“I need a drink.” That’s the phrase characters on television shows use when they’ve been exposed to some type of tragic event. The implication is that substance use allows these characters to soothe their minds and forget about the trauma they’ve seen, so the plot can move forward and the writers can inflict yet more pain on these suffering creatures. In reality, substance abuse and trauma can weave a tangled web with the abuse augmenting the suffering, rather than providing relief. This is particularly true of people who develop an acute stress disorder in the aftermath of a traumatic event. People like this might reasonably lean on either drugs or alcohol to help them cope, but they might need to put those substances away in order to really process and recover from the horrible things they’ve seen.
Few people can plan ahead for tragedy. Instead, most traumatic events take people by surprise, unfolding in minutes that can change the course of a person’s life. Some people who survive an event like this feel lucky, as though they’ve been spared from a terrible fate that was barreling in their direction. There are some people, however, who react to an event like this with feelings of helplessness or even horror. People like this might be incapable of moving past the event.
In 2003, researchers attempted to study how a group of people reacted to a sudden and terrible episode of violence that exploded all around them. In this study, published in the journal Psychiatric Services, researchers examined the staff members of a hospital that was under attack by snipers. In the days that followed, three percent admitted to an increased use of alcohol, and six percent met the diagnostic criteria for an acute stress disorder.
This isn’t a diagnosis that’s tossed out lightly. Instead, it’s a medical condition that is only diagnosed when people can demonstrate a specific set of symptoms appearing within days of the event. Those symptoms include:
- Flashbacks or repeated thoughts of the events that took place
- Avoidance of triggers that cause the person to remember the event
- Hyper-arousal, including inability to sleep, poor concentration or restlessness
- A feeling of disassociation
The symptoms must be so severe that they impact the person’s ability to handle day-to-day tasks. People with these advanced symptoms might feel simply unable to handle heading to work, talking to others or riding in mass transit systems. They may find food unappealing, and television shows may make them weak with fear. They may also feel as though life isn’t really happening to them, as though they’re fictional characters in a play or spiritual creatures that died when the event took place.
Minor episodes of distress don’t seem capable of bringing about this level of dysfunction. Participating in a fender-bender, for example, might be distressing and nerve-wracking, but it might also be the sort of episode people can forget in a day or two. The episodes that are capable of triggering an acute stress disorder are just much more intense. These episodes typically involve death, intense violence or grievous injury.
The Role of Substance Abuse
The American Psychiatric Association reports that substance use is common in the wake of an episode like this, and people might develop substance abuse disorders quite rapidly in the days that follow, even if they never had a history of this type of behavior. There are a number of reasons why substance use might seem attractive to people who have an acute stress disorder, and often, people who have both addictions and acute stress disorders believe they’re actually trying to make themselves feel better.
People with this mental illness may feel as though sleep is elusive and relaxation is impossible. They may find it hard to turn off their minds and relax, as their thoughts are filled with terror as soon as they close their eyes. Using an opiate or a sedative might seem helpful as it can calm that overactive mind and allow feelings of relaxation to set in. People may begin to use substances in the evening, hoping to fall asleep a little easier, but they might quickly begin to use and abuse drugs during the day as well.
Experiencing terror, over and over again, can also make life seem as though it’s just not worth living. Each waking moment of the day is worrisome, and it seems as though things will just never improve. Some substances of abuse can seem attractive, as they can boost pleasurable chemicals in the brain and provide the person with the sensation that life is warm and pleasant. They may not believe these sensations, of course, but the drugs might provide the illusion that life is really worth living. Unfortunately, in time, people may find that they can only feel happy in the presence of drugs, as their brain cells may no longer make pleasurable chemicals without the prompt that drugs can provide.
Since acute stress disorder is also associated with feelings of restlessness and fear, stimulant drugs might also seem appealing. These drugs can make helpless people feel powerful and strong, capable of handling any event that may come to pass. People who lean on these drugs may feel as though they’re wearing a chemical suit of armor that might protect them from future harm. It can be incredibly enticing.
Adding abusive drugs to this mental health issue can be deadly, as the substances can cause chemical damage to vital brain cells.
In time, these cells may be incapable of functioning properly without the presence of drugs, and people may experience symptoms of withdrawal when they attempt to stop using the substance they once thought of as helpful. In addition, many substances of abuse can make the symptoms of acute stress disorder much more severe. The episodes of anxiety and nervousness might be much more intense, and the hallucinations that some of these drugs cause can make flashbacks seem as though they’re happening in real time.
Addictive drugs can also erode the portion of the brain that deals with impulse control, allowing people to act upon any thought that pops into their minds. For people with acute stress disorder, these thoughts may concern running or fleeing, and they may become liable to evade their responsibilities and hide from the people they love. Some people with acute stress disorder may even contemplate suicide, and substance abuse may make those impulses hard to ignore. In fact, in a study in the International Journal of Epidemiology, researchers found a connection between completed suicide attempts and substance use, suggesting that drugs can make people do things they might never feel compelled to do while sober.
Even if addictions don’t set in, and people don’t make terrible mistakes due to their drug use, leaning on addictive substances can keep people from getting the help they need in order to deal with an acute stress disorder. The drugs might help them feel as though they’re in control and therapy isn’t needed, and as a result, their mental illness can progress unchecked. Without help, people with acute stress disorder can develop post-traumatic stress disorder (PTSD). In fact, the National Center for PTSD reports that about 80 percent of people with acute stress disorder go on to develop PTSD.
PTSD very serious mental illness can lead to:
- Even more intense substance abuse
- Feelings of depression or hopelessness
- Divorce or other relationship problems
- Employment difficulties
- Severe isolation
Getting help for acute stress disorder and the substance abuse that feeds into that disorder could be the key that keeps this more serious mental illness from taking hold.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.