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Is There a Connection Between Drug Abuse and PTSD?

In the United States, it is estimated that about 3.6 percent of adults have experienced post-traumatic stress disorder (PTSD) in the past year, according to the National Institute of Mental Health. The estimation for the lifetime prevalence of PTSD is about 6.8 percent of Americans.

Scientists and mental health professionals have been looking into the possible link between PTSD and addiction. This information could help people and their health care providers to better understand how this dual diagnosis occurs.

WHAT IS PTSD?

PTSD is classified as a type of psychiatric disorder. It typically occurs after someone witnesses a traumatic event, such as war or combat, a violent personal or sexual assault, a serious accident, or a natural disaster. PTSD may occur shortly after the trauma or sometimes not until years later, according to the Anxiety and Depression Association of America.

People of all ages are at risk for developing PTSD if they experience or witness a trauma. Compared to men, women are more susceptible to this condition. Experts are not completely sure why some people develop PTSD after trauma and others do not. However, the following are believed to play a role, according to  the Mayo Clinic:

  •  Stressful experiences
  •  Inherited personality features
  •  Inherited mental health risks
  •  The way the brain regulates hormones

When someone has this condition, they may be fine, but then a trigger happens to cause them to experience symptoms. They experience the fight-or-flight response that causes their symptoms to occur because the trigger makes them feel like they are in harm’s way even if they are safe, according to the National Institute of Mental Health.

PTSD can be short-term or long-term. The symptoms of this disorder fall into four categories, according to the American Psychiatric Association.

Avoiding reminders: The person will try to avoid anything that reminds them of the trauma they experienced. They might also refuse to discuss the trauma.

Arousal and reactive symptoms: The symptoms in this category may include angry outbursts, self-destructive or reckless behavior, sleeping problems, irritability, being startled easily, and trouble concentrating.

Intrusive thoughts: Symptoms in this category may include involuntary, repeated memories, traumatic event flashbacks, and distressing dreams or nightmares.

Negative feelings or thoughts: These symptoms might include distorted beliefs about other people or oneself, lost interest in pleasurable activities, feeling estranged or detached from other people, and ongoing feelings of horror, shame, fear, anger, and guilt.

Another possible symptom of PTSD is suicidal thoughts. When someone with PTSD is having suicidal thoughts, they often show the following behaviors, according to the University of Michigan:

  •  Planning to hurt others or oneself
  •  Having a weapon
  •  Feeling out of control of one’s thoughts
  •  Giving away possessions
  •  Hearing voices that promote harming oneself
  •  Thinking about killing oneself
  •  Taking a lot of alcohol or drugs
  •  Spending a lot of time alone
  •  Drawing or writing about suicide or death

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IS THERE A CAUSAL OR CORRELATIONAL RELATIONSHIP BETWEEN PTSD AND DRUG ABUSE?

It is estimated that up to two-thirds of people with PTSD also have a substance use disorder, according to research presented in Time. People with PTSD might turn to alcohol or drugs to self-medicate in an attempt to calm their distressing symptoms. Unfortunately, alcohol and substance abuse tend to worsen PTSD and its symptoms.

The PTSD Alliance lists the following statistics regarding substance abuse among people with PTSD:

  •  Drug abuse is three times more common among people with PTSD compared to people without PTSD
  •  Nicotine dependence is two times more common among people with PTSD compared to people without PTSD
  •  About half of all people with PTSD abuse alcohol

It is estimated that among people who seek treatment for a substance use disorder, about 40.6 percent of them also receive a diagnosis of PTSD, according to research published in the Health Science Journal. Because of this, it is theorized that PTSD makes someone more vulnerable to addiction, but also that addiction may increase a person’s risk of developing PTSD. However, more research is necessary to determine how one disorder affects someone’s development of the other.

WHAT ARE THE COMMON DRUGS OF ABUSE AMONG PEOPLE WITH PTSD?

There does not appear to be a specific drug that people with PTSD favor; however, alcohol appears to be a common substance of abuse. In fact, it is estimated that one-tenth to one-third of the people who experience a trauma also admit to problematic alcohol use, according to the International Society for Traumatic Stress Studies.

Another study published in Recent Developments in Alcoholism looked specifically at U.S. military veterans with diagnosed PTSD. This study concluded that about 60 percent to 80 percent of them also had an alcohol use disorder.

Once the initial trauma is over, a person can experience temporary endorphin withdrawal, according to information published by the National Institute on Alcohol Abuse and Alcoholism.

