PTSD and Addiction: The Relationship Between PTSD and Addiction

Overcoming Trauma: Effective Treatments for PTSD

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Post-traumatic stress disorder (PTSD) and addiction are two conditions that can be closely intertwined. PTSD can cause anxiety, depression, and insomnia, which can lead individuals to seek coping mechanisms. Substance abuse may provide temporary relief but can also worsen the symptoms of PTSD and result in addiction.

This article explores the following:

  • The relationship between post-traumatic stress disorder and addiction
  • What PTSD is and its associated symptoms
  • Types of traumatic events that can lead to PTSD
  • The connection between PTSD and addiction
  • The treatments available for individuals struggling with co-occurring PTSD and addiction. 
ptsd and addiction

What is PTSD?

Post-traumatic stress disorder (PTSD) is a complex mental health disorder that can develop after a person experiences or witnesses a traumatic event. While PTSD is often associated with military combat, it can affect anyone who has gone through a life-threatening, terrifying, or violent personal assault. Natural disasters, serious accidents, terrorist attacks, war, and sexual violence are other events that can lead to the development of PTSD.

PTSD can present itself in several ways, including the following:

  • Intrusive memories or flashbacks
  • Avoidance of triggers or reminders of the traumatic event
  • Negative changes in mood and cognition
  • Hyperarousal or being easily startled. 

People with PTSD may experience physical symptoms such as headaches, gastrointestinal distress, chronic pain, and fatigue.

PTSD can affect anyone, regardless of age, gender, or cultural background. It is a complex disorder that can be difficult to diagnose and treat, but it’s important to seek help if you believe you or someone you know is experiencing symptoms. With the proper treatment and support, recovery is possible.

It’s important to remember that not everyone who experiences a traumatic event will develop PTSD. While most but not all traumatised people experience short-term symptoms, many recover from initial symptoms naturally. A small percentage will continue to experience problems and may be diagnosed with PTSD. Those with PTSD may feel stressed or frightened, even when no danger is present.

Symptoms of PTSD

A doctor with experience in treating mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD. To be diagnosed with PTSD, you must have experienced recognised symptoms (outlined below) for at least a month, and they must be severe enough to interfere with daily life. 

Symptoms can vary widely in severity and frequency from person to person. Some individuals recover within six months, while others may experience symptoms that last much longer. In some cases, the condition may become chronic.

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Re-Experiencing Symptoms

A person with PTSD will experience flashbacks, bad dreams, or frightening thoughts. Reminders of the traumatic event, such as words, objects, or situations, can trigger these symptoms, which can cause problems in a person’s daily routine and sleep pattern. 

Avoidance Symptoms 

Individuals experiencing these symptoms tend to avoid places, events, or objects that are reminders of the traumatic experience. They may also avoid thoughts or feelings related to the traumatic event. 

Avoidance symptoms can cause a person to change their daily routine. For example, someone who usually drives may avoid driving or riding in a car after a car accident. Reminders of the traumatic event can trigger these symptoms, interfering with daily activities and relationships.

Arousal and Reactivity Symptoms 

Arousal and reactivity symptoms include the following:

  • Being quickly frightened
  • Feeling anxious or “on edge”
  • Having trouble getting to sleep
  • Experiencing outbursts of anger.

These symptoms can be constant instead of triggered by reminders of the traumatic event. They can make it difficult to perform daily tasks such as sleeping, eating, or concentrating, and can cause the person to feel stressed and angry.

Cognition and Mood Symptoms 

A person with PTSD may have trouble remembering key features of the event, negative thoughts about themselves or the world, distorted feelings like guilt or blame, and loss of interest in enjoyable activities. These symptoms can begin or worsen after the traumatic event. They can make the person feel alienated or detached from friends or family members and can be severe enough to interfere with daily life. 

To be diagnosed with PTSD, a person must present with, as a minimum, the following:

  • One re-experiencing symptom 
  • One avoidance symptom
  • Two arousal and reactivity symptoms
  • Two cognition and mood symptoms.

