Post Traumatic Stress Disorder (PTSD) and Addiction

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Many people associate post-traumatic stress disorder (PTSD) with military veterans that have witnessed or experienced combat. This is a reasonable assumption, as approximately 20% of veterans from Operations Iraqi Freedom and Enduring Freedom, 12% of Gulf War veterans, and 30% of Vietnam War veterans have been diagnosed with PTSD.

However, recent statistics show that nearly 3/4 of American adults have experienced some form of trauma – rape, the murder or unexpected death of a loved one, natural disaster, severe car accident, house fire, assault, terrorist attack, domestic violence, child abuse, etc. In the United States, mass shootings can also contribute to the development of post-traumatic stress disorder. In addition, some parents can develop PTSD following the diagnosis of a severe illness in their children, such as terminal cancer, and medical professionals and first responders can also develop PTSD after responding to catastrophic, gruesome, or traumatic situations. Of those that witness or experience traumatic events, up to 20% will develop symptoms of PTSD during their lifetime.

Unfortunately, the initial traumatic event can lead to not only PTSD, but also to alcohol and drug use as a way to cope with the trauma and mental health symptoms. The connection between PTSD and alcohol or drug use is significant, with PTSD and addiction often occurring together in those seeking treatment for either condition.

PTSD Overview

Post-traumatic stress disorder has only been recognized as a mental health issue since 1980 when it was added to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. Prior to this, there was much controversy over whether PTSD was a true disorder. It is now well-known and accepted that PTSD is associated with alterations in the structure and function of the brain, which can show up as late as months to years following a traumatic event.

PTSD develops after one has exposure to extreme trauma, whether through personal experience or by witnessing the ordeal. The trauma typically needs to be life-threatening, result in death, or cause significant physical or emotional harm.

Symptoms of PTSD can include:

  • Reliving the event through nightmares, flashbacks, or intrusive thoughts
  • Reminders of the event cause chills, heart palpitations, anxiety, panic, or other physical reactions
  • Avoiding situations that might trigger memories of the event
  • Becoming emotionally detached from family and friends
  • Losing interest in everyday activities
  • Difficulty sleeping
  • Irritability or sudden anger
  • Lack of concentration
  • Being hyper-aroused, easily startled, or constantly “on guard”
  • Depression
  • Anxiety & panic disorders
  • Chronic pain (can be from the trauma or a manifestation of anxiety)
  • Stomach ache with no other biological cause
  • Self-destructive behaviors, such as alcohol or drug abuse or risk-taking behaviors
  • Self-harm or suicidal ideation

While anyone that witnesses or experiences trauma can potentially develop PTSD, there are some things that make a particular person more vulnerable to developing the condition. Those with a greater ability to regulate emotional responses seem to have a higher level of resilience, which is a protective factor against PTSD. This means that children, teens, and young adults whose brains are still developing at the time that they experience trauma are more likely to develop PTSD compared to adults. Individuals that experience multiple traumas, lack a strong support system, have a history of child abuse or neglect, have a pre-existing mental health condition, or who do not have access to affordable and appropriate mental and physical healthcare are also at an increased risk.

Brain Science Behind PTSD  

There are three structures of the brain that play a key role in PTSD. First, the amygdala monitors each situation you encounter. When it recognizes something that resembles danger, whether it is actual danger or the sounds, sights, or smells that were present during previous trauma, the amygdala signals your body to prepare the fight or flight response.

 Second, the hippocampus stores your long-term memories, retrieving them as necessary. The emotional response you have to those memories is also stored in this part of the brain.  Finally, the prefrontal cortex is responsible for decision-making, planning, problem-solving, self-control, and rational thought.

 During a traumatic event, the amygdala signals the body that the event is dangerous. The hippocampus attempts to calm the warning, but if it is unsuccessful, then the event is stored in the hippocampus as a dangerous and traumatic event. The prefrontal cortex is then responsible for helping you react to the situation by fighting back, leaving, or engaging in any number of coping strategies.

 If PTSD develops, there are often changes that occur in the amygdala and hippocampus. This makes it more difficult for the prefrontal cortex to override the hippocampus once the amygdala’s warning system is triggered by a smell, thought, sight, or sound that relates to the initial traumatic event. This means that the body is once again thrown into a fight or flight response, even when the situation is not dangerous. When the body is constantly in a heightened state of alert, the prefrontal cortex’s ability to help you with rational thought and appropriate decision-making is compromised. This can lead to a number of maladaptive coping strategies, including one of the most common connections: PTSD and addiction.

PTSD and Addiction Stats

The link between PTSD and addiction is significant and profound. A study from Maastricht University in The Netherlands found that nearly 37% of patients being treated for a substance use disorder (SUD) also had post-traumatic stress disroder. An astounding 97% of those being treated for a SUD were exposed to some significant trauma during their lives.

The National Center for PTSD‘s statistics reflect this, with 33% of all veterans that seek treatment for substance use disorder also having a comorbid PTSD diagnosis. The National Center for PTSD also found that 20% of all veterans with a PTSD diagnosis also later develop a SUD. There is a strong connection between PTSD and alcohol, and many veterans that have PTSD and use alcohol tend to engage in binge drinking behaviors.

