Co-Occurring Post-Traumatic Stress Disorder (PTSD) & Addiction

Among people with post-traumatic stress disorder (PTSD), it is estimated that 36% to 52% also have a lifetime drug or alcohol addiction. When a mental health disorder and a substance use disorder occur together, they are referred to as co-occurring disorders.¹

This article will cover what post-traumatic stress disorder is, the signs and symptoms of PTSD and substance use disorder, and how to help someone with PTSD and addiction.

What Is Post-Traumatic Stress Disorder (PTSD)?

Post-traumatic stress disorder (PTSD) is a mental health disorder that can develop after a person experiences a traumatic event. PTSD can develop at any age from traumatic events which include but are not limited to:^1,2

• Physical assault
• Sexual assault
• Terror attack
• Natural or man-made disaster
• War or military combat
• Motor vehicle accident
• Witnessing violence

An individual can develop PTSD from:¹

• Experiencing a traumatic event firsthand.
• Witnessing a traumatic event.
• Learning about traumatic events that happened to a close loved one.
• Repeated exposure to details of trauma as a part of one’s job.

Not everyone who experiences trauma will develop PTSD. It is estimated that about 60% of men and 50% of women in the United States experience trauma in their lives but only 4% of men and 8% of women develop PTSD.³

Signs & Symptoms of PTSD

Knowing the signs and symptoms of PTSD can be helpful in deciding when to seek help. According to the Diagnostic and Statistical Manual of Mental Disorders (5^th Edition) used by professionals to diagnose PTSD, the diagnostic criteria are divided into 4 categories, each of which involves symptoms that are associated with the traumatic event(s). These criteria include:⁴

1) One or more intrusion symptoms, such as:

• Recurrent, intrusive, and involuntary distressing memories of the trauma(s).
• Recurrent distressing dreams about the trauma(s).
• Flashbacks in which the person re-experiences the traumatic event(s).
• Intense and upsetting feelings of distress at exposure to internal or external cues that resemble the traumatic event(s).
• Physiological reactions at exposure to internal or external cues that resemble the traumatic event(s).

2) One or both of the following avoidance symptoms:

• Efforts to avoid distressing thoughts, feelings, or memories about the traumatic event(s).
• Attempts to avoid people, conversations, places, objects, situations, and activities that provoke distressing thoughts, feelings, or memories of the trauma(s).

3) Two or more of the following negative changes in cognition and mood symptoms:

• Dissociative amnesia, also known as an inability to remember aspects of the traumatic event(s).
• Persistent and excessive negative beliefs about others, the world, and oneself. For example, “I can’t trust anyone,” “I am a bad person,” or “the entire world is dangerous”.
• Distorted thinking about the consequences or cause of the traumatic event(s) that can lead to blaming oneself or others.
• Repeated negative emotional states including anger, guilt, horror, shame, or fear.
• Significantly diminished interest and/or participation in activities.
• Feeling detached from others.
• Inability to experience positive emotions including feelings of love, happiness, and satisfaction.

4) Two or more of the following changes in reactivity and arousal symptoms:

• Outbursts of anger or irritable behavior from little to no provocation.
• Self-destructive and reckless behavior.
• Hypervigilance.
• An exaggerated startle response.
• Issues with concentration.
• Sleep difficulties including restlessness or difficulty falling asleep.

Symptoms need to be present for more than 1 month and cause clinically significant impairment or distress in important areas of functioning. PTSD, as well as other mental disorders, can only be diagnosed by a licensed professional.

Co-Occurring PTSD and Drug or Alcohol Addiction

It is estimated that 50% of people who experience mental illness will also experience drug or alcohol addiction in their lives.⁵ Individuals with PTSD have up to 1.5 increased odds of also having a substance use disorder.¹

Symptoms of Co-Occurring PTSD and Addiction

Symptoms of co-occurring PTSD and addiction often include a mix of symptoms from both disorders. In addition to the symptoms of PTSD previously listed, individuals also display symptoms of substance use disorders.