It’s also important to note that PTSD is not the only possible outcome after experiencing a traumatic event. Some individuals may experience other mental health conditions like depression, anxiety, or substance use disorders. 

Children and PTSD

Children may have different symptoms of trauma than adults, such as bedwetting, forgetfulness, acting out the traumatic event during playtime, or becoming overly clingy with a parent or another adult. Older children and teenagers are more likely to show symptoms similar to those seen in adults, such as disruptive or destructive behaviour, guilt, and thoughts of revenge.

What Kind of Traumatic Event Can Cause PTSD?

Post-traumatic stress disorder can affect anyone who has experienced a violent, unexpected, or shocking event that is difficult to process. It can occur whether the trauma is experienced firsthand or witnessed from a distance.

There are no established standards for determining the leading cause of PTSD. However, it is not uncommon for PTSD to result from witnessing or experiencing any of the following: 

  • Accidents or natural disasters
  • Witnessing execution or others being killed or hurt
  • Robbery
  • Military combat
  • Sexual assault or rape
  • Kidnapping or hostage situations
  • Imprisonment
  • Marital infidelity
  • Traumatic childbirth
  • Death of a loved one
  • Political or civil unrest
  • Being diagnosed with a terminal disease
  • Physical assault, bullying, or harassment

According to the National Center for PTSD, more than 7% of Americans are likely to develop PTSD at some point in their lives. Women are more susceptible than men, and some individuals may be more prone to developing it due to genetic factors.

While it’s true that not everyone who experiences a traumatic event will develop PTSD, there are some risk factors that may increase your chances of developing this mental health condition. They include the following:

  • Exposure to multiple dangerous or traumatic events
  • History of physical, emotional, or sexual abuse
  • Neglect during childhood
  • History of alcohol or substance abuse
  • Witnessing a dead or mutilated body
  • History of mental health conditions
  • Lack of social support
  • Genetic predisposition. 

Some research shows you’re more likely to develop PTSD if you have to deal with extra stress after a traumatic event, such as enduring pain or injury, loss of a job, or the death of a loved one.

Co-Occurring PTSD and Addiction

Medical professionals believe that PTSD and addiction are closely related. Some people with PTSD begin using drugs or alcohol to cope with the disorder’s symptoms. In contrast, others develop PTSD after becoming addicted to drugs or alcohol. Regardless of the order in which the conditions develop, treating them together is important for the best chance of recovery.

Individuals with PTSD are at a higher risk of being diagnosed with substance abuse disorder (SUD). This is because someone with PTSD may try to self-medicate by abusing substances, believing this will help them avoid or nullify PTSD symptoms. Those with PTSD and SUD are more likely to misuse alcohol or cigarettes than illegal drugs.

Studies have found that military personnel and veterans with heavy drinking tendencies are more susceptible to depression and PTSD. Moreover, war veterans who have been diagnosed with PTSD and consume alcohol are more likely to develop binge drinking problems.

The veteran population is at high risk for PTSD and addiction due to the emotional stress, physical demand, and mental strain of combat in war. PTSD has also been linked to veterans who have been sexually assaulted or harassed during their military service. About 1 in 5 female veterans have been diagnosed with military sexual trauma.

Why Do People with PTSD Use Drugs?

As discussed earlier in this article, people with PTSD commonly report using substances to cope with the symptoms. However, this approach is hugely counterproductive and causes additional, unforeseen problems.

For example, smoking is highly correlated with PTSD, and people with PTSD smoke at higher rates than the general population. Yet, research has shown that the stimulant effects of nicotine not only intensify hyperarousal and avoidance symptoms but can also trigger intrusive symptoms. Quitting smoking is even harder for people with psychiatric disorders, and smoking cessation rates are lower for people with PTSD.

