PTSD and Substance Abuse

PTSD and Substance Abuse

In the African country of Rwanda in 1994, more than 800,000 people were slaughtered in genocide. The season of killing was so devastating there was nothing to be done about the masses of carcasses polluting waterways and spreading Cholera to the survivors.

An epic disaster of homelessness, refugees, violence, women sold into sex slavery, death, grief and unimaginable loss, the Rwandan genocide traumatized the lives of millions.
Some Rwandans, Ugandans, Congolese and other affected peoples recovered, and some never did. After the conflict, 12,000 community courts were set up in villages and convened weekly for a decade to give communities the chance to face the accused.

People need closure, a chance to face their demons, and to heal.

And so it is with anyone who has endured Post-Traumatic Stress Disorder (PTSD) — they need a chance to heal.

Post-Traumatic Stress Disorder, Drugs and Alcohol

Left untreated, post-traumatic stress disorder often leads to substance abuse. According to a research study on the treatment of PTSD and Substance Use Disorder (SUD), approximately half of individuals seeking treatment for substance abuse meet the criteria for PTSD.

Those suffering with PTSD symptoms often use substances to minimize their symptoms. However, research shows alcohol and other drugs worsen the symptoms of mental illnesses.
Both PTSD and SUD are chronic debilitating conditions that frequently co-occur.

Co-occurring Disorder: A co-occurring disorder, or dual diagnosis, refers to the condition of experiencing both a mental illness and a substance use disorder simultaneously.

Simultaneous treatment for PTSD and substance abuse has been shown to alleviate symptoms for both disorders. Dual recovery programs carry the best prognosis and provide clients the opportunity to combat both issues at once.

What Is PTSD?

The majority of people who experience traumatic life events go through a recovery period and then are able to move past the trauma. Those with PTSD have experienced a trauma so very severe their brain has changed in ways that make it difficult to process these events and move forward. When someone experiences functional impairment and symptom-related distress for more than a month, they qualify for the diagnosis of PTSD.

PTSD is a debilitating mental disorder that affects people who have survived a traumatic event or prolonged trauma.

The DSM-5, the bible of psychiatry, categorizes this condition under trauma- and stressor-related disorders. Negative cognitions and moods proceed the trauma, and a person develops an overly fearful and distrusting worldview, as well as negative beliefs about oneself.

There exist other trauma- and stressor-related disorders and subtypes of PTSD, including dissociative disorders that cause individuals to feel disconnected with themselves or parts of themselves.

Children and adolescents can have PTSD, too, and can be susceptible to drug and alcohol use. PTSD can develop in people of any age at any time.

History of PTSD

Although post-traumatic stress itself has been around before the flood of Noah, the diagnosing phrase didn’t come about until 1980, when officially recognized as a mental health problem. Initially, the framers of the PTSD diagnosis were thinking of trauma outside the everyday human experience. Since then, we have become more exposed to large-scale terror, and the understanding of the disorder has expanded to include personal trauma like child abuse.

Perhaps PTSD has been most recognized among our veterans; what used to be called shell shock is now more thoroughly understood. The key in terming these symptoms is they are caused by an external traumatic event or events, not by an internal neurosis.

Warning Signs and Symptoms

It is not uncommon for PTSD sufferers to develop chronic health problems like: fibromyalgia, chronic fatigue, clinical depression, colitis and other stress-based disorders. People with PTSD don’t get the regular mental, physical, emotional and spiritual reprieve they need because their physiology is conditioned to fight, flight or freeze responses.

People suffering from PTSD have these intrusive symptoms:

  • Unbidden, intrusive recollections of the trauma
  • Nightmares
  • Dissociative reactions (flashbacks)
  • Distress, anxiety and physiological stress experienced upon receiving involuntary memories

In addition to these symptoms, people with PTSD will exhibit warning signs of the disorder in mood, thinking and behavior.

According to the DSM-5, after experiencing something horrific, an individual with PTSD will express at least two of these:

  • Irritable or aggressive behavior
  • Self-destructive or reckless behavior
  • Hypervigilance
  • Exaggerated startle response
  • Problems in concentration
  • Sleep disturbance

Substance Abuse and Addiction Defined

Substance use disorder is defined as a disease affecting the brain and behavior that leads to the inability to control use of legal or illegal drugs or medication. Substances such as alcohol, nicotine and marijuana are also considered drugs. SUD is also known as drug addiction.

Addiction is a chronic disease of the brain.

Addiction is a chronic disease of the brain affecting memory, reward, motivation and related circuitry. Dysfunction in this system affects the person biologically, psychologically, spiritually and socially, wreaking havoc in all areas. Like other chronic diseases, it is often relapsing-remitting. Addiction is progressive in nature and, without treatment and continued recovery, results in disability and death.

