD include:^{1, 5, 10–14}

• Exposure therapy. In this setting, a qualified therapist will slowly re-expose you to traumatic feelings and memories. They might ask you to remember things, write about them, and express your thoughts and feelings in different ways.
• Group therapy, where you will hear from and get support from others who have been in your shoes.
• Cognitive-behavioral therapy (CBT), which helps you identify and make healthy changes to negative thoughts and behaviors.
• Cognitive processing therapy (CPT). CPT is a 12-session treatment approach that combines elements of exposure therapy and CBT to help you identify and heal from harmful thoughts about your trauma.
• Concurrent treatment of PTSD and substance use disorders using prolonged exposure (COPE). This structured therapy takes place over 12 sessions and is designed to help you set goals, cope with drug and alcohol cravings, and deal with issues related to the trauma.
• Eye movement desensitization and reprocessing therapy (EMDR). EMDR is one of the most common PTSD therapies. It is an 8-phase treatment approach that uses eye movements, tapping, or sounds to help change the way your brain processes and stores traumatic memories.
• Seeking Safety (SS) helps you learn new coping skills to heal your trauma and feel safe, such as compassion, asking for help, setting boundaries, and being in community.

The type of treatment will vary based on your recovery needs and goals. Since everyone has different experiences, unique traits, and specific health concerns—all of which can contribute to both PTSD and SUDs—not everyone will get the same treatment.⁵ One person may have sleep problems, but someone else may not; some may have more anxious feelings and others might feel more depressed.

How to Get Help for Addiction and PTSD

If you or someone you know has co-occurring PTSD and substance use disorder, integrated treatment can help you deal with both conditions, regain a sense of control over your life, and improve your wellbeing. American Addiction Centers is a leading provider of integrated treatment for co-occurring PTSD and substance abuse in Nevada and nationwide. We use research-based treatments that are proven to help addiction and mental health disorders. If you’re ready to start on the path to recovery, please call our free, confidential helpline at . Our compassionate admissions navigators are standing by to help you any time, day or night.