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The Relationship Between PTSD and Addiction

By Dr. Karl Benzio MD

Page Overview

Post Traumatic Stress Disorder (PTSD), a behavioral health (aka psychiatric or mental) illness, causes significant emotional, psychological, and spiritual distress, as well as much physical disruption. This distress interferes with the person’s functioning, peace, and enjoyment of life. To lessen or escape the distress, PTSD sufferers avoid situations, objects, or people that remind them of the hurtful or traumatic event that precipitated the PTSD. In fact, avoidance is one of the hallmark symptoms and diagnostic criteria for PTSD.

Sometimes, though, avoidance isn’t possible or doesn’t work and the distress still hurts. A common plan B for PTSD sufferers is turning to some maladaptive object or behavior to relieve, soothe, escape, self-medicate, or distract from the distress, symptoms, and pain. These objects can be chemicals like alcohol, drugs, or prescription medication, or behaviors like eating, pornography, or gambling. The resulting addiction causes even more disruption in the person’s life, worsens the PTSD and its symptoms, and makes treatment more complicated and difficult to implement as the person doesn’t have clear thinking to take in and apply the treatment they are receiving.

Obviously, helping a person process a traumatic event ASAP to lessen the chance of developing PTSD is the optimal scenario. But if PTSD does develop, quickly treating while being aware of common ripples like depression, anger, anxiety disorders, and addictions is a must for healing and a successful outcome to occur.

Why PTSD and Addictions Often Occur Together

PTSD develops after an individual has witnessed or experienced a hurtful or traumatic event. If the person was not able to process the trauma correctly or completely, either a minor or a major PTSD emerges, leading to the following areas of suffering:

  • emotional symptoms like agitation, exaggerated startle response, always feeling on edge, anxiety, fear, sadness, anger, vengeful feelings, and panic;
  • psychological disturbances could be flashbacks, nightmares, poor concentration, easily distracted, mistrust of themselves or others, paranoia, relational distance, isolation, decrease in motivation, and unwilling to risk;
  • physical struggles: sleep problems, appetite changes, tremors, restlessness, difficulty breathing, high blood pressure, racing heart, heartburn or reflux, headaches, chronic infections, or vague pain syndromes.

As a result of experiencing this myriad of distressing symptoms or the incredible disruption these symptoms have on the person’s everyday functioning, relationships, and efforts to achieve their God-given potential, it is only natural for the PTSD sufferer to find a way to avoid, lessen, or escape these symptoms and their damaging ripples. Being overwhelmed by symptoms and life falling apart, it is hard to avoid triggering events or to implement treatment options to help them process and sort through the traumatic experience and “undo” the PTSD.

Sadly, they find little escape or soothing comes from a substance or a behavior. The relief is such a welcomed respite from their regular despair, they now have hope that momentary escape is possible. Unfortunately, the use of the substance or behavior becomes one of the few ways they can escape the daily dungeon of PTSD and the frequency of using that escape hatch or self-medicating object progressively increases.

PTSD can easily lead to substance abuse and addiction because of the high level of stress the person is under. PTSD is painful, and addictions are people’s attempt to self-medicate, escape, avoid dealing with internal discomfort, make themselves feel better, forget the pain, numb emotions, sleep, and ease anxiety. Unfortunately, self-medicating with substances is a quick and easy way to become addicted, and addiction leads to its own set of problems. Using drugs and alcohol can only provide temporary relief, and most often it actually intensifies the symptoms of PTSD in the long run.

As the addiction grows, the PTSD worsens. Addiction usually brings more traumatic behavior or lowers our guard to allow more triggering experiences to worsen our PTSD symptoms. Addictions also affect our brain chemistry making us more depressed and anxious. As PTSD worsens, the only “fix” for the distress the sufferer knows is their addiction, so the pursuit of the addiction gets stronger, more frequent, and worsens. Now the PTSD and addiction fuel each other’s terrible spiral.