Related Reading

Why Does PTSD Lead to Substance Abuse?

Part of the PTSD mental condition involves deliberately avoiding things and feelings that might evoke memories of past horrors. Persistent effortful avoidance of people, conversations, places or objects of anything trauma-related is hard work.

As part of this avoidance behavior, people drink to forget. Individuals use substances to mitigate psychological pain, perhaps more than for any other reason. Self-medicating with drugs and alcohol is common.

But self-medicating only feels good at first. It quickly adds weight to an already troubled life, leading to intensified negative symptoms of PTSD and resulting in even less ability to function in life.

Research studies show having PTSD:

  • Contributes to marijuana dependence in adults
  • Leads to alcohol use
  • Leads to cocaine use

Sadly, dozens of research studies indicate the majority of those suffering from SUD and PTSD only ever get treatment for SUD. Adults in treatment for SUD, including alcohol use disorder, are rarely screened for trauma disorders.

Learn More About Co-Occurring Disorders >

Underlying Issues

What causes people to develop PTSD? Scientists have discovered that the make-up of each individual’s brain has a great deal to do with susceptibility for post-traumatic stress disorder and for addiction. There is a correlation between who develops these disorders — the same parts of the brain that makes someone vulnerable to one disorder are the same for the other.

For a diagnosis of PTSD, a person has had to be exposed to:

  • Death
  • Threat of death
  • Injury
  • Threat of injury
  • Sexual violence
  • Threat of sexual violence

In 1994, the Rwandans were exposed to all of these things, directly or indirectly. It was horrifically traumatic to witness the machete massacres of neighbors and family, whether personally threatened or not. A diagnosis of PTSD is just as valid when someone experienced personal violence, witnessed terror, or when it hit home in another way.

Possible situations for developing PTSD include:

  • War
  • Sexual assault
  • Witnessing horrifying things
  • Childhood abuse
  • Physical assault, bullying
  • Natural disasters
  • Terrorist attacks

In order to promote healing, it is important to pinpoint the cause of the original distress. It is natural for our self-preservation mechanism to launch in the face of threats. But once the threat is no longer eminent, individuals see they have survived, process the violence and go on to lead normal healthy lives. When this doesn’t happen naturally, PTSD develops.

Risks of Untreated Trauma

Rwanda endured horror and many of its people developed PTSD. Rwanda created gacaca courts, makeshift outdoor courts to deal with genocide perpetrators, because the country recognized the need for healing.

Unhealed and untreated trauma carries these risks:

  • Isolation
  • Depression
  • Panic attacks
  • Anxiety
  • Phobias

People with PTSD already have difficulties functioning in life with maintaining relationships, job, health and everyday responsibilities. With dual diagnosis, the risks of all these negatives increase.

The most powerful risks of untreated trauma are developing substance abuse and suicide.

Treating Trauma

People wonder what can be done for PTSD, and how sufferers can get better.

When someone has experienced or witnessed a traumatic event, there is a lot going on in their psyche. They may have issues like persistent self-blame or misplaced blame and feel a sense of alienation from others.

People dealing with PTSD have significant negative cognitions and moods following the individual’s trauma.

When someone has been exposed to prolonged trauma, they may not be able to remember key features of the trauma and may have deep and persistent negative beliefs about themselves and their world. They may have lost the ability to experience positive emotions and find joy or interest in activities they once did.

People with PTSD deal with emotions like shame, guilt, fear, horror and anger. It’s important to have someone on their side during PTSD treatment that understands them and what they’re going through.

Research indicates the most promising treatments are psychosocial treatments that incorporate an exposure therapy component.

Cognitive Behavior Therapy

Cognitive behavior therapy (CBT), a type of psychotherapy, is a valuable part of treatment. In CBT, a client spends one-on-one time talking with a therapist with the goal of improving mental health. This psycho-social intervention focuses on changing unhelpful thoughts and behaviors.

Exposure Therapy

In exposure therapy, clients work with a therapist in a safe environment to gently become exposed to what they fear. Clients and clinicians talk about the trauma, memory, objects, situations and people that are triggers for the client. Eventually the person moves into doing what they fear. The goal is repeated safe exposure to perceived dangers so that the individual becomes systematically desensitized.

COPE is the buzzword for a successful, research-backed treatment modality for treating PTSD and SUD together. COPE means Concurrent Treatment of Substance Use Disorders Using Prolonged Exposure. It combines CBT with exposure therapy and treats both disorders concurrently.

Trauma Therapy

Trauma therapy is specifically tailored for clients burdened by stress. In this therapy, a counselor trained in trauma uses techniques to achieve trauma resolution.