Alcohol is another example – frequently chosen because of its accessibility, legal status, and social acceptance. The numbing effects of alcohol and its ability to block traumatic emotions and memories make it an attractive ‘remedy’ for PTSD. However, alcohol use worsens the symptoms. While alcohol can temporarily blot out painful memories and feelings, these usually come back stronger after the effects wear off. Because alcohol is a depressant, it worsens depressive symptoms and affective symptoms of PTSD, such as emotional numbing and irritability. Heavy alcohol use can also trigger dissociative episodes in which people engage in risky or self-destructive behaviour, exposing themselves to situations where they are vulnerable to re-traumatisation.

Marijuana is also increasingly sought as a source of relief for various mental health disorders, including PTSD. Unfortunately, marijuana’s calming effects and dissociative properties can amplify the dissociative symptoms of PTSD and facilitate emotional blunting and avoidance. While marijuana can relieve PTSD symptoms, research shows that the endocannabinoid system in the brain, or the natural brain-made equivalent of cannabis, plays a significant role in PTSD. As marijuana use increases and tolerance develops, these systems in the brain become even more poorly regulated. In addition, heavy marijuana use can trigger paranoia and anxiety and worsen PTSD symptoms like hypervigilance and hyperarousal.

What Causes Addiction?

Addiction is a condition characterised by intense craving, loss of control over use, and continued involvement with the substance or activity despite adverse consequences. It alters the brain’s reward system, affecting natural drives such as learning and motivation. Breaking an addiction can be difficult, but it is possible.

Addiction begins with experimentation with a substance or activity. If the person gets pleasure from the pursuit, they may seek to repeat it to feel good or to get ‘high’. When a person experiences these pleasurable feelings, dopamine is released into the brain’s pleasure centre. Psychoactive drugs, from nicotine to heroin, produce a powerful surge of dopamine in this region. The user then craves the drug, using it more frequently and in higher doses to chase the high. This is what we call psychological addiction. 

Meanwhile, depending on the substance of choice, the body develops a tolerance to the drug and begins to ‘need’ it to function normally. This is a physical addiction. The user must now use the drug in greater doses to achieve the desired high. They may also experience unpleasant and sometimes dangerous withdrawal symptoms if they stop using the substance. Cravings, withdrawal symptoms, and often underlying mental health issues keep the user locked in the cycle of addiction. 

The Connection Between PTSD and Addiction

The connection between PTSD and addiction is complex. People who have experienced trauma and developed PTSD are more likely to develop an addiction than those who have not, with individuals who seek residential mental health programmes for PTSD being 14 times more likely to have a substance use disorder.

PTSD can cause anxiety, depression, and insomnia, which can lead individuals to seek coping mechanisms. Substance use may provide temporary relief but can also worsen the symptoms of PTSD, causing addiction.

Studies have shown that service members and veterans with heavy drinking tendencies are more susceptible to depression and PTSD. Moreover, war veterans who have been diagnosed with PTSD and consume alcohol are more likely to develop binge drinking problems.

Substance Abuse Can Make PTSD Harder To Overcome

Substance abuse can intensify reckless and risk-taking behaviour and expose individuals to dangerous situations where they can be re-traumatized. Those abusing alcohol or benzodiazepines may dissociate and end up in unexpected and violent situations. Large amounts of any substance, especially disorienting ones like alcohol and marijuana, can lead to places where individuals are less able to defend themselves and are at higher risk of exploitation and harm.

Substance abuse can worsen the symptoms of PTSD. It prolongs the avoidance cycle and blocks progress in treatment. Substances ultimately worsen depression, anxiety, and trauma-related symptoms. Many drugs directly cause these symptoms; others can trigger them as residual effects. Even in cases where substance use has not progressed to dependence, negative feelings alleviated by the substance return with greater intensity as it wears off, which can quickly lead to a vicious cycle of escalating drug use. This becomes even more of an issue when substance use progresses to addiction and includes acute withdrawal symptoms.

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How Does a Person with PTSD Develop an Addiction?

The symptoms of PTSD are powerful, frightening, and hugely disruptive to a person’s life. For many, drugs and alcohol provide a means of coping with these symptoms, and using becomes habitual, leading to dependence and potential addiction. 

