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Is there a Connection Between Drug Abuse and PTSD?

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Post-traumatic stress disorder is a problem that is known to affect veterans and first responders, but it can also happen to people simply going about their daily lives. If something like a car accident or an assault causes fear that’s difficult to cope with, you may develop PTSD. 

Unfortunately, PTSD also increases your risk of other behavioral and mental health issues, especially substance use disorders. In fact, research shows that people that experience trauma and have PTSD are significantly more likely to also have substance use problems. PTSD can increase your risk of developing a substance use problem as many as three times. 

But what is the connection between PTSD and addiction? What makes the two problems likely to overlap? Learn more about PTSD, addiction, and how they can be treated.

What Is Post-Traumatic Stress Disorder?


Post-traumatic stress disorder (PTSD) is an anxiety disorder that’s caused when a person is exposed to a traumatic event like assault, an accident, or abuse. A traumatic event can develop into PTSD if a person experiences a traumatic event and is unable to cope or process it in a healthy way. 

PTSD is characterized by anxiety, panic attacks, depression, nightmares, and flashback memories that have to do with a particularly traumatic event. It may also involve avoidance behavior that’s related to places and situations that may trigger uncomfortable memories or flashbacks.

These flashbacks often contribute to anxiety and a feeling of isolation. PTSD is often associated with veterans that have seen combat, but it can happen to anyone that experiences any type of frightening scenario. It can come from both momentary events like a car accident, but it can also come from prolonged exposure to trauma like years of abuse. 

PTSD is thought to be related to the fight-or-flight response, which is an important function of the brain that helps to protect you from harm. Fight-or-flight floods the body with chemicals that boost your energy and prepares you to run or fight a threat. You may feel this response anytime you’re watching a movie, and there’s a jump scare. 

You suddenly become more alert, your heart starts beating faster, your breathing increases, and you become extremely vigilant. People who have PTSD may experience a misfiring of that response. Small triggers can cause flashbacks to a traumatic event that causes the fight-or-flight response to fire. 

This can cause you to panic at inappropriate times, like when you’re trying to sleep or in the middle of a social interaction. 

ptsd-and-drug-use

What Is Self-Medication?

PTSD often causes symptoms that are difficult to cope with in your day-to-day life. For instance, it can cause insomnia due to nightmares or isolation from friends and family. PTSD can make things like maintaining employment or developing healthy relationships more difficult. 

For that reason, people with PTSD are often willing to look anywhere for relief. In many cases, relief comes in the form of drug or alcohol misuse. Using chemical substances to mask uncomfortable psychological symptoms without consulting a doctor is called self-medication. 

Alcohol is a common substance in self-medication for PTSD. What starts as social drinking to blow off steam grows into problem use. Other drugs can also be used to mask uncomfortable PTSD symptoms and emotions, especially after alcohol fails to give you lasting relief. 

Self-medication can offer temporary relief, but it only lasts as long as the high. Once the drug wears off, you’ll still be left with unaddressed traumas and anxiety symptoms. 

Self-medicating with drugs and alcohol can lead to substance use problems, such as chemical dependence and addiction. Instead of treating PTSD, substance use disorders only add to the stresses that are getting in the way of your life. For instance, if insomnia was keeping you awake before, adding alcohol addiction will make it so that you will struggle to sleep, and you’ll feel the need to drink in the morning just to feel normal. 

What Are the Signs of Self-Medication?

The line between social drinking or recreational drug use and self-medication can be difficult to recognize. In fact, self-medication is culturally accepted and even encouraged. It’s common to hear the words, “I need a drink,” after someone experiences a stressful day. The idea of using alcohol or drugs to mask feelings or to treat symptoms feels normal. You may even think this is what everyone does. However, there are a few signs that regular alcohol or drug use is turning into self-medication. 

The first is the reason you’re using it. Social or recreational drug use is usually done to achieve a pleasurable high or to bond with other people. But your motivation for self-medication is likely to feel better, to numb your mind to painful memories, or to distract yourself from problems. 

