Exploring the Connection Between PTSD and Substance Abuse

Veteran with PTSD

How many veterans do you know personally? How many veterans have you met who are living on the streets?

Chances are that the latter number is disproportionate. In fact, while less than 10% of Americans are veterans, they account for almost 13% of the adult unhoused population. One of the most common reasons is substance abuse. This reality applies not only to veterans, but to anyone who has post-traumatic stress disorder (PTSD).

But what is the connection between PTSD and substance abuse? In this article, we’ll explore why these illnesses commonly co-occur and what we can do about it.

Physiological Connections Between PTSD and Substance Abuse

PTSD and substance abuse both have significant impacts on the body. In some instances, the impact of each is very similar. In others, they are almost the opposite. Both the similar and dissimilar physiological effects can account for why these mental illnesses often co-occur.

The Reward System

PTSD and substances both impact the brain’s reward system. Trauma has been shown to impact neurotransmitter systems, leading to a greater sense of reward or relief when using substances. Substances already activate the brain’s reward system in a significant way. The amplified impact of substances increases the urge to use them more and more.

The brain gets used to the substances after regular use, and the person has to use greater quantities more often to get that reward. This leads to dependence and addiction.

The Nervous System

When trauma occurs, the nervous system reacts so as to get the person through the crisis. They become more alert, their heart pounds at a faster rate, and their blood pressure rises. This is necessary in the moment. However, people with PTSD show sustained hyperactivity of the sympathetic and parasympathetic nervous system. In other words, the person’s body continues to respond as if they are still in danger.

This leads to a number of the most common symptoms of PTSD, including sleep disturbances, hypervigilance, irritability, and difficulty relaxing. These symptoms can be very distressing, leading to the urge to find a quick fix.

Substances seem to provide that quick fix at first. Alcohol and drugs can have numbing effects, giving temporary relief to these symptoms. As such, the connection between PTSD and substance abuse in this case is due to their contradictory effects on the body.

Psychological Connections Between PTSD and Substance Abuse

The relationship between Post-Traumatic Stress Disorder (PTSD) and substance abuse is significantly influenced by psychological mechanisms. These mechanisms are rooted in the attempt of individuals with PTSD to manage their distressing symptoms and emotions.

Emotional Regulation and Coping Strategies

People with PTSD often struggle with emotional regulation, finding it challenging to manage intense emotions such as fear, anger, and sadness. Substance use can become a coping mechanism, providing a temporary escape from these overwhelming emotions and their associated behaviors. The immediate relief that substances initially offer can create a compelling reinforcement loop. As individuals continue to use substances to mitigate their distress, they may develop a dependency, viewing drugs or alcohol as essential tools for emotional management.

Avoidance Behavior and Negative Reinforcement

Avoidance behaviors are common in PTSD, where individuals attempt to steer clear of thoughts, feelings, or reminders of the traumatic event. Substance use can be a part of this avoidance pattern, serving as a means to numb or block out painful memories.

Trauma and Self-Identity

Trauma can profoundly affect an individual’s sense of self and world view. People with PTSD may experience feelings of worthlessness, guilt, or shame, with many associated disturbing thoughts. They may turn to substances to dull the feelings and quiet the mind. Substance use can also lead to a temporary surge of confidence and euphoria, providing a break from the negative self-image.

Impaired Judgment and Risk-Taking

PTSD can impair judgment and increase impulsivity, leading to higher risk-taking behaviors, including substance abuse. The impaired decision-making process can diminish the perceived risks of substance use, making the individual more susceptible to abusing drugs or alcohol as a quick fix for their distress.

This can unfortunately go both ways. People with substance abuse issues often end up in dangerous situations due to the impaired judgment that substances cause. They may become victims of trauma, leading to PTSD and a vicious cycle.

Integrated Treatment of PTSD and Substance Abuse

Mental health experts understand the importance of treating co-occurring illnesses together, rather than in isolation. As such, people with both disorders should look for integrated treatment plans for PTSD and substance abuse.

Potential Treatment Plans

Integrated treatment models combine elements of psychological therapy, pharmacotherapy, and social support to create a comprehensive care plan. Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Eye Movement Desensitization and Reprocessing (EMDR) are commonly used to treat the symptoms of PTSD, while motivational interviewing and relapse prevention strategies are employed to address substance abuse.