Types of Addiction

Addiction that stems from PTSD can be a substance or process addiction. Substance addiction, or the dependence on a physical substance like drugs or alcohol, is what is commonly thought of when people hear the term “addiction.” Alcohol is the number one substance people use to self-medicate, but drugs like marijuana, cocaine, methamphetamine, heroin, and prescription medications like sleeping pills, painkillers, tranquilizers or sedatives, stimulants and even caffeine and tobacco are also commonly used to ease anxiety and symptoms of PTSD.

However, we can become addicted to many other things, especially processes or behaviors, and these activities are also used to self-medicate conditions like PTSD. Eating, anorexia, shopping, pornography, masturbation, sex, gambling, exercise, work, self-harm such as cutting, and screen addictions like internet, social media, cell phones, video-gaming, and TV are all activities that can become an addiction and are used as an attempt to forget the feelings of anxiety, fear, sadness, lack of control, hopelessness, isolation, and uncertainty associated with PTSD.

Some with PTSD turn to relaxers like alcohol, tranquilizers, benzodiazepines, heroin or other opiates, food, or porn to take an edge off the anxiety, anger, bitterness, depression, or stress or to try and get to sleep. Others use stimulants like caffeine, tobacco, cocaine, methamphetamine, or Adderall to stimulate excitement, motivation, or energy in their distressed and listless lives. Others use hallucinogens like marijuana, acid, mushrooms or designer drugs to escape of relax. The process addictions serve a different role for everybody, but common reasons are the desire for control, excitement, power, risk-free connection, escape into fantasy, or opportunity to be someone different than who they really are.

Prevalence of PTSD and Substance Abuse

It is very hard to study process addictions and caffeine is so prevalent, we almost don’t even count it anymore. So alcohol is the most common type of addiction associated with PTSD, with 52 percent of men and 28 percent of women with PTSD meeting the criteria for alcohol abuse, according to the U.S. Department of Veterans Affairs. The Department of Veterans Affairs summarizes the following statistics related to PTSD and substance abuse:

  • 7.7 million American adults have PTSD – using a very strict and extreme criteria of what a traumatic event or serious injury is defined as. If we were more realistic, this number would probably be 5-10 times this reported number (Bethany, link here to page 2 for further explanation of “traumatic event or serious injury” discussion)
  • 1 out of every 3 people seeking treatment for substance use disorders have the strict criteria version of PTSD
  • 65 percent of people with PTSD have a co-occurring substance use disorder
  • Three quarters of those who have survived abusive or violent trauma report drinking problems
  • Up to a third of those who survive traumatic accidents, illness, or disasters report drinking problems
  • Sixty to eighty percent of Vietnam Veterans seeking PTSD treatment have alcohol use problems

Signs of PTSD

Symptoms of PTSD can begin immediately after the traumatic event occurs, or they can take months or even years to develop on their own or when triggered by a new event. Symptoms of PTSD are grouped into four different categories with these common examples:

  • re-experiencing elements of the traumatic experience – flashbacks; nightmares; frightening thoughts and images; having the feelings of fear, powerlessness, or lack of control
  • avoidance of certain situations, people, thoughts, feelings related to the traumatic event or avoidance/lapse of memory for event; isolative
  • heightened arousal and hyper reactivity symptoms – fear of crowds, easily startled, agitated, difficulty sleeping or relaxing, feeling on edge or on alert, irritability, restless, fidgety
  • disrupted thinking and mood symptoms – memory trouble; distractible; depressed; anxious; anger; explosive emotions; crying; difficulty trusting, being open or vulnerable; guilt, shame, self-blame, survivor guilt

To learn more about the signs of PTSD, visit page 1 of our guidelink here).

