PTSD and Substance Abuse

Many people with a substance use disorder also have PTSD or symptoms of PTSD. Studies estimate that about 25% of men and women who seek rehab for drug and alcohol use have PTSD symptoms.

Other studies have found individuals with PTSD are between two and four times more likely than those without PTSD to have a substance use disorder.

The link between PTSD and substance use disorders in women is especially strong. Studies estimate the rates of PTSD in women who seek substance abuse treatment are as high as 60%.

People who have PTSD experience numerous mental and physical health problems. PTSD symptoms may drive individuals to use drugs and alcohol in an attempt to relax and distract themselves from disturbing thoughts, to forget painful memories of the event or numb distressing feelings, such as guilt, shame, anger or fear associated with the trauma. Post-traumatic stress disorder is what’s known as a co-occurring disorder, because it often occurs in individuals who are struggling with alcohol and drug use.

PTSD Symptoms

It’s both normal and common after a traumatic event for people to have difficulties coming to terms with what happened. They might have nightmares, trouble sleeping, flashbacks of the event when they least expect it, or memories that make it difficult to go about their daily lives. Fear of seeing or experiencing a similar trauma may cause them to alter their daily routines – for example, the person in the bad car wreck who refuses to drive.

In time, many people gradually begin to feel better. Disturbing memories begin to fade, and intrusive thoughts about what occurred become less frequent. Individuals might even be able to face their fears and go back into a similar situation; for instance, a person who has seen combat might choose to sign up for another tour of duty, or an individual who has been mugged starts going out again at night.

But research has shown that the ability to recover from traumatic experiences varies from person to person. Some traumatic events, particularly childhood abuse and sexual assault, are harder to move past than others. And for a wide variety of reasons that involve the type of trauma experienced, the duration, individual personality traits and support systems available to help with recovery, some people find that time doesn’t heal all wounds. Instead, the traumatic event has a lingering impact on their thoughts, emotions and behavior. When people don’t fully recover from what they have experienced or witnessed, they may have PTSD.

An estimated 7% to 8% of the U.S. population will have PTSD at some point in their lives, according to the U.S. Department of Veterans Affairs. Women are somewhat more likely to develop PTSD. About 10% of women develop PTSD, compared to 4% of men. One reason women may be more likely to develop PTSD is they are more likely than men to be victims of childhood sex abuse and rape or sexual assault.

Signs of PTSD

Feeling stressed, anxious, upset, or jumpy after a traumatic event is normal. In most situations, those symptoms gradually ease. Symptoms that last several months or more, cause significant distress, and continue to disrupt work and family life may be PTSD.

PTSD can vary from person to person, but there are four categories of PTSD symptoms: reliving, or re-experiencing the event; avoiding situations or people that trigger memories of the event; negative changes in feelings and personality; and feeling keyed up, also known as hyper-arousal or hyper-vigilance. Specific symptoms of PTSD include:

  • Nightmares
  • Severe anxiety or fear
  • Flashbacks, caused by specific triggers. Triggers can be
    sights, sounds, or smells that remind the individual of the trauma and cause them to feel they are experiencing it again.
  • Agitation and irritability
  • Insomnia
  • Self-destructive behavior
  • Feeling emotionally detached from others
  • Intrusive negative thoughts and emotions
  • Guilt
  • Loneliness, social withdrawal and isolation
  • Loss of interest in activities that used to be enjoyable
  • Difficulty concentrating
  • Distrust and wariness, even in situations that seem safe to others
  • Sudden reactions that don’t fit a given situation
  • Hostility toward others for no apparent reason
  • Depression

Not all survivors will show all of these PTSD symptoms. Some people experience flashbacks; some don’t. There might be only one or two that persist, but that can be enough for a diagnosis of PTSD. Symptoms may be subtle and it can be difficult to know for sure if the cause is PTSD or something else. PTSD is often mistaken for depression or another form of anxiety.

It’s important for anyone who has witnessed or survived a traumatic situation and is dealing with PTSD symptoms to contact a PTSD treatment center such as Bluff. Our team of psychiatrists, therapists and other clinicians can provide PTSD treatment and screening that can help people move beyond the past trauma so that it no longer continues to cause problems.

Causes of Post-Traumatic Stress Disorder

PTSD is a complex condition that experts are still working to fully understand. Some of those who have PTSD describe feeling as if they are caught in a never-ending cycle of “fight or flight,” in which they react again and again to the events of the past. Even during times when a person isn’t actively thinking about the traumatic event, something that reminds them of what happened can trigger a response that evokes the same “fight or flight” reaction they felt when the trauma first occurred.

What triggers the post-traumatic stress response is different for every person. PTSD first gained wide recognition in military veterans who served in combat. It’s estimated that between 11% and 20% of the men and women who served in the Iraq and Afghanistan wars have PSTD in a given year, while 15% of those who served in Vietnam developed PTSD. That doesn’t mean that everyone with PTSD has it forever. In some, the symptoms of PTSD improve over time. In others, PTSD symptoms may wax and wane over time. For example, a survivor of childhood sexual abuse may be doing OK, until he or she is subjected to unwanted attention or advances from someone they know. Then, symptoms of PTSD may re-emerge.

