PTSD, or post-traumatic stress disorder, is a disorder that may develop after people have been the victim of physical harm or experienced the threat of physical harm. Some individuals may develop PTSD after witnessing such an event, despite not being the recipient of the harm or threat of harm. In individuals with PTSD, the brain’s fight-or-flight response is changed, which causes them to feel as if they are in danger when they are not.
PTSD is well known to occur in veterans who were involved in combat, but it can also occur in individuals who were raped, abused, kidnapped, involved in a car accident, or experienced a natural disaster, such as a hurricane or earthquake.
Researchers don’t know why some people develop PTSD while others who go through the same event do not. They are attempting to locate genes that may be involved in the development of PTSD, as it’s likely that genetic makeup may play a role in whether or not the disorder takes hold.
There are multiple signs and symptoms of PTSD, and they generally fall into three categories:
Re-experiencing symptoms: These symptoms involve re-experiencing the traumatic event. They often disrupt daily life and can be caused by thoughts and/or feelings as well as reminders of the trauma.
- Flashbacks, which include reliving the event and can cause rapid heartbeat and sweating
- Terrifying thoughts
Avoidance symptoms: These symptoms can affect daily life as well and cause individuals to change their routines. For example, a war veteran who experienced a traumatic explosion may avoid fireworks or other loud, startling noises.
- Emotional blunting or feeling of numbness
- Avoiding events, places, or objects that remind the individual of the trauma
- Strong feelings of guilt, anxiety, and depression
- Loss of interest in hobbies or activities
- Difficulty remembering the traumatic event
Hyperarousal symptoms: These symptoms are constant and not triggered by reminders of the event. They also affect daily life.
- Difficulty sleeping
- Excessive anger, with or without angry outbursts
- Being easily startled
- Feeling tense
In order to obtain a diagnosis of PTSD, individuals must experience one instance of re-experiencing the event, three signs of avoidance, and two signs of hyperarousal over a period of one month. Sometimes, PTSD may not appear until months, or even years, after the traumatic event.
When individuals have a diagnosis of both PTSD and a substance use disorder, they are considered to have a dual diagnosis. More than 20 percent of Americans with a mental illness also have a substance use disorder, and the reverse is also true.
Most individuals who have this particular dual diagnosis began using drugs and/or alcohol to help dull the symptoms of PTSD, such as drinking to help them sleep.
In fact, PTSD increases the risk that the individual will develop drug and/or alcohol dependence. The United States Department of Veterans Affairs states that more than two out of 10 veterans experiencing PTSD have also developed drug and/or alcohol dependence, and it is more common in individuals who are experiencing ongoing health problems or pain.
PTSD and drug and/or alcohol dependence can cause individuals to experience more problems when attempting to deal with the symptoms of either disorder. Drinking and/or using depressants may help them sleep but can cause poor sleep where individuals wake up not feeling refreshed. Drug and/or alcohol use can increase feelings of anxiety, anger, irritability, and depression; these substances may also make it harder to concentrate.
In addition, substance abuse can complicate treatment for PTSD. People often use substances in an effort to numb emotions, so it’s not likely that someone who is abusing substances will have much progress in therapy. In order to effectively address both issues – PTSD and substance use disorder – treatment for co-occurring disorders is needed.
Individuals should seek care at a facility that is equipped to provide comprehensive treatment for both substance abuse and PTSD. Most healthcare professionals prefer to treat PTSD and substance abuse at the same time, as they believe that some of the symptoms of PTSD, such as nightmares and fear, can lead to substance use relapse if left untreated.
While medications are sometimes used to treat specific systems, such as antidepressants, anti-anxiety medications, and sleep aids, the primary treatment for PTSD and substance abuse is therapy. Therapy comes in many forms and may include Cognitive Behavioral Therapy, group therapy, family and/or couples therapy, and PTSD therapies, such as cognitive processing therapy, prolonged exposure therapy, and Eye Movement and Desensitization and Reprocessing therapy.
Cognitive Behavioral Therapy (CBT) involves individuals working with a therapist to isolate thoughts related to the traumatic event and identifying how those thoughts can cause symptoms to increase.
Individuals will learn how to change these thoughts into more positive ones that will help to decrease the anxiety, anger, fear, and depression that they are already experiencing.
In addition, CBT is often used in substance abuse treatment to identify thoughts that trigger substance abuse and to change behaviors related to those thoughts.
In exposure therapy, individuals will talk with their therapist about the trauma repeatedly, which will help them gain control of their feelings and learn that these memories do not have to increase their feelings of fear and anxiety. Individuals will perform both desensitization and flooding exercises. These will help them work with less severe memories first (desensitization) or to work with many memories at once (flooding).
Group therapy brings individuals with PTSD and substance use disorders together to discuss their trauma, substance abuse, and the feelings they have associated with both issues. Group therapy provides peer support, meaning that individuals can forge relationships with others in similar situations and learn from their experiences.
Family and/or couples therapy can help loved ones understand why individuals experience the feelings and symptoms that are related to PTSD. In addition, family therapy can help to repair relationships that were damaged by addiction or PTSD.
The consensus in the treatment community is that treatment for co-occurring disorders should target both disorders simultaneously. Researchers used to think that treatment for PTSD should not be initiated until individuals had achieved sobriety for a set amount of time, for fear that causing individuals to relive traumatic memories may cause them to relapse to substance abuse. However, a study in Australia showed that exposure therapy was effective for treatment of PTSD, regardless of an individual’s status in recovery from substance abuse. The study followed 103 individuals who were dependent on multiple drugs, mainly heroin, alcohol, and marijuana. The individuals were separated into two groups – one group received treatment for only substance abuse, and the other group received exposure therapy to treat PTSD as well as substance abuse treatment. Those in the exposure therapy group did not experience any negative effects or increased substance use compared to the group that was only treated for substance abuse.
Recovery from both PTSD and substance abuse is possible. The key to effective recovery is comprehensive care that addresses both issues simultaneously. As a result, it’s important to seek out care at a facility that is experienced in treating cases of co-occurring substance abuse and/or addiction and PTSD.