Sexual abuse survivors are another population with a significantly high rate of PTSD. Statistics show that approximately 30% to 50% of rape and sexual abuse survivors develop PTSD. Sexual assault survivors with PTSD are then 13 times more likely to abuse alcohol and 26 times more likely to have a drug addiction compared to the general population. Some studies have also suggested that these survivors have a higher risk of future sexual assaults as a result of alcohol and drug use, trapping these individuals into a cycle of addiction and re victimization.

Children of Addicted Parents: Hidden Victims

An often-overlooked population that frequently exhibits signs of PTSD are children of addicted parents. Children with parents who abuse or are addicted to drugs or alcohol often experience abuse and neglect, with some children even witnessing the overdoses or deaths of their parents.

This population is already at a higher risk of drug and alcohol abuse themselves, but the risk is much higher in children with PTSD. In fact, children of addicted parents are eight times more likely to develop a substance use disorder disorder compared to their peers. These staggering statistics illustrate the importance of providing mental healthcare to the entire family if a parent is undergoing treatment for substance use disorder disorders. Without proper treatment for the children, the cycle of drug abuse and PTSD can continue for several generations.

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Why People with PTSD Use Drugs or Alcohol

It is thought that the hopelessness and frustration that individuals with PTSD feel can lead that individual to seeking extreme ways to cope with those feelings. Perhaps the individual has survivor’s guilt or they believe they should have done something more to save their loved one. They might also be in a situation of repeated abuse and can’t see a way out. Finally, repeated flashbacks and trauma triggers might make them believe that they will never be able to heal and move past the trauma.

Each of these feelings can make the sufferer disparate to find a way to cope. Unfortunately, the connection between PTSD and addiction often stems from these coping mechanisms. Perhaps they see a doctor, who prescribes a benzodiazepine or other anti-anxiety medication or they are prescribed an opioid to deal with the physical pain of the trauma. Using benzodiazepines or opioids over an extended period of time can lead to dependence on those medications, and eventually to abuse or addiction.

It’s a double-edged sword, however, because many doctors will provide patients with only a limited amount of the medication so that it can be used as a short-term solution. If there are still symptoms of PTSD and addiction has already begun, the individual may turn to other substances, such as alcohol or heroin, to dull the symptoms.

The connection between PTSD and addiction is also present through self-medication. Individuals may turn to alcohol or illicit drugs as a way to cope with their pain and anguish, especially if they keep their PTSD a secret. Those with PTSD and alcohol use might have difficulty controlling how much they drink, especially if they need increasing amounts of alcohol to feel the same trigger-dulling effects as previously felt.

Individuals with PTSD and addiction to drugs or alcohol may also continue using as a way to cope with withdrawal symptoms when the effects of the drugs or alcohol wear off. This causes the cycle of PTSD and addiction to continue in an effort to reduce painful withdrawal symptoms.

Those with PTSD and alcohol addiction might also experience job loss, legal problems, or financial problems that increase their stress level, negatively impacting their already-malfunctioning fight or flight response. This might result in increased symptoms of PTSD and alcohol use increases as a way to combat those symptoms.

Regardless of how the PTSD and addiction connection started for a particular individual, the symptoms of PTSD and addiction to drugs or alcohol becomes a reinforcing cycle. The symptoms of PTSD lead to increased alcohol or drug use, which then causes increased anxiety or other difficulties, leading to increased PTSD symptom severity or frequency. This ongoing PTSD and addiction cycle becomes challenging to break.

Because the link between post-traumatic stress disorder and substance abuse is so strong, it is important to examine any potential traumas in individuals with substance use disorders, as well as screen trauma victims for risk factors that might contribute to the development of drug or alcohol addiction.

Treatment Therapy Solutions

Because of the difficulty in breaking the cycle of PTSD and addiction, it is necessary to seek the help of a qualified dual diagnosis treatment program that specializes in both PTSD and alcohol or drug addiction. Programs that treat only the mental health disorder or the substance use disorder are often not successful long-term because the PTSD and addiction cycle is so difficult to break. In contrast, a dual diagnosis treatment center understands the PTSD and addiction cycle and can provide you with the tools needed to detox from alcohol and drug use, cope with symptoms of anxiety and depression, and overcome the significant trauma you’ve experienced in your life.

As part of your treatment for PTSD and addiction, you will be assigned addictions and mental health specialists that can help create a personalized treatment and recovery plan for you. A treatment facility that takes a holistic approach will help you overcome your PTSD and alcohol or drug addiction with individual and group therapy, as well as providing options like art and music therapy, tai chi, yoga, meditation, exercise and physical fitness, spiritual or religious counseling, and outdoor activities designed to help you connect with nature and relieve stress in a healthy way.

Your treatment program will also help you to break the cycle of PTSD and alcohol or drug addiction by helping you develop safe coping mechanisms that you can use when memories of your traumatic event occur so that you can feel safe without causing further harm to your body by turning to self-medication. You will learn how to use techniques like mindfulness to reset your body’s fight or flight response, causing those triggers to lose their ability to impact you.

Experiencing a significant trauma can profoundly impact your life. If you are currently battling PTSD and alcohol or drug addiction, it is important to take the first step and reach out for help. You are not alone in your fight. Getting help is the first step towards living a new life free from addiction, anxiety, and panic.

Medical disclaimer:

Sunshine Behavioral Health strives to help people who are facing substance use disorder, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.

Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.

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