What is Post-Traumatic Stress Disorder?
It is not unusual for someone who has gone through a stressful event to feel on edge or have disturbing memories for a few weeks or months afterwards. But if symptoms such as trouble sleeping and an inability to perform daily activities continue beyond a few months, it could be post-traumatic stress disorder.
Anyone can develop PTSD, which is a mental health condition and not a sign of weakness. People who have experienced prolonged trauma are more likely to develop the condition. For example, stress related to combat and sexual assault makes it more likely that symptoms of post-traumatic stress will develop. In fact, 3 out of 10 people who have spent time in a war zone suffer from PTSD.
It is noteworthy that post-traumatic stress disorder is twice as likely in women than men - 10 percent of women suffer from PTSD at some point in their lifetime compared to 4 percent of men.
Besides combat, other intense traumatic experiences can lead to post-traumatic stress disorder. The condition affects an estimated 8 percent of Americans. This means almost 25 million Americans are living with post-traumatic stress disorder at any given time.
PTSD is more than just a bad mood or depression. It has both a psychological and physical component. People with post-traumatic stress often develop additional problems, such as memory difficulties, severe depression, or a dependence on drugs or alcohol.
Risk Factors for Post-Traumatic Stress Disorder
- Environmental – Severity and type of trauma, prior exposure to trauma.
- Social – Family instability, lack of social support.
- Demographic – Gender (being female), young age, lower socioeconomic status, divorced or widowed, ethnic minorities.
- Psychiatric – Past history of psychological problems, prior substance abuse.
- Cognitive – Lower intellectual functioning, impairments in explicit memory.
- Biological – Higher heart rate in ER, low cortisol levels.
- Genetic – Parents with mood or anxiety disorders, substance use disorders, or PTSD.
Who can get post-traumatic stress disorder? Anyone, regardless of gender, age, ethnicity, and occupation can develop symptoms of this condition following exposure to a severely traumatic event. However, certain populations are more vulnerable than others. As mentioned, women are more likely to develop symptoms of post-traumatic stress than men. War veterans, firefighters, first responders, and police officers are high-risk groups based on their profession. Among the civilian population, victims of rape, domestic violence, and gang violence are at risk of PTSD. This mental health condition is also seen in survivors of natural disasters, political confinement, ethnic imprisonment, or genocide.
Types of Post-Traumatic Stress Disorder
Scientists have classified post-traumatic stress disorder into five main types based on the type of traumatic event and symptoms.
This type of PTSD occurs following a single discrete event during adulthood. Symptoms include having intense bad memories, feeling emotionally numb, and disconnecting from relationships. Recovery is usually possible in a few weeks with a debriefing, open discussions, and education on positive coping strategies.
This is relatively uncommon and occurs following a single life-threatening trauma. Symptoms include insomnia, suspicion, panic, confusion, dissociation, and inability to care for oneself. Treatment includes crisis intervention, removal from the scene, medications for anxiety and insomnia, and psychotherapy.
This type of post-traumatic stress disorder is relatively uncommon and is typically associated with symptoms such as persistently reliving the traumatic event, avoidance of stimuli that provoke memories, emotional numbness, and heightened arousal. It is treated with cognitive-behavioral therapy (CBT), group therapy, and pharmacological approaches.
This is a common type of post-traumatic stress disorder that co-occurs with other psychiatric conditions such as depression or substance abuse. Treatment for dual diagnosis requires careful management of all coexisting conditions. Modalities include psychotherapy and medication-assisted treatment.
This type of post-traumatic stress disorder occurs following exposure to prolonged stress such as sexual abuse during childhood or long-term deployment to a war zone. Symptoms include extreme emotional difficulties and antisocial behaviors such as aggression, alcohol and drug abuse, self-destruction, impulsiveness, and sexual misdemeanors. Treatment is usually prolonged and involves a structured program delivered by specialists in post-traumatic stress disorder.
What Causes Post-Traumatic Stress Disorder?
Scientists and researchers have tried to figure out why some people develop post-traumatic stress disorder and others do not. They have found that people with PTSD have high levels of stress hormones. It has also been noted that people with this condition process emotions differently and exhibit changes in the hippocampus, the part of the brain that deals with fear. Experts believe some of the symptoms of the condition are a survival mechanism. For example, flashbacks and reliving details of the event are ways to be better prepared should the event happen again.
