PTSD and Substance Abuse
What is PTSD?
The American Psychiatric Association defines Posttraumatic Stress Disorder (PTSD) as “a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape, or other violent personal assault.” Other traumatic events can include mental illness, childhood trauma, child abuse, sexual assault, sexual abuse. Trauma experienced may be acute (a single occurrence), chronic (repeated and prolonged trauma such as domestic violence or abuse), or complex (repetitive, prolonged trauma involving ongoing abuse or abandonment within an interpersonal relationship with an uneven power dynamic). It is important that individuals who have experienced or been exposed to some type of traumatic event and/or substance abuse receive treatment for seeking safety therapy in order to increase the safety for themselves and for the people around them.
Someone diagnosed with PTSD continues to experience intense and disturbing thoughts and feelings related to the experience after it has ended. Someone may experience vivid flashbacks or nightmares related to the event and may experience a bodily response more closely linked to extreme stress or fear despite presently being out of danger. An individual may also experience feelings of anxiety, sadness, fear, depression, or disconnection from others. Many times, when a person experiences something traumatic, the experience is locked away in the brain with strong emotional responses tied to the memories. Despite being safe in the current moment, the emotional response to a trigger or memory is so strong that the body responds as if they are still in immediate danger.
The PTSD symptoms someone may experience are pervasive and may make it difficult for a person to live fully and participate fully in their activities of daily life. Work, relationships, hobbies, and the daily tasks of life feel overwhelming and impossible to navigate. Typically, when someone experiences symptoms of PTSD, they also find a way to tolerate those symptoms, to make it through their day or night.
Each of us finds ways to cope with unpleasant feelings of emotions. Many people use safe coping skills like talking with a friend or therapist, taking a walk, engaging in a relaxing experience or using soothing self-talk. Many people also use unsafe coping skills when experiencing emotional discomfort. They may distance themselves from others, use alcohol or substances to numb their pain, engage in cutting behaviors, or use degrading and harsh self-talk. Our brain is always trying to find a way to cope or make sense of life. We are hardwired for survival, so when our emotion center takes the reigns and sends us into panic, fear, stress, or survival mode as a result of one or more traumatic events from the past, our brains will work overtime to keep us afloat. It is important to remember that regardless of whether our coping is safe or unsafe, we are engaged in a behavior in which we believe will make the pain or discomfort stop.
Typically, when we find a behavior that “fixes” the problem, we will continue to use it until it no longer works. We are creatures of habit. For some people, the behavior that brings the most reprieve from the discomfort is alcohol or substance use. Some research shows that at least 50% of individuals in inpatient treatment for substance abuse also suffer from PTSD (see Souza & Spades). While substance use may have origins elsewhere for some, for many, a history of trauma is involved in the desire to feel different. By their very nature, use of alcohol and other substances typically induces an alternate feeling or experience in the body.
SAMSA estimates that in 2016, 20.1 million people aged 12 or older had a substance use disorder related to use of alcohol or illicit drug abuse. While their findings do not specify how many of those individuals were also suffering from PTSD, it is important to recognize the high rates of substance abuse we’re seeing in the United States at this time and to know that this is not an issue limited to a select group of individuals. Research shows that in the veteran population, veterans stand as a high percentage of the individuals with a substance use disorder who also suffer from PTSD. The VA sites that more than 2 of 10 veterans with PTSD also have a substance use disorder and almost 1 of every 3 veterans seeking treatment for a substance abuse disorder also has PTSD.
Substance abuse does not discriminate on the basis of race, socioeconomic status, gender, or religious beliefs. The problem with substance dependence or alcohol abuse is that it becomes a common coping skill used to deal with anxiety, fear, loneliness, depression, sadness, and for many, is a behavioral reaction to just about any emotion one might experience.
Given the high rates of alcohol misuse and substance abuse, and the overwhelming symptoms experienced emotionally and physiologically, it is understandable that someone diagnosed with PTSD who is experiencing the symptoms or reliving the trauma might use a substance or alcohol to cope.
Treatment Modalities Commonly Used With Substance Abuse
Generally speaking, substance abuse treatment typically involves increasing internal motivation for change and then helping individuals increase coping skills to deal with triggers that previously led them to the substance abuse. It also involves a look at underlying issues that might be causing problematic symptoms someone might try to numb with the use of alcohol or a substance.
Motivational Interviewing (MI) is a therapeutic model that helps individuals resolve ambivalent feelings and insecurities to find the internal motivation they need to make changes in their behavior. It is a highly empathetic, short-term model that respects the challenges involved in making changes and helps individuals move through the emotional process of change required to increase motivation.
Cognitive-behavioral therapy (CBT) is a short-term, goal-focused modality with the goal of changing thought patterns and behaviors that are behind an individual’s challenges, thus changing the way an individual feels as a result.