Despite the link between PTSD and addiction, not everyone with PTSD will become an addict. Other factors are at play, such as genetics, environmental factors, and early life experiences.

Treatments for PTSD and Substance Use Disorders

Treatment for co-occurring PTSD and addiction generally involves therapy, medication, or a combination of both. Treatment plans may vary depending on the severity of symptoms and the individual’s circumstances. Support groups and peer counselling can also be beneficial. 

Therapy

Cognitive Behavioural Therapy (CBT)

CBT helps individuals identify negative thought patterns and replace them with positive ones. CBT can help individuals with PTSD develop coping strategies and reduce anxiety and depression symptoms.

Exposure Therapy

Exposure therapy helps individuals confront their fears and memories in a safe environment. This can help individuals with PTSD overcome avoidance behaviours and reduce the severity of their symptoms.

Dialectical behaviour therapy (DBT)

DBT is a talking therapy, similar to CBT, that can help individuals learn how to regulate intense emotions and cope with stress.

Eye Movement Desensitisation and Reprocessing (EMDR)

EMDR helps individuals process traumatic memories by following a therapist’s hand movements or flashing lights. EMDR has been shown to reduce the symptoms of PTSD, although the mechanism is still not fully understood.

Medication

Antidepressants

Antidepressants can help alleviate the symptoms of depression and anxiety associated with PTSD. They may also help with sleep disturbances, common in individuals with PTSD.

Mood Stabilisers

Mood stabilisers may be prescribed to individuals with PTSD who experience mood swings or irritability.

Antipsychotics

Antipsychotics may be prescribed to individuals with PTSD who experience hallucinations or delusions.

Substance Abuse Medications

Medications like methadone, buprenorphine, and naltrexone can be used to treat addiction by reducing cravings and withdrawal symptoms.

Trauma Therapy at Castle Craig

Castle Craig Hospital is a world-leading drug and alcohol rehab clinic that provides inpatient detox and treatment for individuals struggling with addiction. The healthcare facility has provided expert private medical care and extensive services since 1988.

Detox

Castle Craig provides an alcohol and drug detox facility where patients receive personalised care and medication to manage withdrawal symptoms. Antidepressants, mood stabilisers, and antipsychotics may be prescribed to individuals who experience depression, anxiety, mood swings, hallucinations, or delusions. Patients may also be offered medications such as methadone, buprenorphine, and naltrexone to help manage cravings. 

Therapies

Castle Craig is well equipt to support people with co-occurring PTSD and addiction. Treatments include a combination of therapy and medication to address the addiction and PTSD simultaneously. The goal of treatment is to provide individuals with the therapeutic tools they need to stay in recovery and lead a fulfilling life.

Experienced and qualified therapists deliver the hospital’s trauma therapy programme. The therapies available include the following:

  • Dialectical behaviour therapy (DBT) 
  • Cognitive behavioural therapy (CBT) 
  • Eye movement desensitisation and reprocessing (EMDR).

Patients may also engage with complementary therapies such as acupuncture and mindful meditation to optimise their mental and spiritual health and experiential therapies such as therapeutic art and equine therapy to help process past emotional traumas. 

Peer Support 

In addition to the treatments mentioned above, individuals with PTSD and addiction may benefit from peer support groups such as Alcoholics Anonymous and Narcotics Anonymous and peer counselling. Here patients can feel a sense of belonging and share their experiences and challenges in recovery. 

Aftercare

Castle Craig’s Continuing Care programme is delivered over 24 weeks via online or in-person therapy by CATCH Recovery. This ongoing support helps individuals sustain the gains they have made in rehab and supports their transition back into their home and work environment, navigating them through any risk of relapse.

If you or someone you know is struggling with co-occurring PTSD and addiction, it’s important to seek professional help to achieve the best chance of recovery. Castle Craig Hospital provides a comprehensive and personalised treatment approach. Located in the beautiful hills of the Scottish Borders, amid 50 acres of private woodland, Castle Craig is a sanctuary for recovery.  

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ptsd and addiction

FAQs

Is Addiction Part of PTSD?

