One of the most emotionally debilitating mental disorders, post-traumatic stress disorder causes intense anxiety, intrusive memories and nightmarish flashbacks that interfere with daily life. Many individuals with PTSD will turn to drugs or alcohol as a way to numb their pain or to gain some measure of control in their lives.
Chronic substance abuse creates a complicated Dual Diagnosis, or the co-existence of a serious psychiatric disorder and an addictive disorder. Recovering from this Dual Diagnosis requires a careful exploration of the causes of PTSD, combined with treatment for drug or alcohol addiction.
What Is Post-Traumatic Stress Disorder?
PTSD is a condition in which an individual experiences tremendous stress or anxiety after witnessing or being engaged in a traumatic event. Any physical or psychological trauma that leaves the individual feeling powerless and out of control may lead to PTSD.
Some of the most common causes of the condition include:
- Military combat
- Violent assault
- Natural disasters
- Sexual assault
- Childhood abuse
The nightmares and flashbacks of PTSD typically involve crises that have never been fully resolved in the individual’s psyche. For instance, a soldier who was taken prisoner in a battle and couldn’t fight his captors might have flashbacks to the incident as a way to work through unresolved anger and fear. A child who felt powerless when she was sexually abused by an older relative might grow up living with intrusive feelings of helplessness and revenge.
In women, sexual abuse is one of the most common causes of PTSD and addiction, according to the National Center for PTSD at the U.S. Department of Veterans Affairs. Combat is another common reason for PTSD, especially in men. In Vietnam veterans seeking treatment for PTSD, between 60 and 80 percent also require treatment for substance abuse.
Symptoms of PTSD include nightmares, flashbacks, avoidance of things related to the event, severe anxiety, sleeplessness, aggressive behavior and angry outbursts. These symptoms can strike the individual at any time, most commonly when he or she is reminded of the events in question.
Individuals who meet the diagnostic criteria for PTSD and substance abuse often experience other serious disorders, such as:
- Attention deficit disorder
- Chronic pain
- Chronic illness such as diabetes, liver disease or high blood pressure
The symptoms of PTSD can be divided into three general categories:
- Re-experiencing the traumatic incident
- Avoiding experiences that evoke memories of the incident
- Symptoms of hyperarousal, such as irritability, anger or extreme anxiety
People who experience these symptoms for at least one month may be diagnosed with PTSD. Alcoholism and drug abuse fall into the category of avoidance symptoms, as the individual may use these chemicals to avoid memories or to numb fear.
When alcohol or drugs are used to manage PTSD symptoms, the symptoms of the disorder only become more severe. As a central nervous system depressant, alcohol can worsen depression and anxiety and interfere with normal sleep patterns. Under the influence of alcohol, someone with PTSD is more likely to engage in risk-taking behavior, such as driving under the influence, or to engage in an altercation with someone else.
For this reason, PTSD and substance abuse often lead to legal problems, incarceration, poverty, broken homes and chronic unemployment. Getting the right treatment for this Dual Diagnosis may make the difference between whether or not an individual is able to lead a satisfying, healthy life.
PTSD and Addiction
The symptoms or PTSD can be extremely distressing. Because they cause such a great amount of stress on the individual, many with PTSD will be unable to cope and turn to drugs or alcohol as a means of escape. As a result, 52 percent of males and 28 percent of females with PTSD meet the lifetime criteria for alcohol abuse or dependence, according to findings on posttraumatic stress disorder in the National Comorbidity Survey, published in 1995 in the Archives of General Psychiatry (Kessler et al.). When it comes to drug abuse, statistics from the same study show that 35 percent of men and 27 percent of women with PTSD meet the criteria.
Endorphin withdrawal plays a part in the use of alcohol or drugs to control PTSD. When an individual experiences a traumatic event, his or her brain produces endorphins — neurotransmitters that reduce pain and create a sense of well-being — as a way of coping with the stress of the moment. When the event is over, the body experiences an endorphin withdrawal, which has some of the same symptoms as withdrawal from drugs or alcohol:
- Emotional distress
- Physical pain
- Increased cravings for alcohol or drugs
According to Alcohol Research & Health, many of those with PTSD will turn to alcohol as a means of replacing the feelings brought on by the brain’s naturally produced endorphins. But the positive effects of alcohol are only temporary.
With increased use of alcohol, the individual can become chemically dependent on the drug. He or she will need more alcohol or drugs to produce those numbing effects. Eventually, dependence can turn into addiction, which is characterized by compulsive use of the substance, tolerance to the drug and an insistence on abusing the drug in spite of its devastating effects.
The use of alcohol to numb PTSD symptoms leads to a vicious cycle. Drinking alcohol worsens the fear and anxiety of PTSD, which leads to a release of endorphins.
As the effects of the endorphins subside, the individual needs more alcohol to escape the nightmares and flashbacks of PTSD. Anti-addiction medications like naltrexone, an opioid antagonist, can block the positive effects of alcohol, breaking this destructive cycle. Naltrexone, buprenorphine, acamprosate and other anti-addiction drugs can be used in the treatment of PTSD and substance abuse to reduce the overwhelming cravings that lead to relapse.
Finding Specialized Treatment
Recovering from a Dual Diagnosis of PTSD and an addictive disorder demands intensive support from psychiatric professionals, family members and peers. People who are battling PTSD and a substance use disorder may be reluctant to seek treatment. Many of those who experience PTSD live with intense guilt and shame caused by the traumatic event. Their addictive behavior may add to their guilt, making it even harder to reach out to others.
Once they enter a treatment facility, they may have trouble finding the motivation to use their recovery resources at their disposal unless they have support and encouragement from an integrated treatment team.
Those with a Dual Diagnosis such as PTSD and drug addiction need to work with mental health professionals and addiction experts who understand their special needs. Conventional rehab facilities are likely to be ill equipped to deal with the intense psychological problems brought on by PTSD. By the same token, a psychiatric facility may not have the counseling and detox programs the individual needs in order to properly treat the addiction.
What the Dual Diagnosis patient needs is integrated care, where recovery resources are centralized in a single facility, and all the professionals on the treatment team have dealt extensively with Dual Diagnoses in the past.
An integrated treatment plan for PTSD and substance abuse should include:
- Individual psychotherapy to teach the client how to handle the triggers that lead to substance abuse
- Counseling sessions with other clients who also suffer from PTSD and an addictive disorder
- Couples therapy or family counseling to strengthen relationships and educate family members about the disorder
- Membership in a 12-step group to strengthen the client’s support network
- Medication therapy with anti-addiction drugs or psychotherapeutic medications (antidepressants or anti-anxiety medications)
Our professionals understand the fragility of those clients who suffer from both PTSD and drug addiction. If you are living with this difficult combination of conditions, there’s no place better to turn than our residential facilities: Black Bear Lodge (Georgia), Michael’s House (California), Skywood Recovery (Michigan) and Talbott Recovery (California).
Contact us at Foundations Recovery Network treatment centers today and get help from the people who know your condition best. Call 844-768-1248 now.
Further Reading About Post Traumatic Stress Disorder and Addiction
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.