Post-Traumatic Stress Disorder (PTSD) and Addiction
Substance use disorders (SUDs) and mental health disorders (like PTSD and addiction) impact many people across the country. When mental health and substance use disorders exist simultaneously, they are referred to as co-occurring disorders.1
There are several mental health disorders that commonly co-occur with substance use disorders, post-traumatic stress disorder (PTSD) being one of them.1 Post-traumatic stress disorder occurs when a person experiences or witnesses a traumatic event that is dangerous or threatening.3 It is estimated that as many as 8 out of every 100 people will develop PTSD at some point throughout their lives.3 Additionally, roughly 12 million adults in the United States have PTSD in any given year.4
This article will help you better understand the link between PTSD and addiction, including potential causes of PTSD, signs of PTSD, and treatment options for co-occurring disorders.
What Is PTSD?
Post-traumatic stress disorder is a mental health disorder that develops after you have been exposed to threatened or actual death, violence, or serious injury. This includes directly experiencing a traumatic event, having a loved one experience the event, witnessing the event, or being exposed to chronic trauma through your profession (police officers, first responders, ER doctors, etc.).2, 3
When you experience trauma and subsequent feelings of fear, the “fight-or-flight” response is triggered, which is designed to protect you from a threat.3 However, some people continue to experience the “fight or flight” response long after the trauma is over and may develop PTSD.3
Many people associate PTSD with war veterans and active-duty personnel, which does occur; however, PTSD can affect anyone who has experienced a traumatic event. Common traits in people with PTSD include:3
- Re-experiencing/intrusive symptoms like bad dreams and flashbacks.
- Avoiding people, places, and things that remind you of the traumatic event.
- Angry outbursts and feeling jumpy (hypervigilant).
- Negative perceptions about yourself and the world; feelings of guilt and blame.
Causes of PTSD
PTSD is a result of direct or indirect trauma, however, not everyone who experiences trauma will develop PTSD or a substance use disorder.3 Certain risk factors can make you more vulnerable to developing PTSD. Risk factors for PTSD include:3
- Being female.
- Being in a profession where you experience hazardous events and circumstances (police officers, veterans, emergency medical personnel).
- Getting physically hurt in traumatic events.
- Feeling intense fear, horror, and helplessness during the event.
- Witnessing a deceased person or a severe injury.
- Experiencing trauma during childhood.
- Having minimal to no social support after the trauma has occurred.
- Having a previous history of addiction or mental health disorders.
- Experiencing other stressors after the traumatic event (financial hardship, the death of a loved one).
Signs of PTSD
Symptoms of PTSD can range in length and severity, and treatment varies from person to person. Only a mental health practitioner can diagnose PTSD. However, there are signs to look out for if you think you or someone you love is struggling with PTSD.
According to the Diagnostic and statistical manual of mental disorders, 5th Edition, to meet the criteria for PTSD in adults: 2
- You must experience at least 1 symptom in each symptom group for at least 1 month.
- The experience of trauma causes clinically significant impairment in social, occupational, family, and other essential areas of functioning.
- The impairment is not caused by physiological effects of drugs or alcohol or any other health condition.
As previously stated, to meet the criteria for PTSD, you must experience at least 1 symptom from each of the symptom groups listed below.
