What Is The Relationship Between PTSD & Substance Use?

Mental health experts have long known that posttraumatic stress disorder (PTSD) commonly co-occurs with other psychiatric conditions, including depression and anxiety. But one of the most common conditions to co-occur with PTSD is substance use disorders (SUD), and the complicated combination can result in more complex issues, including increased health problems, poorer social functioning, higher rates of suicide attempts, and more. 

According to the U.S. Department of Veterans Affairs, 44.6% of individuals with lifetime PTSD also meet criteria for an alcohol use disorder (AUD) or SUD. Understanding just how common the co-occurrence of PTSD and SUD is can help empower individuals to seek appropriate, evidence-based treatment to successfully—and simultaneously—treat both conditions.

What is the connection between PTSD and SUD?

It has been well documented that PTSD and SUD often co-occur, but the explanations behind the connection vary widely. The self-medication theory, for example, posits that those with PTSD incur an increased risk for developing SUDs due to a propensity to use substances to mitigate distressing PTSD symptoms.

“People with PTSD seek to avoid trauma memories and one form of avoidance is through the use of drugs and alcohol,” says Nema Clinical Director, Lashauna Cutts, LCSW. “Self-medication for PTSD and mental health disorders in general is well-known and well-studied. While these substances may be a temporary distraction from reliving the trauma, consistent use increases the likelihood of developing a separate Substance Use Disorder.”  

Cutts also points out that while those with PTSD might subsequently develop SUD as a form of self-medication, substance use itself can also precede the development of PTSD. “Individuals with SUD/AUD tend to experience more anxiety and hyperarousal,” she says. “This coupled with poor decision making when intoxicated, a higher likelihood to be in high risk environments, and limited distress tolerance leaves these folks more susceptible to experiencing trauma and developing PTSD.”

Are individuals with PTSD more likely to use certain substances over others?

While SUD can refer to the uncontrolled use of any substance, including tobacco or psychoactive drugs, individuals with PTSD are more likely to use alcohol than any other substance. While SUD and AUD are distinct diagnoses, both are considered chronic conditions characterized by the ability to stop or control substance use despite adverse consequences.

“After just one drink, an individual may be able to momentarily avoid distressing memories or tolerate trauma reminders,” Cutts says. “Also, one of the more common PTSD symptoms is sleep disruption. Individuals often use alcohol as a way to get uninterrupted sleep, although over time alcohol induced sleep compromises sleep quality and quantity by causing sleep disruptions later in the night.”

Are there any prevention strategies to keep individuals with PTSD from developing SUD?

While the co-occurrence of PTSD and SUD is common, it is far from inevitable. According to Cutts, the most important first step in prevention and/or treatment is to seek an accurate expert diagnosis. “Assessment, assessment, assessment,” she says. “If you suspect that you have PTSD, call Nema and get an intake evaluation for trauma treatment done as soon as possible. Some intake evaluations include a Brief Addiction Monitor (BAM), a questionnaire that assesses alcohol and substance use, risk factors, and protective factors.”

If you or someone you know has already received a PTSD diagnosis, it is imperative to seek evidence-based care to not only treat the existing condition, but to prevent the development of SUD. “If you have PTSD, get into effective PTSD treatment as soon as possible,” Cutts says. “And rely on your support system! You can tell trusted loved ones what symptoms you are experiencing and ask for their support in attending appointments with you—even if they stay in the waiting room.”

Cutts also advises individuals with PTSD to seek out and practice a form of dialectical behavior therapy (DBT) known as “alternate rebellion” which focuses on substituting problematic or risky behaviors with more neutral ones. “While originally developed to curb addiction behaviors, alternate rebellion is a DBT skill that offers alternatives to acting out in harmful, ineffective ways towards self and others,” Cutts says. “Instead of going to the liquor store, a person may decide to do something else out of the norm that doesn't cause harm to themselves or others, like blasting music in the car while going for a ride.”

The most effective treatments to concurrently address PTSD and SUD

While PTSD and SUD are both complex conditions, research has shown that there are effective methods for treating both simultaneously. “PTSD and SUD often co-occur and individuals with PTSD and SUD can tolerate and benefit from evidence-based trauma-focused PTSD treatment,” Cutts says. “If an individual is able and willing to curb use while engaging in treatment (not use during treatment sessions and during practice assignments) then I would recommend trauma-focused treatment for PTSD: Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Eye Movement Desensitization and Reprocessing (EMDR).” 

Nema utilizes CPT because it is the most-effective treatment designed specifically for PTSD, helping patients understand how they interpret their trauma and how it affects their feelings and behavior. Firmly rooted in empirical research, CPT leads to a positive response in up to 90% of patients, and these results have proven to last for decades after treatment completion. If you or someone you know is struggling with PTSD, contact Nema today for more information.