Challenges in Treatment

Treating co-occurring PTSD and substance abuse presents unique challenges, including the need for providers to have expertise in both areas, the potential for treatment interference (where symptoms of one condition exacerbate the other), and the higher risk of relapse. Careful monitoring and a flexible approach to treatment are necessary to navigate these complexities, ensuring that progress in one area does not lead to setbacks in another.

Considerations for Effective Management

A key consideration in the treatment of co-occurring PTSD and substance abuse is the need for a phased approach, starting with establishing safety and stability, followed by trauma-focused therapy and relapse prevention. Treatment should also be personalized, taking into account the individual’s history, severity of symptoms, and specific needs.

Prevention and Education

Ideally, the co-occurrence of PTSD and substance abuse should be prevented. While it is impossible to eradicate trauma from human experience, education and training can help prevent trauma from leading to PTSD, and from PTSD leading to substance abuse.

Prevention Strategies

Preventing PTSD and substance abuse, particularly in high-risk populations, involves early intervention and education. Programs that focus on resilience training, stress management, and healthy coping mechanisms can reduce the incidence of these conditions. For individuals who have already experienced trauma, early therapeutic intervention can prevent the development of PTSD and subsequent substance abuse.

Importance of Education and Awareness

Education plays a crucial role in prevention, with awareness campaigns aimed at destigmatizing PTSD and substance abuse, thereby encouraging individuals to seek help early. Education can also inform the public about the risks of substance use as a coping mechanism for trauma, highlighting the importance of addressing underlying issues rather than resorting to self-medication.

Community and Support Networks

Building strong community and support networks is essential for prevention and recovery. Social support can mitigate the effects of trauma and reduce the likelihood of substance abuse. Community programs that offer support and resources to those at risk can prevent the onset of PTSD and substance abuse and provide a safety net for those in recovery.

Future Directions in Research and Treatment

Expanding Research on Co-occurring Disorders

Future research should aim to unravel the complex interplay between PTSD and substance abuse further. Studies need to explore the underlying neurobiological, genetic, and environmental factors that contribute to the co-occurrence of these conditions. Longitudinal research tracking individuals over time can provide insights into how the relationship between PTSD and substance abuse evolves and how early interventions can alter trajectories.

Innovations in Treatment Modalities

Advancements in technology and neuroscience offer promising new avenues for treating co-occurring PTSD and substance abuse. Virtual reality (VR) therapy, for example, is emerging as a potent tool for exposure therapy in PTSD, allowing for controlled and safe exposure to trauma cues. Similarly, neurofeedback and other brain stimulation techniques are being explored for their potential to regulate brain activity and reduce substance cravings and PTSD symptoms.

Integrating Personalized Medicine

The field is moving towards personalized medicine, where treatments are tailored to the individual’s genetic makeup, lifestyle, and specific symptomatology. This approach could be particularly effective for those with co-occurring disorders, as it allows for treatments that are specifically designed to address the unique patterns of brain activity and psychological responses found in each individual.

Enhancing Access to Care

There is a critical need to improve access to mental health services for individuals with PTSD and substance abuse. Telehealth and online therapy platforms are expanding the reach of mental health services, making it easier for individuals in remote or underserved areas to receive the care they need. Policies that increase insurance coverage for mental health services and reduce stigma around seeking help are also vital.

Collaborative and Community-Based Approaches

Future treatment models should emphasize collaborative and community-based approaches that involve families, peer support groups, and community organizations. These networks can provide comprehensive support, from prevention and early intervention to treatment and long-term recovery, creating a holistic ecosystem of care.

Conclusion

PTSD and substance abuse often co-occur. While there are a number of reasons for this, the connection is preventable. Trauma is a part of human life and will sometimes lead to PTSD no matter how prepared a person is. However, we can take steps to better prepare people, and to help people who do develop PTSD avoid the dangers of substance abuse.

Sources
  • Dialogues in Clinical Neuroscience: Post-traumatic stress disorder: the neurobiological impact of psychological trauma
  • National Institute of Mental Health (NIMH): Post-Traumatic Stress Disorder
  • National Institute of Mental Health (NIMH): Substance Use and Co-Occurring Mental Disorders
  • Statista: Veteran homelessness in the U.S. – statistics & facts