PTSD Medication Therapy

Medication is often used as part of a treatment plan for the individual suffering with PTSD. Antidepressants might be suggested for symptoms of depression and anxiety. Mood stabilizers, antipsychotics and benzodiazepines are often employed to ease the various symptoms the individual is experiencing. Medication is most successful when used in conjunction with other modalities.

Other Help for PTSD

Eye Movement Desensitization and Reprocessing (EMDR) is an effective therapy that helps people reshape thoughts about traumatic experiences. Clients follow a therapist’s finger or object with their eyes as it moves right and left, all the while thinking about a past trauma. Discussing the event before, during, and after the eye movement, the client allows the brain to process the event in a more logical and helpful way.

Other helpful treatments for PTSD with substance abuse include:

  • Exercise
  • Developing social support networks
  • Spiritual development
  • Meditation and mindfulness

It is also proven helpful for the client to do creative work, such as music, writing, art and drawing.

The Best Rehabs for PTSD

Drugs and alcohol provide a fleeting escape, but as soon as the high ends, the psychological pain comes back twice as hard. That happens because drugs stimulate natural pleasure and tranquility chemicals in the brain. When these substances wear off, dopamine levels drop and gamma-aminobutyric acid levels increase again, making the user feel agitated and depressed. With repeated drug use it becomes harder and harder for the brain to regulate these and other chemicals.

The high is not worth the pain.

Rehabs are known for helping people stop drugging and drinking. America has come to expect that a rehabilitation facility will prevent their loved one from accessing the addictive substances that were killing them. Individuals hope that by the time the chemicals are gone from their system, they will be able to go about life without having to use.

However, when there is a dual diagnosis situation, simply stopping the use of substances will not fix the problem or prevent relapse.

Research shows individuals with PTSD and SUD have worse outcomes in treatment than those who don’t have PTSD. This underlines the necessity for finding a treatment center with specialization in dealing with PTSD.

These two conditions influence each other. Those with co-occurring PTSD statistically:

  • Have more intense cravings for drugs and alcohol
  • Relapse more quickly than others
  • Have more legal problems
  • Are at more risk for experiencing violence
  • Are prone to severe physical health problems
  • Have a greater risk for suicide

Many clinical settings are experienced in one or the other. But if an individual is dealing with both disorders, it is absolutely crucial they find a treatment facility that is experienced in both.

The best rehabs are the ones that address their clients’ underlying issues. Most people who abuse substances get into the predicament because they are in some kind of pain. And unless the internal pain is salved, stopping the external substance habit alone won’t heal the person. The result of unresolved pain is the addict going right back to their favorite drug or, in some cases, finding a new drug or drug-like behavior.

How Should Drug and Alcohol Facilities Deal with PTSD?

The most meaningful advancement in PTSD research is the knowledge that we need to treat both of these things at once. People who receive treatment only for substance abuse are likely to relapse quickly. And treatment for PTSD alone has not been effective for those suffering from a concurrent addiction. The only route to success is to offer the client the ability to heal from both issues at once, allowing the brain to reset.

Drug and alcohol facilities should promote full and abundant healing and well-being for their clients, using the latest research and evidenced-based methods.

It is vital to look for a treatment center that handles both PTSD and substance use disorder. People need to know whether the facility offers treatment for co-occurring disorders, specifically PTSD and drug addiction. People should ask if the drug and alcohol rehab center they are considering offers trauma treatment.

A Continuum of Care for Recovery

Knowing what to look for in a rehabilitation facility can make the search for the right PTSD and addiction treatment on point. Because there are a variety of stages in the recovery process, ensuring that each of them are readily available helps ease the fear and stress often associated with entering into treatment.

Continuum Recovery Center has built a reputation upon being an evidenced-based addiction treatment facility. By addressing both the physical characteristics of the disease as well as emotional imbalances and how they impact behavioral health, past trauma can be identified and worked through by helping clients shift personal perspective and the way they view the world around them.

Through a suite of clinical and holistic therapies, the negative power of the past gives way to a better ability to live in the moment, through positive support.

Continuum Recovery Center provides trauma resolution, through:

  • EMDR (Eye Movement Desensitization and Reprocessing Therapy)
  • CBT (Cognitive Behavioral Therapy)
  • DBT (Dialectical Behavioral Therapy)
  • Meditation
  • Music Therapy
  • Art Therapy
  • And more

To help reduce the risk of relapse, our Aftercare program nurtures personal development while strengthening sobriety. As such, the road to recovery includes healthier relationships with other like-minded clients who have graduated the program, and honing essential life skills and confidence to enjoy a newfound freedom from substance use.

Among our experienced and educated staff, many of us have personal experience overcoming an addiction. We are passionate about seeing our clients heal, grow and find joy in a clean and sober life.

Continuum Recovery Center offers dual diagnosis treatment in conjunction with evidence-based therapies for PTSD to help heal you, your loved one, and the family.