Acceptance and Commitment Therapy (ACT) uses mindfulness and behavioral activation to increase psychological flexibility and the ability to engage in values-based, positive behaviors while experiencing difficult thoughts, emotions, or sensations.
Dialectical behavioral therapy (DBT) is a treatment modality that emphasizes balancing behavioral change, problem-solving, and emotional regulation with validation, mindfulness, and acceptance.
Treatment Modalities Commonly Used for People With PTSD
Treatment for post-traumatic stress disorder and trauma typically involves some form of processing a trauma while also increasing coping skills to tolerate the strong emotion that comes along with the memory of it. It may involve desensitizing a memory or restructuring thoughts related to the trauma to be adaptive and supportive. This can be accomplished by various types of trauma focused therapy.
Exposure therapy involves the client coming into some form of contact with the traumatic memory. Exposure to the memory may be done in imaginal (remembering the event), interoceptive (remembering the emotion or physiological reactions during the event), or in vivo (returning back to a place or having direct contact with an object or place related to trauma). Each exposure is intended to decrease the intense emotional and physiological arousal state associated with the memory and increase the individual’s ability to desensitize their brain and body to triggering stimuli.
Cognitive therapy works by modifying negative assessments and memories of trauma with the intent to alter the behavior and/or thought patterns that have been problematic in the individual’s activities of daily living. Cognitive therapy uses some exposure to the trauma with the intent of identifying strong emotional responses and the restructuring of thoughts in the moment.
Relaxation training is used to manage physiological reactions which manifest as a result of ongoing exposure to the traumatic memory. Using techniques like mindfulness, grounding, yoga, and deep breathing, and relaxation training increases an individual’s ability to tolerate and be successful in more traditional therapies.
Eye Movement Desensitization and Reprocessing (EMDR) targets the unprocessed memories that connect negative emotions, sensations, and beliefs. By activating the brain’s information processing system, old memories can be digested with the idea that what is useful can be learned and what is no longer useful can be discarded. A clinician uses bilateral stimulation via eye movements, tapping, or sounds to activate both sides of the brain while processing the trauma.
Treatment for PTSD and Substance Abuse
There is good news. It is possible to heal from PTSD and to maintain a recovery free from substances if you are ready. Many people have braved the road to recovery for both PTSD and substance abuse and used different treatment options for addressing both.
Many practitioners recommend that an individual begins managing the substance use prior to beginning processing trauma, or to handle them both simultaneously. This may involve attending 12-Step meetings, admitting to a treatment facility, or attending an outpatient treatment program. The primary goal of obtaining sobriety initially or while also working to process trauma, is to increase coping skills. Therefore, when an individual begins to work through the trauma, they will have some coping skills other than the substance use to manage the overwhelming thoughts or emotions associated with the trauma that will likely emerge during the process. Without the addition of new, safe coping strategies, an individual is likely to return to problematic substance use to manage symptoms of trauma in the same way they had managed them initially.
Some modalities like Seeking Safety, target individuals who have a history of both trauma and substance abuse and help them when building and seeking safety coping skills that will help the healing process of both PTSD and substance abuse, simultaneously. In general, it is recommended that an individual has support as they begin to work towards sobriety and processes trauma. Support can entail a formal inpatient or outpatient treatment program, a therapeutic relationship, support groups, or sponsors/mentors. Though the processing and recovery are independent, increased support is encouraged through multiple channels when possible. Individuals might couple a treatment program with individual therapy or twelve-step programs with an individual therapist. Someone might join a PTSD support group for group treatment and admit to a treatment program. As with any major change one might make, individuals are encouraged to increase their safe support system in as many ways as are possible.
You Are Not Alone
Many times, individuals who are experiencing symptoms of PTSD and addiction to substance use feel very alone and isolated from others. The weight of it may feel unbearable, and the thought of working through it all may feel impossible. Know that you are not alone and you are not meant to bear this alone. You are not the first ,and you are not the last. There is hope and help for you. It is a brave thing to take the first step towards healing when you are unsure where the path will lead you. The path each person takes is different, and no two journeys are ever the same – there is room for everyone on this road to wellness. When we are ready and able to take that first step, we will learn that there are others walking this journey with us. When we look closer, we will notice that not only are they on their own journey towards wellness, but they are ALL cheering us on, every step of the way.
You had no control of the trauma that occurred in your life, but you have the ability to take control of the trauma you experienced, now. The first step might be telling a friend or loved one that you think you need help. It may be calling the VA for referrals. Your first step might be checking yourself into rehab, and at APEX Recovery, our trained clinical staff are able to help you not just achieve sobriety, but also overcome underlying traumatic experiences and issues. Whatever that first step is, take it. People all over the world will tell you that hope and healing is possible if you’re ready to engage and do the work. You are worth any amount of work it will take to achieve wellness. At APEX Recovery, we are ready to hear your story and help you write the rest of it in its best form. By contacting us today, you can invite our team to be a part of your healing journey.