- Intrusive, involuntary, and chronic distressing memories about the traumatic event
- Chronic and distressing nightmares about the event
- Physiological reactions to environmental or internal reminders of the traumatic event
- Flashbacks/re-experiencing the traumatic event
- Severe and lengthy psychological distress when reminded of the trauma
- Intentional avoidance of people, things, places, objects, and circumstances that are reminders of the event
- Intentional and frantic efforts to avoid thinking about the event, feeling emotions related to the event, and acknowledging memories about the event
Negative Mood and Cognition Symptoms:2
- Difficulty remembering significant facts about the traumatic event
- Persistent and inaccurate beliefs about the cause or outcomes of the traumatic event that causes feelings of blame towards oneself or others
- Anhedonia (loss of pleasure in once pleasurable activities)
- Social withdrawal and detachment from others
- Difficulty experiencing feelings of joy and pleasure
- Experiencing chronic feelings of fear, anger, guilt, shame, and horror
- Chronic and embellished negative thoughts and expectations about oneself, the world, and other people
Arousal and Reactivity Symptoms:2
- Difficulty concentrating
- Exaggerated startled reaction
- Self-destructive, risky, or reckless behavior
- Difficulty sleeping (restless sleep, problems falling or staying asleep)
- Angry reactions and irritability
Relationship Between PTSD and Addiction
There is a significant connection between PTSD and addiction; however, the reason behind the connection can be complex.5 People with co-occurring PTSD and alcohol use disorder report more traumatic childhoods, psychiatric conditions like anxiety and depression, suicidality, and more intense PTSD symptoms.5 People with PTSD also tend to misuse the most potentially dangerous substances like opioids and cocaine.5
Statistics on co-occurring PTSD and addiction (also known as SUDs) show that:
- Among people who meet the criteria for PTSD, lifetime rates of SUDs range from 36% to 52%.5
- People with a lifetime or 12-month drug use disorder (excluding alcohol use disorder) have a 1.6 times increased risk of having PTSD.5
- Among people with SUDs, the lifetime prevalence of PTSD is estimated at 26% to 54%, and current rates of PTSD are between 15% to 42%.5
- Adults with PTSD are at a 1.3 to 1.5 times increased risk of having a past year or lifelong SUD.5
- Women with PTSD were 2.48 times more likely to have an alcohol use disorder (AUD) and 4.46 times more likely to have a drug use disorder (DUD) than women without PTSD.6
- Men with PTSD were 2.06 times more likely to meet the criteria for an AUD and 2.97 times more likely to meet the criteria for a DUD.6
- People with PTSD are more likely to misuse hazardous substances such as opioids and cocaine.5
Veterans and PTSD
Veterans may be at an increased risk of developing PTSD and SUDs due to their experiences in the military and combat.7 However, it isn’t only active combat and being exposed to war that increases a veteran’s risk for PTSD. Victims of military sexual trauma, those injured while in the military, and military personnel who are not in active combat but deployed to war zones may witness and/or be victims of acts of violence, which can increase the risk of developing PTSD.5 Roughly 16% of veterans have co-occurring PTSD and SUD.5
Unfortunately, social stigma and feelings of shame can prevent veterans from seeking help for co-occurring disorders. In the military, underlying values of masculinity and independence are fostered to support resilience while in active combat; however, these values can deter veterans from seeking help as they are afraid of being seen as “weak.”5
Veterans may also be at greater risk of suicide. The risk of suicide may be increased if a veteran:5
- Has a history of trauma in childhood.
- Is also experiencing depression.
- Has experienced sexual trauma while in the military.
PTSD and Addiction Treatment
In the past, trauma has not been included in the treatment of substance use disorders for fear of worsening the trauma symptoms.5 However, current research shows that failing to address trauma during addiction treatment could lead to poorer outcomes.5 People with co-occurring PTSD and addiction face significant challenges that need to be addressed in treatment.
These challenges include:5
- Rapid relapse after treatment completion.
- Reduced rates of symptom remission.
- Increased cognitive difficulties.
- Poorer treatment outcomes.
- Higher risk of suicide attempts.
- Decreased social and interpersonal functioning.
- Increased risk of death.
Effective treatment for co-occurring disorders is individualized and tailored to meet all your needs at the same time. More specifically, addiction treatment needs to be flexible, and treatment plans need to include services, treatment settings, and interventions that are specific to each person like substance use history, mental and medical health disorders, and other factors.8
Research shows that addressing PTSD and addiction simultaneously is preferred by clients and combining multiple services such as psychotherapy and medications can be effective.5
Behavioral Therapies for PTSD
Many therapies are effective in treating PTSD as well as SUDs. Trauma-focused psychotherapies are successful in reducing the severity of SUDs and PTSD after treatment completion; however, more research is needed.5
Common behavioral therapies used include:5
- Exposure Therapy.
- Cognitive Restructuring.3
- Eye Movement Desensitization and Reprocessing (EMDR).
Medication for PTSD
Medications may be a part of your treatment plan. Currently, there are 4 primary medications used to treat PTSD, and they have been shown to decrease the severity of PTSD symptoms.10 All 4 medications can also be used to treat depression and are either an SSRI (selective serotonin reuptake inhibitor) or an SNRI (serotonin-norepinephrine reuptake inhibitor).10
The four medications are:10
- Paroxetine (Paxil).
- Sertraline (Zoloft).
- Venlafaxine (Effexor).
- Fluoxetine (Prozac).
Find Treatment for Co-Occurring Disorders Near Me
If you or someone you love is struggling with PTSD and addiction, or any substance use disorder, help is available. American Addiction Centers (AAC) provide effective and supportive co-occurring disorder treatment. Call AAC free today at to speak with a trained and compassionate admissions navigator who can help answer questions and even check your insurance coverage.