As you start to develop a substance use disorder, you may start to use drugs just to feel normal, not even to feel better. When you develop a chemical dependence, you’ll experience uncomfortable withdrawal symptoms if you miss a dose or try to cut back. You’ll need to use drugs just to stave off these symptoms. 

Another common sign is a growing tolerance. Tolerance builds as your brain and body get used to the drug. You’ll notice that the same dose or the same number of drinks no longer have the same effects that they once did. You may feel the need to take high doses to compensate. You may also need to use more often, which means spending more time seeking drugs, getting high, and recovering. 

For alcoholism, a telltale sign of tolerance is the need to drink early in the morning. If you’re chemically dependent, drinks from the night before may start wearing off and causing withdrawal symptoms in the morning.

Other signs can include emotional issues like a growing sense of shame, hopelessness, and irritability. You may try to hide drug or alcohol use from loved ones. You may also use more of a drug than you intend to and feel that your substance misuse is getting out of control. Eventually, self-medication can turn into a substance use disorder, which only further complicates your PTSD.

Why Addiction Makes PTSD Worse

Ultimately, self-medication just makes PTSD worse. For one thing, it adds a substance use problem to the issues that you’re already dealing with. Addiction tends to take over your life, affecting your health, finances, relationships, and even your legal standing. 

Addiction, depending on the specific drug, can make common symptoms of PTSD worse. For instance, insomnia is a common problem associated with PTSD, but many substances can cause sleep disturbances or insomnia as a side effect or a symptom of withdrawal. Even depressants can disrupt sleep. Alcohol is known to make people feel sleepy, but it can also prevent or disrupt REM sleep, making the sleep you do get less restful. 

It’s clear that PTSD can lead to drug misuse as a coping mechanism. A severe substance use problem can also increase your risk of experiencing traumatic events. People in active addiction are more likely to become the victim of crimes, including assault and sexual assault, which can lead to trauma. 

How Are PTSD and Addiction Treated?

It’s important to deal with PTSD and addiction at the same time. Any attempts to address one while ignoring the other may result in limited success. Since mental health issues and addiction often feed off one another, they may be thought of as different parts of the same problem. Addiction treatment programs often have therapies specifically designed to address past traumas. There are also some therapies that can be useful in treating PTSD and addiction. 

One of the latter is cognitive behavioral therapy (CBT). CBT is a behavioral therapy that can be used to treat various mental health and behavioral conditions. It involves a close look at the learning processes that contribute to behaviors like repeated substance misuse. In CBT, you’ll learn to identify triggers and high-risk scenarios that may cause cravings or PTSD symptoms. You’ll also learn effective coping responses that can help you handle high-risk situations without panic or using drugs. CBT is often instrumental in relapse prevention planning. 

Exposure therapy, a common method of dealing with trauma, shares some similarities with behavioral therapies. Exposure therapy involves making a list of fears from least to most distressing and working through the list slowly, developing coping skills to deal with them.

For past traumas, this may involve talk therapy, going through common triggers, or visiting places you avoided. Eye Movement Desensitization and Reprocessing (EMDR) therapy involves a similar concept of talking through traumatic experiences, but it also involves desensitizing you to triggers with the help of a stimulus that draws your focus during therapy sessions, like following an object that’s moving back and forth with your eyes.

Sources

American Psychiatric Association. (2017, January). What Is Addiction? from https://www.psychiatry.org/patients-families/addiction/what-is-addiction

Gielen, N., Havermans, R., Tekelenburg, M., & Jansen, A. (2012). Prevalence of post-traumatic stress disorder among patients with substance use disorder: It is higher than clinicians think it is. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415609/

Mayo Clinic. (2018, July 06). Post-traumatic stress disorder (PTSD). from https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967

National Institute on Drug Abuse. (2020, June 01). Cognitive-behavioral therapy (alcohol, marijuana, cocaine, methamphetamine, nicotine). from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies/cognitive-behavioral-therapy

National Institute of Mental Health. (2018, February). Depression. from https://www.nimh.nih.gov/health/topics/depression/index.shtml

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