PTSD and Substance Use Disorder: Signs of Self-Medication

Various types of trauma can cause post-traumatic stress disorder (PTSD), a mental health disorder that is characterized by high levels of fear and disturbing thoughts or feelings related to a specific traumatic event or series of events. People who have PTSD and a history of trauma are more likely to develop a substance use disorder than others as a self-medication strategy.

Read on to find out more about PTSD and how substance use disorder comes into play for people who suffer from the disorder.

What Is PTSD?

PTSD is a mental health disorder that develops after a person is either witness to or involved in a traumatic event. Examples of traumatic events include natural disasters, serious accidents, and being in a war, especially active combat.

PTSD was originally associated with people who had fought in wars. It was referred to as “shell shock” or “combat fatigue” during World Wars I and II.

It was later discovered that PTSD can happen to anybody who experience any form of trauma regardless of their ethnicity, gender, nationality, culture, or age. According to the American Psychiatric Association, as many as 3.5% of American adults cope with PTSD every year.

PTSD recovery sometimes can be divided into stages. These include:

• Impact: This stage occurs directly following the incident.
• Denial/Numbing: In this stage, people avoid dealing with their emotions as a way of protecting themselves.
• Rescue: Rescue involves coming to terms with trauma.
• Intermediate recovery: This is when recovery begins, and the person with PTSD is starting to exit survival mode.
• Long-term recovery: The long-term recovery stage occurs when a person with PTSD works through a treatment or recovery plan to develop proper coping mechanisms and skills to move forward with their life. 

What Are the Symptoms of PTSD?

PTSD can be a debilitating condition. According to the diagnostic criteria used in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), 20 symptoms that are divided into four groupings are used to diagnose PTSD. They include:

• Intrusion: People with PTSD experience intrusive and repetitive thoughts surrounding the traumatic event, such as distressing dreams and flashbacks that feel so real that people may believe they are reliving the incident.
• Avoidance: Practicing active avoidance includes staying away from people, places, objects, or activities that may bring up a memory of the traumatic event. Avoidance may also involve a reluctance to talk about the event and trying to avoid thinking about it.
• Negative alterations in cognition and mood: When people have trouble remembering events associated with the trauma, have negative feelings and thoughts about themselves, and have ongoing feelings of fear, horror, anger, guilt, or shame they are exhibiting mood and cognitive changes that can occur in a person with PTSD. A person with the disorder may also feel detached from others and lack the ability to feel happiness or joy.
• Marked alterations in arousal and reactivity: Some examples of alterations in arousal and reactivity are angry outbursts, behaving in a reckless manner, or engaging in self-destructive behaviors. A person with PTSD may also be overly alert in their surroundings, easily startled, and have difficulties with both sleep and concentration. 

What Are the Types of Trauma Linked to PTSD?

Many people used to believe that PTSD was simply a combat veteran’s disorder, however, it can happen to anyone. Types of trauma that can be linked to PTSD include:

• Witnessing another person being killed or getting badly injured
• Being in an accident that is serious or life-threatening in nature
• Being threatened with bodily harm by a person with a weapon
• Living through a natural disaster
• Being in combat
• Being raped or exposed to sexual abuse as a child
• Being the victim of intimate partner violence

Is There a Link Between PTSD and Substance Use Disorder?

PTSD and substance use disorder go hand in hand for many people. This is because substances appear to grant temporary relief from symptoms.

How Many People With PTSD Have a Problem With Substances?

The risk of people with PTSD abusing substances is 3 times higher than it is in the general population. Because of their disorder, people with PTSD are highly vulnerable when it comes to substance reliance and substance use. According to research, up to 36.6% of people with substance use disorder also have PTSD.

Why Do People With PTSD Turn to Self-Medicating?

After traumatic events, people may turn to substances to help them cope with their symptoms. The type of symptoms a person experiences may also dictate the substances they will use to help cope with their disorder. For example, certain symptoms that involve the inability to calm the mind may drive a person to use depressants such as alcohol.

Other Theories About the Link Between PTSD and Addiction

When a person with PTSD begins to self-medicate to cope with the symptoms of their disorder, they often begin to feel relief. However, that relief only occurs when they are using the substances.

This leads to an increased risk of substance use because the only time people with PTSD may feel as though they can control or cover up their thoughts, feelings, or actions is when they are under the influence of certain substances.

The reliance on these substances to feel positive emotions and escape from the negative ones can contribute to addiction.

What Other Conditions Co-Occur with PTSD?

Substance use disorder is an example of a mental health disorder that co-occurs with PTSD. Other conditions or symptoms that can develop in a person with PTSD include:  

• Panic disorder or other anxiety disorders
• Depressive disorders
• Suicidal thoughts or ideations

How to Treat PTSD and Substance Use Disorder

Treating someone with both PTSD and substance use disorder is a complicated process. The outcome of treatment is also less favorable when compared to treating a person with just one of the two conditions. There are several treatment options available for someone who has both PTSD and substance use disorder.