Signs of Substance Addiction

The signs of addiction can be similar to those of PTSD, and sometimes symptoms of one mask or complicate the symptoms of the other. Symptoms of addiction can be symptoms while under the influence, symptoms seen during withdrawal from an addiction, symptoms from the effects of continued addiction use, and stressors that lead to starting or propelling an addiction. In general, symptoms of substance abuse and addiction include:

  • Bloodshot eyes or pupil dilation or restriction
  • Appetite or weight changes
  • Changes in sleep habits
  • Change in personal grooming habits
  • Slurred speech or impaired coordination
  • Drop in performance at work or school
  • Changes in friends, personality, routine, style, interests, direction, without clear and good explanation
  • Relationship mismanagement, conflict, stress, and letdowns
  • Increased secrecy, lies, or lame excuses
  • Legal or financial trouble
  • Mood swings or Labile emotions
  • Agitation, Anxiety, Depression, Anger
  • Paranoia
  • Lack of motivation, Lethargy
  • Decreased interest in past hobbies or healthy activities
  • Impulsive decisions or behaviors
  • Spiritual confusion, apathy, or extreme change without cause
  • Me-centered behavior and decisions/focus
  • Episodes of being sorry and vowing to change

Treatment for Both PTSD and Substance Abuse or Addiction

The best treatment for someone struggling with both PTSD and Addiction is to treat both disorders at the same time. Treatment should be by a licensed professional therapist experienced and equipped in understanding and tackling both. A residential facility provides the most supervision, accountability, and support to abstain from the addiction, allowing the body and mind to detox and heal. When compared to outpatient treatment, going to a residential facility provides a significant intensity and quantity (7-10 hours per day) of therapeutic activities to quickly move a long way down the healing path in a short amount of time. Most importantly, a residential environment provides nurturing camp-like environment to overcome the barriers to openness, connection, and trust the patient has developed to “protect” themselves or hide their problems. The residential intensity of  daily treatment for 30-90 days builds a powerful, trusting, and therapeutic relationship allowing the patient to open up and then dig into the underlying psychological struggles and PTSD to let light into the deep wound.  This is the safest, quickest, and most thorough way to overcome both PTSD and addiction for lasting healing and ongoing life transformation to occur.

Often times, medications are used to help manage detox from a chemical addiction and the symptoms of anxiety, fear, depression and insomnia. Talk therapy is useful for helping the individual process the traumatic event that occurred at the start of the disorder, and therapies such as Cognitive Behavioral Therapy (CBT), exposure therapy, and Eye Movement Desensitization and Reprocessing (EDMR) are commonly used to treat PTSD. In addition to medication and psychological therapies, addressing the spiritual aspect of the person’s being is vital to access a divine power to change a person’s thinking and actions by receiving love and hope that change is possible. Infusing spiritual truths, principles, and life management skills into the treatment for PTSD and addiction renews the mind and delivers a lasting peace.

Outpatient treatment, either in a Partial Hospital Program (PHP), Intensive Outpatient Program (IOP), or weekly outpatient therapy allows the person to stay at home during treatment. The disadvantages are:

  1. lack of structured supervised environment to stay away from the addiction;
  2. lack of efficient, comfortable, and safe detox;
  3. lack of intensity of 7-10 hours of treatment 7 days per week to provide the frequency of contact for important information to come out and life-changing skills to be taught;
  4. lack of quick and trusting connection with therapist to fully relax, open up, and divulge the inner struggles and information necessary for the therapist to provide the customized healing program that is needed.

Going away from home for treatment can be a difficult decision, but also the best decision to get the maximum help in the shortest amount of time while being away from stressors and focus 100% on getting better without distractions. Thankfully, because of the dangers of having PTSD and an addiction and the difficulty treating it on an outpatient basis, many insurances cover a significant part of residential care.

See page 3 of our PTSD guide for treatment, page 4 for spiritual aspects of treatment, and page 5 for spiritual resiliency factors helping treatment to find out more about the treatment of PTSD. 

Get Help Today

For individuals with both PTSD and a substance abuse disorder/process addiction, recognizing the signs of the disorders is the important first step to recovery. If co-occurring PTSD and substance addiction are suspected, getting help at a trusted facility that specializes in treatment for addiction and PTSD from a Christian worldview is vital and gives the best chance of lasting freedom from past trauma and hurts. If you suspect a loved one is struggling with PTSD with or without a substance abuse disorder, help is available today, so please don’t hesitate and suffer any longer. Call today.