Addiction, more formally diagnosed as a substance use disorder (SUD), is characterized by the compulsive use of drugs or alcohol that often continues despite the harmful consequences of these substances.⁴

A list of criteria used by professionals to diagnose a substance use disorder can be found in the Diagnostic and Statistical Manual of Mental Disorders (5^th Edition) and includes the following:⁴

• The substance is taken in larger quantities or over a longer duration than intended by the individual.
• An inability to reduce or discontinue use of the substance despite a desire to do so.
• A lot of time is spent obtaining, using, or recovering from the substance.
• There is a strong urge or desire to use the substance, also known as craving.
• A failure to fulfill major obligations at home, school, or work due to continued substance use.
• Repeated substance use despite social or interpersonal problems worsened or caused by the effects of the substance.
• Reducing or giving up important occupational, recreational, or social activities due to substance use.
• Being put in physically dangerous situations because of recurrent substance use.
• Continued substance use despite knowing psychological or physical problems are likely caused or made worse by the substance use.
• A need for noticeably larger amounts of the substance to achieve intoxication or the wanted effect, also known as tolerance.
• Acute negative symptoms when the substance isn’t taken, also known as withdrawal.

As with PTSD, substance use disorders can only be diagnosed by a licensed professional but knowing the signs and symptoms can be helpful in recognizing when someone is suffering from PTSD and addiction.

Can PTSD Cause Substance Use Disorder?

The presence of PTSD and a substance use disorder doesn’t mean that one disorder caused the other.⁵ It is often difficult to know what came first, PTSD or addiction.

However, having PTSD can lead to a greater risk of developing drug or alcohol addiction. Both PTSD and addiction have common risk factors that can lead to a higher chance of developing a co-occurring disorder.⁵

Risk Factors for PTSD

Risk factors for developing PTSD include but are not limited to:^2,6

• Exposure to traumatic events or dangerous situations.
• Having little to no support from family or friends after the traumatic event.
• Having extra stress after the traumatic event including loss of a home or job, loss of a loved one, experiencing pain, or suffering an injury.
• Having a family history of mental illness.
• Childhood trauma.
• Seeing others hurt or killed.
• War zone deployment.

Risk Factors for Substance Use Disorder

Researchers estimate that 40% to 60% of a person’s susceptibility to developing a substance use disorder is due to genetics. Other risk factors for substance use disorders include:⁵

• Environmental influences.
• Chronic stress.
• Trauma.
• Negative childhood experiences.
• Brain region involvement.

People with PTSD may begin using drugs or alcohol as a way of attempting to reduce the distressing symptoms of PTSD and avoid dealing with the trauma. This “self-medicating” can lead to drug and alcohol addiction.⁵

Veterans With PTSD and Substance Use Disorder

Veterans are at an increased risk of developing PTSD compared to non-military individuals.⁷ It is estimated that almost 1 out of every 3 Veterans seeking treatment for drug or alcohol addiction also has PTSD.⁸

River Oaks Treatment Center has an addiction treatment program for Veterans called Salute to Recovery. This program was created to specifically meet the needs of Veterans.

To build a strong community of people who can understand and relate to each other, patients participate in groups with other Veterans. Treatment is geared toward rebuilding from traumatic experiences by learning about topics such as:

• Post-traumatic responses.
• Military culture.
• Grief and loss.
• Relapse prevention.
• Values and character.
• Family and relationships.
• Pain management.

Another helpful resource for Veterans is the VA. The VA supports substance use disorder treatment through the MISSION Act and other community care programs.

River Oaks also offers specialized trauma-informed care for first responders, including police, EMTs, firefighters, and more.

How to Help Someone With PTSD and Substance Use Disorder

There are several ways you can help a loved one with addiction and PTSD, including:⁹

• Communicating your concerns openly and honestly.
• Being patient and showing compassion.
• Refraining from judgment or blame.
• Researching treatment facilities.

Your support can make a difference in your loved one’s recovery.

Treating Co-Occurring PTSD and Drug or Alcohol Addiction

Research has shown that treating PTSD and substance use disorders together yields better treatment outcomes than treating each disorder separately.⁵ With this in mind, River Oaks approaches co-occurring PTSD and addiction treatment with an integrated treatment approach.

Our drug rehab in Tampa, FL, offers various levels of addiction treatment to fit the needs of each patient. Levels of care provided include:

• Medical detox.
• Inpatient residential rehab.
• Outpatient rehab.

Each program at River Oaks offers many addiction and co-occurring disorder therapies ranging from cognitive behavioral therapy to holistic therapy and family therapy.

River Oaks offers multiple rehab payment options, with or without insurance. If you are unsure about what your rehab insurance coverage is, you can instantly check your addiction treatment coverage by completing our .

For more information on our rehab admissions process, reach out to an admissions navigator by calling . We’re available 24/7 to help you start your journey to recovery.