Post traumatic stress disorder, or PTSD, is an anxiety disorder developed from negative emotional events. This can be experienced by anyone, any age, and it is generally experienced by people who have seen violence, engaged in violent activities such as warfare, suffered physical, psychological, sexual or emotional abuse, and victims of other violent crimes. This should not be confused with Acute Stress Disorder, which is short-term – usually lasting less than a month. Those who suffer from a traumatic event for more than one month should be evaluated by a medical professional as they are likely to have post-traumatic stress disorder. A review of treatments and comorbidity between PTSD and Substance Use Disorder (SUD) was conducted in 2007. The paper published in Psychological Science notes that between 36 and 50% of those seeking treatment for SUDs meet the criteria for a post-traumatic stress disorder. The connection clearly exists, but why? Let’s delve deeper into PTSD to find out. Signs and symptoms of PTSD:
- Anger (and outbursts)
- Attention Deficit Disorder
- Feeling of numbness (detachment)
- Memory difficulties
- Feeling on edge
- Thoughts of suicide
Those suffering from PTSD will often avoid being in situations that may trigger the traumatic events in their lives. This causes them to withdraw and can affect their work, relationships and everyday interactions with people. Some revert to self medicating due to these stresses, and overuse can lead to addiction.
How does PTSD develop?
Many know of post traumatic stress disorder in relation to soldiers returning from war. The U.S. Department of Veteran Affairs estimates that nearly 31% of Vietnam vets, 10% of Gulf War (Desert Storm) vets, and 11% of those who fought in Afghanistan suffer from PTSD. Other causes include:
- Natural disasters
- Death of a loved one
For women, who are most likely to experience sexual assault, 10% are likely to develop PTSD over men (4%). A few reasons it is more prevalent in women is that, besides the higher likelihood of sexual assault, women are more likely to blame themselves for traumatic experiences than men. The risk increases further if a woman already has a mental health issue, did not have a good social support network, had a severe reaction after the event, or was injured during the event. The risk is further increased by women serving in the military. Those currently serving are more likely to be exposed to combat, sexual harassment and sexual assault. Since women began serving in the military, more efforts are being taken to record and analyze their experiences in relation to mental health. In previous years, more attention was paid to male veterans. Children and teens with post traumatic stress may have suffered from a variety of stressful experiences. In the U.S., Child Protection Services received around three million reports each year. 30% of those reports involve proof of abuse. The types of abuse, according to the National Center for PTSD are: neglect (65%), physical abuse (18%), sexual abuse (10%), psychological abuse (7%). It should be noted that two-thirds of all child abuse cases are NOT reported. Like adults, children and teens experience PTSD with flashbacks, reliving trauma through play, fear, worry, anger and aggression. Teens are more likely to turn to substance abuse in order to self-medicate after the age of 12. Post traumatic stress in teens have symptoms much more similar to adults than to children. Therefore treatment options for teens integrate methods often used for adults.
How are PTSD and addiction connected?
The stress of being unable to cope with the terrifying memories and flashbacks that those with post traumatic stress experience can drive them to abuse substances. It may also cause sleeplessness, and thus alcohol or other drugs are ingested in order to sleep. Drugs and alcohol offers an escape from their pain. The brain changes for someone with PTSD similarly to someone struggling with addiction. Dealing with both issues at once can lead to a vicious cycle that exacerbates both. After a traumatic experience, the brain experiences a drop in endorphin levels. This feel good hormone drops enough to make someone feel depressed or anxious. So, they turn to a substance to make themselves feel good again. However, once they stop using the substance, the cycle begins again. According to the National Center for PTSD, “27% of Veterans in VA care diagnosed with PTSD also have Substance Use Disorder (SUD).” The Veteran-specific statistics don’t lie:
- Over 2 out of 10 vets with PTSD also abuse substances
- Veterans of war also tend to be binge drinkers
- 1 of every 3 veterans seek treatment for both SUDs and post traumatic stress disorders
- Twice as many veterans with PTSD smoke cigarettes over those without a diagnosis
- 1 in 10 soldiers returning from Iraq or Afghanistan and seen in VA abuse alcohol or drugs
According to the National Center for PTSD, sexual abuse is the most common cause of post traumatic stress disorder in women, and “Women who go through trauma have more risk for drinking problems. They are at risk for drinking problems even if they do not have PTSD. Women with drinking problems are more likely than other women to have been sexually abused at some time in their lives. Both men and women who have been sexually abused have higher rates of alcohol and drug use problems than others.”
Treating PTSD & Addiction Together
With both diagnoses, it’s imperative that those with post traumatic stress disorder and substance abuse work with qualified mental health professionals and those who understand the special needs of a PTSD patient. A dual diagnosis requires an expert team effort and an integrated effort within a single facility. An integrated treatment plan should include:
- Individual cognitive-behavioral therapy and group therapy
- Drug or alcohol treatment plan or detox
- Follow-up plan for continued treatment and aftercare
- Avoidance of triggers
Getting help is the first step in recovery. The best way to handle co-treatment of these disorders is to do so under one roof, with a full-service plan in place. Rehabilitation is possible.