Post-traumatic stress disorder (PTSD) is one of the most common co-occurring disorders with both alcohol use disorder and substance use disorder (AUD and SUD). That’s important, both because PTSD is considered a risk factor for developing AUD or SUD, and because those with dual diagnoses can show less favorable outcomes in treatment and recovery for both. But there is reason to be optimistic. Treatment options have increased substantially in recent years, and often an integrated approach works best.
What is PTSD?
PTSD, or post-traumatic stress disorder, is a cluster of symptoms that develops in response to experiencing or witnessing a traumatic event. Exposure to a traumatic event – such as violence or serious injury, threat of death or witnessing a death, and similarly catastrophic events – creates a response of intense fear, powerlessness, or horror. Examples may include events survived or witnessed in wartime, as well as accidents, rape, or assault.
The distinctive symptom clusters include intrusive thoughts or memories of the traumatic event or events (sometimes referred to as flashbacks), avoidance or emotional numbing, and hyperarousal (sometimes called hypervigilance). The stress correlated with these symptoms can be all-consuming, affecting all aspects of life.
PTSD is quite prevalent in the population. Studies show that around 70 percent of adults in the United States have experienced a traumatic event at some point in their lives. Approximately 20 percent of those – or around 13 million Americans – go on to develop PTSD. Women are twice as likely as men to develop PTSD, and veterans are also at higher risk.
Self-Medicating for PTSD
The co-occurrence of PTSD with AUD and SUD is well-documented in several large-scale studies. One showed individuals with PTSD were between two and four times more likely to have PTSD symptoms than the general population. Another survey showed that roughly 46 percent of individuals with PTSD also had a diagnosis of an SUD.
Over 22 percent of those individuals rose to the level of substance dependence. This means, among other things, that they:
- Exhibited tolerance of the substance as well as withdrawal symptoms
- Used longer or more than planned
- Experienced significant consequences from their substance use
- Made unsuccessful efforts to reduce or control use
What explains this rate of co-occurrence? One theory is that people with PTSD turn to alcohol or other substances to self-medicate. Alcohol is relatively cheap and readily available, and a state of intoxication can seem comfortingly numb. It’s also easy to acquire alcohol and substances independently. Seeking structured intervention through therapy or professional care requires a level of trust that may be difficult for people with PTSD, who may experience exaggerated feelings of isolation and mistrust.
Trying to escape painful symptoms through use of controlled substances can create a worsening pattern of dependence. Why? If the person with PTSD becomes dependent on alcohol or another substance to the extent of experiencing tolerance, their escape becomes less effective. The numbing or euphoria of intoxication becomes more difficult to achieve. Worse, withdrawal symptoms may mimic some symptoms of PTSD. These include sleeplessness, anxiety and irritability, or feelings of detachment. The co-occurrence creates a vicious cycle – and finding the origin becomes challenging.
While self-medicating is one explanation for the co-occurrence of these disorders, some researchers present competing hypotheses. One such theory, known as the high-risk hypothesis, holds that SUDs predispose people to develop PTSD. The idea is that disordered substance use involves high-risk behaviors that expose users to traumatic experiences. Also, some evidence supports the susceptibility hypothesis, which contends that a certain constellation of personality traits – including anxiety and poor coping skills — may make individuals vulnerable to developing PTSD in response to trauma.
Whatever the reason, it’s clear that PTSD and SUDs are deeply intertwined, and that these conditions can reinforce each other.
An Integrated Approach to Treatment
It’s a complex phenomenon, and the interrelated nature of PTSD and SUDs may make the picture seem grim for people diagnosed with co-occurring PTSD and SUD/AUD. But while the challenges are intense, it’s important to note that there is hope.
Recent advances in treatment have identified promising new approaches, including:
- Refined and improved screening for both PTSD and SUD/AUD in routine physical checkups
- Monitoring of symptoms to track progress
- Pharmacological interventions
- New therapies for PTSD, such as eye movement desensitization and reprocessing (EMDR) and Cognitive Processing Therapy (CPT).
That’s one reason why raising awareness of PTSD is crucial. Without public education about PTSD and SUDs, people with dual diagnoses and their loved ones may not know the struggles they face can be diagnosed and treated. Others may be aware they have PTSD, but don’t know about advances in treatment. Whatever the case, knowledge and awareness can help people seek treatment and care for the first time, allowing them to take those first steps on the road to a life not dominated by the symptoms of PTSD and SUD/AUD.