Effective Therapy Approaches

Cognitive behavioral therapy (CBT), which is a type of therapy that focuses on problematic thought processes and behaviors, is one of the most effective treatments for PTSD and substance use disorder. One specific type of CBT that has been shown to be effective for both disorders is prolonged exposure.

Prolonged exposure therapy allows people to take a gradual approach to their trauma-based feelings and memories so that the fear can be processed in a healthy way. The two facets of exposure used in this type of therapy are:

• In vivo: In vivo exposure encourages people to create a list of situations that are safe yet triggering so they can repeatedly engage in those activities or situations until the fear is relieved.
• Imaginal exposure: This type of therapy has a person recount their trauma to their therapist for up to an hour without stopping. The sessions are recorded so that the person with PTSD can replay them every day.

These methods of therapy have been shown to be effective for people who suffer from both substance use disorder and PTSD.

Cognitive processing therapy is also strongly recommended for people with PTSD. It works by challenging and modifying unhelpful beliefs related to the trauma in a way that leads to changes in disturbing thought patterns or behaviors.

Mindfulness Training to Reduce Anxieties

Mindfulness is a practice that is used to encourage people to pay attention to and be fully present in the current experience and to nonjudgmentally accept feelings, thoughts, and sensations regardless of how negative they are. For people with substance use disorder and PTSD, mindfulness is designed to help a person become less reactive or overwhelmed by feelings of fear that may lead to substance use.

Medications for Underlying Conditions

There is little research surrounding the use of medications for PTSD and co-occurring substance use disorder. Medications may be given for symptoms of PTSD, and, in addition, medication-assisted treatments for substance use disorders may also be prescribed.

One study looked at alcohol overuse in people with PTSD and found that combining the medications Paxil (paroxetine) and Vivitrol (naltrexone) led to both fewer PTSD symptoms and a reduction in days in which a person drank heavily. Paroxetine is an antidepressant and naltrexone is a type of opioid drug.

By combining medications that work on both PTSD symptoms and substance use disorder, researchers were able to find something that could positively influence the recovery of both conditions.

The Seeking Safety Program

The Seeking Safety program is a nonexposure-based therapy that helps patients with co-occurring substance abuse and PTSD. Topics raised during the Seeking Safety program are:

• Detaching from any emotional pain
• Asking for help
• Feeling compassion for oneself
• Being honest about trauma and trauma-related issues
• Taking advantage of community resources such as support groups
• Coping with triggers
• Nurturing the self to help cope with symptoms
• Recovery thinking, which involves talking to oneself with both respect and support to help quell negative self-talk and feelings

Other Substance Use Treatments

According to the American Addiction Centers, substance use disorder requires different forms of treatment. They include:

• Detoxification: For people who are addicted to a substance, stopping it altogether can bring on significant health conditions. A supervised detox program gives people the opportunity to detox in a safe and comfortable environment. Detox is the term used to describe ridding the body of a particular substance or toxin completely.
• Inpatient or outpatient rehab: In- and out-patient rehab are similar in that they encourage people to refrain from using substances while attending therapy. In inpatient rehab, people remain in a facility overnight for a certain amount of time.

Other PTSD Treatments

Aside from the aforementioned therapy methods, PTSD can be treated using:

• Brief eclectic psychotherapy (BEP): The main goal of BEP is to change negative thoughts and feelings while using elements of CBT and psychodynamic psychotherapy, which is a form of therapy that gets to the root cause of an issue.
• Eye movement desensitization and reprocessing (EMDR): This type of therapy exposes a person to images, emotions, and sensations of the trauma experienced in a safe way so that the brain can slowly heal and process emotions in a different and more adaptive manner.
• Narrative exposure therapy (NET): NET works by having a person narrate their life with a large focus on the traumatic events they experienced. It is designed to encourage understanding of the event that allows a person to process and re-contextualize the traumatic experience.
• Medications: Medications used to help treat PTSD include antidepressants and antianxiety medications.

Summary

PTSD and substance use disorder are often co-occurring conditions. Self-medicating can be an easy to way to escape the negative thoughts or sensations for a short time. However, using substances to help quell the negative emotions does not help in the long term.

There are many techniques and treatment options available for people who are suffering from PTSD and substance use disorder, such as therapy, medications, and mindfulness practices. Getting help as soon as possible for both PTSD and substance abuse will aid in a quicker and more lasting recovery. 

A Word From Verywell

Living with PTSD can be extremely difficult. When you find something that helps dim the negative feelings, thoughts, or behaviors, it’s easy to fall into the trap of using it to help shut out the memories of your trauma. Unfortunately, the relief is generally short lived and may even lead to worsening of the disorder.

Traumatic experiences are personal and only you know how you feel. Getting proper treatment for both substance use disorder and PTSD can help you get through your past trauma.