This can result in emotional distress and other PTSD symptoms. Alcohol can increase endorphin activity, providing a temporary reprieve from the uncomfortable symptoms. This is believed to be the reason why many PTSD sufferers turn to alcohol.

However, alcohol ultimately makes someone’s PTSD worse. It can worsen the depressive symptoms and other consequences of this disorder.

The acronym PTSD emboldened and highlighted in a book

People can develop a tolerance to alcohol quickly, causing them to need larger amounts to achieve the same feeling. This can lead to alcohol addiction.

Other drugs that someone with PTSD might abuse include anti-anxiety medications, heroin, and prescription opiate painkillers.

WHAT STEPS SHOULD BE TAKEN FOR THOSE WITH THIS DUAL DIAGNOSIS?

PTSD symptoms can be made worse by drug withdrawal symptoms, making it harder to overcome a substance use disorder. Coping with PTSD symptoms by abusing alcohol or drugs can delay treatment and make someone’s PTSD symptoms last longer, according to the American Academy of Experts in Traumatic Stress.

Due to treatment challenges, it is imperative that programs simultaneously treat a person’s PTSD and substance use disorder. Such programs may include a combination of the following:

  •  Supportive counseling
  •  Skills-building classes to help people cope
  •  Art therapy
  •  Group activities and therapy
  •  Classes to learn more about substance abuse and PTSD
  •  Relaxation exercises
  •  Medical care

Some of the treatments will focus more on one disorder than the other. For example, a person might undergo medical detox for alcohol or substance abuse. For the PTSD specifically, the U.S. Department of Veterans Affairs cites the following as possible treatments:

  • Cognitive processing therapy helps people to change the negative feelings and thoughts they have been experiencing since the traumatic event.
  • Eye movement desensitization and reprocessing (EMDR) works to help people make sense of the trauma they experienced while simultaneously observing a back-and-forth sound or movement.
  • Prolonged exposure helps people to gradually confront the trauma and other situations and feelings they have avoided since experiencing the trauma.

On average, these therapies last for three to four months. Some people will need longer to learn to manage their substance use disorder and their PTSD. The exact treatment regimen varies among people and will depend on what an individual best responds to.

It is essential that those with PTSD talk to someone and receive proper treatment. Those with a dual diagnosis of a substance use disorder and a mental health disorder should choose a facility that can handle simultaneous treatment of both disorders.

Sources

Post-Traumatic Stress Disorder (PTSD). National Institute of Mental Health from https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd.shtml

(August 2012) How PTSD and Addiction Can Be Safely Treated Together. Time from http://healthland.time.com/2012/08/15/how-ptsd-and-addiction-can-be-safely-treated-together/

Symptoms of PTSD. Anxiety and Depression Association of America from https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd/symptoms

Post-Traumatic Stress Disorder. National Institute of Mental Health from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

What is Post-Traumatic Stress Disorder? American Psychiatric Association from https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

Post-Traumatic Stress Disorder (PTSD). Mayo Clinic from https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967

PTSD and Suicide Thoughts. University of Michigan from https://www.uofmhealth.org/health-library/ad1034spec

PTSD and Addiction. PTSD Alliance. from from http://www.ptsdalliance.org/ptsd-and-addiction/

(2011) Comorbidity of Post-Traumatic Stress Disorders and Substance Use Disorder. Health Science Journal from https://pdfs.semanticscholar.org/bb91/ccb73c76a07fbf96f2ea89b77c776984676a.pdf

Traumatic Stress and Substance Abuse Problems. International Society for Traumatic Stress Studies from https://www.istss.org/ISTSS_Main/media/Documents/ISTSS_TraumaStressandSubstanceAbuseProb_English_FNL.pdf

The Interrelationship of Substance Abuse and Post-Traumatic Stress Disorder Epidemiological and Clinical Considerations. Recent Developments in Alcoholism from https://link.springer.com/chapter/10.1007/978-1-4615-7718-8_2

The Role of Uncontrollable Trauma in the Development of PTSD and Alcohol Addiction. National Institute on Alcohol Abuse and Alcoholism from https://pubs.niaaa.nih.gov/publications/arh23-4/256-262.pdf

PTSD and Problems with Alcohol Use. American Academy of Experts in Traumatic Stress from http://www.aaets.org/article126.htm

Understanding PTSD Treatment. U.S. Department of Veterans Affairs from https://www.ptsd.va.gov/understand_tx/index.asp

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