Post-traumatic stress disorder (PTSD) and substance abuse interact in complex ways. As an intense anxiety disorder, PTSD deeply affects a person’s ability to feel safe, cared for, and calm. Unfortunately, many people who develop PTSD may attempt to self-medicate with drugs or alcohol to alleviate their symptoms. In addition, people who struggle with addiction are more likely to experience or witness an event that causes them to develop PTSD.
What Is PTSD?
Post-traumatic stress disorder (PTSD) is a mental health condition that develops when a person experiences or witnesses a life-threatening event. Natural disasters, terrorist attacks, wars, serious accidents, or assaults are all experiences that might cause a person to develop PTSD, according to the Office of Veterans Affairs (VA). Of course, PTSD does not necessarily develop immediately after any of these experiences. For the first few days or weeks after such an intense event, it is normal to have insomnia, nightmares, anxiety, and other symptoms; however, if a person continues to experience these symptoms for months after the event, they get worse, or they have a delayed start, it is an indicator of PTSD.
Aside from an inciting incident, no one is entirely sure what causes PTSD. Like other mental health and substance use disorders, it is a combination of genetics, environment, and experiences. Due to chemistry and neuron patterns, some people’s brains could be more likely to develop PTSD if they are exposed to life-threatening danger. However, PTSD is not a sign of weakness, and it can happen to anyone.
The National Center for PTSD reports that at least seven or eight people out of every 100 will experience PTSD at some point in their life; this includes people of any age, gender, personal history, or job history. However, some groups of people are at greater risk than others: women and war veterans, for example. The Anxiety and Depression Association of American (ADAA) notes that 7.7 million Americans ages 18 and older have PTSD, as do 67 percent of people who have been exposed to mass violence. Those who have experienced trauma in the past are more likely to develop PTSD.
Four signs of PTSD include:
- Reliving the event: Flashbacks, memories, or nightmares are ways a person re-experiences the trauma associated with the event that triggered PTSD.
- Avoiding certain situations: If something is likely to remind the individual of the dangerous event, they are likely to avoid it or panic if they cannot avoid it.
- Having lower mood, negative feelings, or beliefs: A person is more likely to see the world as a harder place to live in or people as less friendly or helpful. The person is also more likely to view themselves in a negative light.
- Hyperarousal: The individual is more likely to feel jittery, “keyed up,” have trouble concentrating, or experience panic attacks.
People who develop PTSD are likely to experience symptoms and display certain behaviors, such as:
- Experiencing shame with no cause
- Feeling despair
- Substance abuse, especially issues with cigarettes, alcohol, and marijuana
- Physical symptoms like heart pain, fatigue, or chronic muscle or joint pain
- Trouble with employment, school, or personal relationships
To be diagnosed with PTSD, a person must meet the following criteria, as laid out in the DSM-5:
- At least one symptom must be re-experienced
- At least one instance of avoidance
- Two arousal or reactivity symptoms
- At least two cognition and mood symptoms
Specifics of Substance Abuse and Addiction
Substance use disorders are among the most common behavioral disorders in the US. The American Society of Addiction Medicine (ASAM) defines substance abuse and addiction as a primary, chronic disease that changes the reward center of the brain. Drugs and alcohol change how neurotransmitters are released and absorbed by neurons, which increases a person’s sense of pleasure, relaxation or stimulation, and wellbeing. Because the reward center gets triggered by dopamine, serotonin, and other neurotransmitters, the individual is likely to associate the euphoria from drugs and alcohol as positive; then, after consuming drugs compulsively to achieve a certain balance of neurotransmitters, the individual is likely to develop physical dependence on and tolerance to the substance. Dependence means the body needs the presence of the addictive chemical to feel normal; tolerance means they require larger doses of the chemicals to get the original level of intoxication.
Types of substances most often associated with PTSD include:
- Opiates or opioids
- Anxiolytics or anti-anxiety drugs
- Analgesics or painkillers
Consuming drugs and alcohol causes serious physical harm, and experimenting with substances puts a person at greater risk for developing an addiction. However, mental health conditions are also closely associated with substance abuse; one will often trigger the other. Post-traumatic stress disorder is often linked with substance abuse because suffering that kind of anxiety disorder puts a person at risk of developing a substance abuse problem while struggling with substance abuse puts a person in vulnerable, potentially dangerous situations and increases their likelihood of developing PTSD.
When PTSD and substance abuse occur together, they are referred to as co-occurring disorders. In the veteran population, according to the VA, two out of 10 veterans in the United States have both PTSD and a substance use disorder (SUD). Veterans who abuse alcohol are more likely to binge drink when symptoms intensify than drink heavily but consistently. One out of every three veterans who seek treatment for SUD have diagnosable PTSD.
Veterans who have received a PTSD diagnosis smoke cigarettes at twice the rate of those who do not have PTSD – six out of 10 compared to three out of 10, respectively. Inpatient substance abuse treatment programs have reported that half their clients meet the criteria for PTSD alongside their SUD when they enter treatment.
How Do PTSD and SUD Affect Each Other
One report using urinalysis to study the prevalence rates of certain substances among those struggling with PTSD found that certain drugs presented at different rates than others:
- Opiates: 23 percent
- Marijuana: 20 percent
- Benzodiazepines: 11 percent
- Cocaine: 8 percent
- Other drugs: 5 percent
Another survey examined the correlation between specific substances people struggled with and how many of those people also had PTSD. Forty-five percent of people dependent on cocaine addiction also had PTSD. Twenty-four percent of those currently struggling with cocaine addiction also had PTSD.
Cocaine appears to increase a person’s risk of developing PTSD after suffering a traumatic event. Opioids also put people mentally at risk of developing PTSD, though at lower rates than cocaine. Withdrawal symptoms for both may include recurring PTSD symptoms or exacerbation of those symptoms.
Long-Term Health Problems with PTSD and SUD
People who struggle with untreated PTSD for a long time may, even if they do not develop substance abuse problems, develop other health issues from consistent stress on their bodies. There is no conclusive link between physical and mental health, but some conditions appear to correlate. Some of these conditions include:
- Cardiovascular problems
- Heart attacks
- Musculoskeletal problems and chronic pain
- Gastrointestinal disorders, including ulcers
Substance abuse has direct, measurable impacts on the body. Depending on what types of substances are abused, long-term health risks can affect specific bodily systems. However, most long-term substance abuse that goes untreated typically harms multiple body systems. Some of these include an increased risk of:
- Cardiovascular damage and morbidity
- Lung disease
- Kidney failure
- Liver damage
- Other mental illnesses, like anxiety or depression
- Infectious diseases, especially HIV, pneumonia, tuberculosis, and hepatitis B and C
Treating Substance Abuse and PTSD
Clinicians must assess their clients for co-occurring disorders in order to appropriately treat both conditions. Exposure therapy is one kind of therapy found to help PTSD very effectively, while Cognitive Behavioral Therapy works well for substance use disorders. Medical interventions may be necessary to help people suffering from potentially life-threatening withdrawal symptoms or extremely uncomfortable symptoms. Working with a care team that includes physicians, pharmacists, counselors, and therapists in a rehabilitation program that is equipped to treat co-occurring disorders will allow people to get the best treatment possible.