It was later understood that police and law enforcement, firefighters, EMS workers and others were at added risk of PTSD due to on-the-the-job experiences that caused them to fear for their own lives, or due to witnessing horrible tragedies happening to others. There may even be something called “indirect” or “secondary” PTSD, in which repeated exposure to other’s pain and suffering may lead to psychological impacts similar to PTSD. Social workers, for example, may be at risk of secondary PTSD.

Impact of PTSD

Research indicates that PTSD can lead to changes in certain areas of the brain, including the amygdala, hippocampus and prefrontal cortex. Traumatic stress is also associated with increased cortisol and norepinephrine responses to stress.

PTSD causes a wide range of emotional, psychological and physical problems. In addition to impacting relationships, the ability to work, and enjoy life, PTSD is also associated with poor cardiovascular health and gastrointestinal problems. The insomnia associated with PTSD can interfere with quality of life and raise the risk of substance use.

PTSD is also associated with chronic pain. According to the Department of Veterans Affairs, 15% to 35% of patients with chronic pain also have PTSD. PTSD is also associated with higher rates of depression and suicide.

The link between PTSD, substance use and depression has been well established. A person with PTSD and depression may have insomnia and may use alcohol or other drugs to fall asleep. They may turn to alcohol or drugs to calm down, distract their thoughts or in an attempt to lift their mood. PTSD can also cause people to feel numb, so they may turn to stimulants, such as cocaine or meth, to help them face the demands of daily life.

All of these conditions can, and should, be treated at the same time. By overcoming the symptoms of PTSD, managing depression and relieving insomnia, the urge to use alcohol and drugs decreases.

PTSD Treatment

For individuals in recovery from drug and alcohol addiction, overcoming the emotional pain of past trauma is essential to recovery. People with PTSD may need to try various therapies, medications and other techniques to alleviate their symptoms. There are a variety of treatments that have been proven effective in helping PTSD, yet there is no one PTSD treatment that is best for everyone. The goal of post-traumatic stress disorder treatment is to help men and women regain a sense of control over their life and reaction to stress. Components of PTSD treatment include learning specific skills to cope with symptoms; boosting feelings of empowerment and self-efficacy so that patients are able to recognize that the events of the past do not define their present and developing ways to cope if any symptoms arise again.

It’s critical to treat other problems often related to traumatic experiences, such as depression, anxiety, and substance use disorders. Bluff is a trauma-sensitive drug and alcohol rehab. Throughout each step of PTSD treatment, we ensure patients feel safe and supported. PTSD treatment typically involves a combination of psychotherapy, EMDR, insomnia relief, holistic therapies, and medications such as SSRIs and SNRIs.

Psychotherapy: There are several types of therapy shown to help with PTSD treatment. One is trauma-focused cognitive behavioral therapy (TF-CBT), which helps process thoughts and emotions related to the trauma, and acquire tools to alleviate the overwhelming feelings that lead to stress, anxiety, depression and the urge to use alcohol and drugs.

Eye movement desensitization and reprocessing (EMDR): The Department of Veterans Affairs and the American Psychiatric Association recommend EMDR therapy for PTSD. EMDR uses a series of guided eye movements that help individual reprocess traumatic memories so that those memories no longer pack such a strong emotional wallop. After EMDR, people still remember what happened, but the memory no long evokes the same strong physical and emotional reaction.

Medications: Medications such as SSRIs and SNRIs, such as paroxetine (Paxil), sertraline, (Zoloft) and venlafaxine (Effexor), have been shown to be effective in treating PTSD and depression. These medications may impact the biology of PTSD by acting on the neurotransmitters in the brain altered by PTSD.

Relieving insomnia: An important goal of the PTSD treatment center at Bluff is working with patients to restore healthy sleep habits. Insomnia is associated with depression, substance use, pain conditions and PTSD. When people are unable to get a good night’s sleep, their ability to cope with stress and anxiety is compromised. We use a variety of therapies to help people get quality sleep so they can better cope with their PTSD symptoms.

Holistic Treatment for PTSD: At our PTSD treatment center, we utilize multiple holistic therapies that can help alleviate the symptoms of PTSD. Meditation and yoga focused on the mind-body connection can help people relax and learn to identify, and eventually, release the feelings that are causing them distress. Mindfulness, which guides individuals in staying in the present moment and observing thoughts, feelings and sensations without harshly judging themselves for having those feelings, has also been shown to help people with regulating their emotions and achieving a more peaceful state of mind. Mindfulness can also help people from worrying or going over and over the past trauma. Instead, individuals learn to recognize the distressing memory and the physical or emotional sensations elicited, accept what they are feeling, then move past it and continue on with their life.


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