Why Self-Medicating Post-Traumatic Stress Disorder With Drugs And Alcohol Is Generally A Bad Idea

Living through trauma, and living with the post-traumatic stress disorder that can follow, is emotionally tough in all sorts of ways.

If you're reading this, you're probably already familiar with the symptoms of PTSD described in the diagnostic and statistical disorder of mental disorders (DSM-5), as well as some of the ways post-trauma life can impact you that aren't listed in the DSM-5. 

Nightmares, flashbacks, intrusive memories, constantly being prepared for new threats even if you know that your current environment is safe, feelings of tremendous but ultimately unwarranted (survivor) guilt and shame, and angry outbursts are just some of the things that can make life with PTSD difficult. So are broken relationships, feelings of alienation from the world and your former life, trouble dealing with the fact that your functioning is impaired, a loss of faith, and the feeling that you simply have no future at all. 

Why self-medicating PTSD with harmful substances is so appealing

Several theories to explain the high rates of substance use disorders — that is, alcohol and drug addictions — among folks with PTSD exist. They include the ideas that people who were already addicts before are more likely to get themselves into dangerous situations that can ultimately prove to be traumatic and cause PTSD, that a person can be genetically vulnerable to both PTSD and addiction, and that substance use reduces coping skills and emotional resilience (the ability to "bounce back" from stressful situations, including trauma), thereby increasing the risk of PTSD. 

If you usually use drugs or alcohol to cope with specific PTSD triggers, the combination becomes locked into your mind over time, too. That is, you'll automatically start craving the substance of your choice (or circumstance) every time you experience a particular trigger. 

What may start off as a harmless-seeming nightcap or joint to relax can quickly spiral. Rather than helping you keep your symptoms under control, the substance will start to control you, and add new symptoms. For people who already abused substances before they developed PTSD, the problem can grow exponentially worse. 

In fact, research has found that people with co-occurring PTSD and substance use disorders are more functionally disabled, have worse PTSD symptoms, and are less likely to have successful outcomes if they start treatment for their post-traumatic stress disorder.

Should anyone who isn't abusing alcohol or drugs but is considering it, to numb their PTSD symptoms, read this — basically, don't go there. If you have access to evidence-based treatment for your PTSD, use that instead. If not, still refrain from taking this road; it's one you won't be able to get off on your own.

What treatment models are available for you if you have PTSD and a substance use disorder?

The first, "sequential", model is often a bad idea. If you started abusing alcohol or drugs to cope with your PTSD symptoms, your PTSD symptoms won't go away when you stop using. Without PTSD treatment, which involves learning better coping techniques and processing your trauma to the point where you can better live with it, a big vacuum is left in the space that substance abuse previously filled. Your main coping mechanism is removed, with nothing to replace it. This is frequently a recipe for relapse. 

The second, "integrated", model involves treatment for both conditions — your addiction, and your post-traumatic stress disorder — at the same time, so that you are supported and equipped with emotional coping tools as you fight to get clean and sober. Most people with PTSD who also have addictions prefer this model. Science, too, suggests that this is the best way to go about treating coexisting addiction and PTSD.

US Veterans Affairs notes, mind you, that people who have post-traumatic stress disorder and are addicted to drugs or alcohol can absolutely still benefit from PTSD treatment even if they do not get clean and sober.

As for exact treatments for people who live with both PTSD and addiction, they can include:

• Psychotherapy — cognitive processing therapy or prolonged exposure therapy seem to work best. 
• Medication — SSRI antidepressants can help with both PTSD and being newly clean or sober. Naltrexone can help with substance use disorders. 

Substance abuse, PTSD, and COVID-19

The COVID-19 pandemic brought new challenges to everyone, including people living with post-traumatic stress disorder. Triggers galore — perhaps the lockdown itself was difficult for you to handle, you were isolated from your in-person support network, and general political and economic instability are big triggers for you. Perhaps your therapy sessions were canceled, and perhaps the lockdown meant spending more time in close quarters with people in a way that made it very hard for you to function. 

Both changed circumstances and a reduced ability to stay in treatment has made COVID-19 a special trap for substance abuse. During this difficult time — both the pandemic and the social issues that arise from it — please stay in touch with your support network, or work to create a new one. Online therapy sessions may replace in-person treatment, and if you find yourself struggling with substance abuse, try reaching out to an online helpline. 

A final word

Alcohol and drugs are often more easily accessible than evidence-based treatment for PTSD. Other people around you will already be using them, and getting drunk or high might even be seen as a more acceptable coping mechanism than psychotherapy in your (sub)culture. PTSD, and mental health struggles generally, still comes with stigma in many settings. 

Even if you don't develop a full-blown addiction and are becoming "just" a problem drinker or someone who uses (for instance) weed recreationally a bit too often, your substance use can worsen your physical and emotional health over time. This path is not recommended. If you're not already on it, don't go there. If you're on your way there but can still get off on your own, do it.

And if you're in up to your neck, remember that help is available.