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The co-occurrence of addiction and post-traumatic stress disorder (PTSD) is a significant issue that affects many individuals. Both conditions can have a profound impact on a person’s mental health and well-being, and the relationship between addiction and PTSD is complex. Understanding how these two conditions intersect is essential in providing effective treatment and support for those affected.

Addiction and PTSD often co-occur, with individuals struggling with PTSD being more vulnerable to developing substance use disorders. The presence of PTSD can increase the risk of developing an addiction, and vice versa. The relationship between addiction and PTSD is bidirectional, with each condition influencing and exacerbating the other. Treatment approaches that address both conditions simultaneously are crucial in helping individuals achieve lasting recovery and healing.

What is PTSD

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event, series of events or set of circumstances. An individual may experience this as emotionally or physically harmful or life-threatening and may affect mental, physical, social, and/or spiritual well-being. Examples include natural disasters, serious accidents, terrorist acts, war/combat, rape/sexual assault, historical trauma, intimate partner violence and bullying,

PTSD has been known by many names in the past, such as “shell shock” during the years of World War I and “combat fatigue” after World War II, but PTSD does not just happen to combat veterans. PTSD can occur in all people, of any ethnicity, nationality or culture, and at any age. PTSD affects approximately 3.5 percent of U.S. adults every year. The lifetime prevalence of PTSD in adolescents ages 13 -18 is 8%. An estimate one in 11 people will be diagnosed with PTSD in their lifetime. Women are twice as likely as men to have PTSD. Three ethnic groups – U.S. Latinos, African Americans, and Native Americans/Alaska Natives – are disproportionately affected and have higher rates of PTSD than non-Latino whites.

People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.

Symptoms of PTSD

Intrusion: Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are reliving the traumatic experience or seeing it before their eyes.
Avoidance: Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that may trigger distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.
Alterations in cognition and mood: Inability to remember important aspects of the traumatic event, negative thoughts and feelings leading to ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); distorted thoughts about the cause or consequences of the event leading to wrongly blaming self or other; ongoing fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; feeling detached or estranged from others; or being unable to experience positive emotions (a void of happiness or satisfaction).
Alterations in arousal and reactivity: Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being overly watchful of one’s surroundings in a suspecting way; being easily startled; or having problems concentrating or sleeping.

The Relationship Between Addiction and PTSD

Individuals with PTSD may turn to substances as a way to cope with the symptoms of their trauma. Drugs and alcohol can provide temporary relief from feelings of anxiety, depression, and hypervigilance commonly associated with PTSD. For example, a military veteran who has experienced trauma during combat may use alcohol to numb the painful memories and emotions related to their experiences.

On the other hand, substance abuse can also contribute to the development of PTSD. Individuals who misuse drugs or alcohol may engage in risky behaviors that increase their likelihood of experiencing trauma. For example, someone who regularly uses drugs may be more likely to be involved in accidents or dangerous situations that lead to traumatic experiences.

The co-occurrence of addiction and PTSD can have a compounding effect on an individual’s mental health and well-being. Both conditions can exacerbate symptoms of the other, leading to a cycle of negative emotions and behaviors. For example, someone with PTSD who also struggles with addiction may find it challenging to engage in therapy or other treatments due to their substance use, hindering their recovery process.

Treating PTSD

Effective treatment for individuals with co-occurring addiction and PTSD involves addressing both conditions simultaneously. Integrated treatment approaches that combine therapy for trauma, substance abuse counseling, and support for mental health are essential in helping individuals achieve lasting recovery. By addressing the underlying causes of both addiction and PTSD, individuals can work towards healing and rebuilding their lives. Common modalities used in treating PTSD at TRUE Include:

Cognitive Processing Therapy is an evidence-based, cognitive behavioral therapy designed specifically to treat PTSD and comorbid symptoms. It focuses on changing painful negative emotions (such as shame, guilt, etc.) and beliefs (such as “I have failed;” “the world is dangerous”) due to the trauma. Therapists help the person confront such distressing memories and emotions.

Prolonged Exposure Therapy uses repeated, detailed imagining of the trauma or progressive exposures to symptom “triggers” in a safe, controlled way to help a person face and gain control of fear and distress and learn to cope. For example, virtual reality programs have been used to help war veterans with PTSD re-experience the battlefield in a controlled, therapeutic way.

Trauma Focused Cognitive Behavioral Therapy is an evidence-based treatment model for children and adolescents that incorporates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles and techniques.

Eye Movement Desensitization and Reprocessing for PTSD is a trauma-focused psychotherapy which is administered over approximately 3 months. This therapy helps a person to reprocess the memory of the trauma so that it is experienced in a different way. After a thorough history is taken and a treatment plan developed the therapist guides the patient through questions about the traumatic memory.

In Conclusion

The relationship between addiction and PTSD is complex and multifaceted, with each condition influencing and exacerbating the other. Understanding the interplay between these two conditions is crucial in providing effective treatment and support for individuals struggling with co-occurring addiction and PTSD. By addressing both conditions simultaneously and providing comprehensive care, individuals can work towards healing, recovery, and a brighter future.