Addiction is not a part of PTSD, but the two conditions are often closely related. PTSD can cause anxiety, depression, and insomnia, which can lead individuals to seek coping mechanisms. Substance abuse may provide temporary relief but can also worsen the symptoms of PTSD, causing addiction. Individuals who have PTSD are at a higher risk of being diagnosed with a substance abuse disorder. 

Is There a Link Between Trauma and Addiction?

Yes, there is a link between trauma and addiction, although it is not straightforward and can vary from person to person. Trauma can alter the reward system in the brain, making it harder to feel pleasure from everyday activities. This can lead to a greater desire for substances that provide a stronger sense of pleasure, such as drugs or alcohol. 

Additionally, people with PTSD may turn to drugs or alcohol to cope with their symptoms, as the brain’s chemical balance is impacted following a traumatic experience, producing fewer endorphins. 

What Kind of Trauma Leads to Addiction?

Post-traumatic stress disorder (PTSD) can affect anyone who has experienced a violent, unexpected, or shocking event that is difficult to process. It can occur whether the trauma is experienced firsthand or witnessed from a distance. While there are no established standards for determining the leading cause of PTSD, the following types of traumatic experience are known to lead to PTSD in some people: accidents; natural disasters; violent crimes, sexual assault or rape; kidnapping or hostage situations; imprisonment; marital infidelity; traumatic childbirth; the death of a loved one; political or civil unrest, witnessing others being killed or hurt; bullying or harassment; military combat.

References

  1. Post-Traumatic Stress Disorder (no date). Available at: https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd 
  1. Fedele, K.M. et al. (2017) “The impact of comorbid diagnoses on the course of posttraumatic stress disorder symptoms in residents of battered women’s shelters.,” Psychological Trauma: Theory, Research, Practice, and Policy, 10(6), pp. 628–635. Available at: https://doi.org/10.1037/tra0000335
  2. Jeffirs, S.M. et al. (2019) “Veterans with PTSD and comorbid substance use disorders: Does single versus poly-substance use disorder affect treatment outcomes?,” Drug and Alcohol Dependence, 199, pp. 70–75. Available at: https://doi.org/10.1016/j.drugalcdep.2019.04.001
  3. Vujanovic, A.A. et al. (2019) “A Novel, Integrated Cognitive-Behavioral Therapy for Co-Occurring Posttraumatic Stress and Substance Use Disorders: A Case Study,” Cognitive and Behavioral Practice [Preprint]. Available at: https://doi.org/10.1016/j.cbpra.2018.03.003
  4. Flanagan, J.C. et al. (2016) “Concurrent Treatment of Substance Use and PTSD,” Current Psychiatry Reports, 18(8). Available at: https://doi.org/10.1007/s11920-016-0709-y
  5. McCauley, J.L. et al. (2012) “Posttraumatic stress disorder and co‐occurring substance use disorders: Advances in assessment and treatment.,” Clinical Psychology-science and Practice, 19(3), pp. 283–304. Available at: https://doi.org/10.1111/cpsp.12006
  6. Gielen, N. et al. (2012) “Prevalence of post-traumatic stress disorder among patients with substance use disorder: it is higher than clinicians think it is,” European Journal of Psychotraumatology, 3(1). Available at: https://doi.org/10.3402/ejpt.v3i0.17734
  7. Post-Traumatic Stress Disorder (PTSD) & Addiction: Signs, Symptoms & Treatment (2022). Available at: https://americanaddictioncenters.org/co-occurring-disorders/ptsd-addiction
  8. Brewin, C.R., Andrews, B. and Valentine, J.F. (2000) “Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults.,” Journal of Consulting and Clinical Psychology, 68(5), pp. 748–766. Available at: https://doi.org/10.1037/0022-006x.68.5.748
  9. VA.gov | Veterans Affairs (no date). Available at: https://www.ptsd.va.gov/understand/common/common_adults.asp
  10. Post-Traumatic Stress Disorder (no date b). Available at: https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd

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