Clinicians might describe post-traumatic stress disorder as a trauma-related anxiety disorder, but for those who suffer from it, it's more like a horror film that never stops playing. Keeping you in the inescapable orbit of the trauma you've suffered, nightmares, flashbacks, and dissociative reactions can show up at the most unwelcome of times to tell you that you're still there. Still stuck in the past. You may constantly look over your shoulder, prepared for new threats, and be eaten up by all-consuming feelings of guilt and worthlessness. If you actually feel stuff, it's more likely to be fear, irritability, and pain that never quite leaves, than anything positive. Numbness — not feeling anything at all — seems like a step up.
A look at the rate of substance abuse among people with PSTD
How common is it for people who suffer from post-traumatic stress disorder to also abuse drugs, alcohol, or both? The numerous studies that have investigated exactly this have all come up with different answers. General estimates lie somewhere between a third and half of all people with PTSD. Some of these people will abuse one substance, usually alcohol, while others will be addicted to several substances at the same time. People in treatment for PTSD, meanwhile, have substance use disorders at 14 times the rate of the general population — meaning, in this context, everyone who isn't in treatment for PTSD.
Combat veterans are among the best-studied groups of people who often develop post-traumatic stress disorder. Research has demonstrated that nearly a third of returning veterans who saw combat abused alcohol. The more severe your combat experience, the more likely you are to develop both PSTD and a substance use disorder. More than 41 percent of US vets with a substance abuse disorder from the Vietnam era onward also have post-traumatic stress disorder.
Why do people with PTSD develop substance use disorders?
The most popular and obvious theory is that abusing a substance temporarily stops the symptoms associated with PTSD, or at least takes the edge off. This theory, which almost anyone with PTSD who abuses alcohol or drugs will also be able to confirm anecdotally, has been supported by findings that:
- It appears that people with PTSD "tailor" their substance of choice to the symptoms they're plagued by. Those who are especially hard-hit by symptoms like hyper-vigilance, irritability, trouble sleeping, and an out-of-control startle reflex, are more likely to abuse alcohol — a central nervous system depressant that dulls everything.
- Experiencing triggers that set off PTSD symptoms predict that people with PTSD will abuse a substance, and the more severe the symptoms, the more likely they are to use soon after.
Some studies have instead proposed that substance abuse itself can trigger post-traumatic stress disorder, as well as that the same person can be genetically predisposed to developing both PTSD and a substance use disorder.
What treatment options are available to you if you have PTSD and are also a substance addict?
We're not going to lie — there's no easy answer. People who suffer from either PTSD or a substance use disorder on their own already face significant challenges, and research into the most effective ways to help people who have both disorders is still very much ongoing. Many people drop out of treatment, research shows.
The go-to treatments for PSTD as a stand-alone disorder — cognitive processing therapy and prolonged exposure therapy — may not be the best option for people who also have a substance use disorder. Rather, you may benefit from one of the programs designed especially for people with a dual diagnosis of PTSD and a substance use disorder.
- Transcend programs, for instance, start off with treatment for substance abuse — which can include inpatient rehab — and then begin a course of therapy that combines elements of cognitive behavioral therapy, psychodynamic therapy, and the 12-step approach (pioneered by Alcoholics Anonymous).
- Others will benefit from integrated cognitive behavioral therapy that takes a problem-solving approach and seeks to minimize harm in the short-term, a program that teaches new coping skills and that has had promising results in improving both PTSD symptoms and substance abuse.
- Exposure therapy, in which you process the trauma in a safe environment, has had success with combat veterans with PTSD who are also substance addicts, but it is not yet clear how effective this approach is.
Medication can play an integral part in the process — if you were using as a form of self-medication, antidepressants including SSRIs and SNRIs can be incredibly helpful, leading to symptom reduction in around 60 percent of all patients. Those using alcohol may also find that medications such as naltrexone help them on their path to sobriety.