Who is at risk for post-traumatic stress disorder? People who have experienced a prolonged traumatic event or an intensely dangerous, distressing, or stressful event can develop this condition. People with a past history of depression and anxiety and individuals without much social support are more susceptible to the condition.
PTSD in the Military
Military personnel who have been in combat are exposed to dangerous and horrific experiences, some of which are life-threatening. Many veterans of the Gulf War, Iraq, Afghanistan, and Vietnam are diagnosed with PTSD. In addition to the combat situation, other mental health conditions, politics surrounding the deployment, being away from home, and living in difficult terrain and climate can all add to the mental trauma. Military sexual assault is a known cause of post-traumatic stress disorder, both during peacetime and in war zones. Both men and women can be victims – 23 percent of women in the military report sexual assault. Sexual harassment is reported by 55 percent of military women and 38 percent of military men.
PTSD in Civilians
PTSD is not limited to war veterans who have suffered trauma during combat. It can affect ordinary citizens regardless of age, gender, ethnicity, income, or lifestyle. In fact, one study found that 65 percent of people experience a severe traumatic event at some point in their lives, enough to cause symptoms of PTSD, and more than 50 percent of these traumatized individuals go on to develop symptoms. Civilian post-traumatic stress disorder is essentially the same disease as combat PTSD with much of the same symptoms. In the civilian population, this condition can be caused by:
- Natural disasters, such as Hurricane Katrina.
- Terrorist attacks, for example, 9/11.
- Serious accidents (car crashes).
- Sexual assault (rape).
- Domestic violence.
- Childhood abuse.
- Life-threatening illness.
- Traumatic death/suicide by family member or friend.
- Mugging or kidnapping.
- Imprisonment or hostage situations.
Sexual Assault: In the first two weeks following a sexual assault, almost all women report symptoms of post-traumatic stress disorder, including nightmares, bad memories, difficulty sleeping, and jumpiness. Symptoms are still present in 30 percent of women nine months after the assault. The National Women’s Study found that one-third of rape victims go on to develop PTSD.
Childhood Abuse: Childhood abuse is associated with an increased risk of developing a post-traumatic stress disorder. Difficulties with emotional regulation and behavioral problems persist into adulthood in many victims of childhood abuse. Symptoms such as anger, irritability, avoidance, and inability to deal with strong emotional stimuli are noted in such individuals.
Death: The unexpected or violent death of a loved one is associated with an increased risk of psychological disorders including PTSD in the surviving family and friends. The bereavement period is most commonly associated with anxiety, depression, and alcohol use disorder, especially in the first few months following the death of a loved one.
Symptoms of Post-Traumatic Stress Disorder
Post-traumatic stress disorder manifests as a variety of physiological and psychological symptoms, ranging in severity from mild to debilitating. Symptoms of PTSD are divided into four subgroups as follows:
- Unwanted distressing memories or frightening thoughts
- Recurrent nightmares
- Flashbacks (re-living the event)
- Intense emotional or physiological response to any reminder of the event
- Avoiding thoughts and memories of the event
- Avoiding external reminders such as people, places, things, sounds, smells
- Memory lapse or blacking out
- Persistent negative views and emotions
- Misdirected blame on others
- Distorted feelings of guilt and shame
- Inability to experience positive emotions
- Loss of interest in previously enjoyed activities
- Detachment from loved ones and a feeling that they do not understand
- Anger, aggression, irritability
- Self-destructive behaviors and recklessness (rash driving, unprotected sex)
- Excessive alertness or being on edge
- Hypervigilance and hyperarousal (increased perception of threat)
- Easily startled
- Problems concentrating
- Difficulty falling asleep and staying asleep
Post-Traumatic Stress and Addiction
Some people are unable to cope with their post-traumatic stress disorder and begin to smoke too much, drink heavily, or use illicit drugs to deal with their symptoms. People struggling with post-traumatic stress are at high risk of developing problems with drugs and alcohol. Each of these conditions can make the symptoms of the other one worse. Many military personnel undergoing addiction treatment have co-existing PTSD. A dual diagnosis of post-traumatic stress disorder and substance use disorder is associated with a number of health and social problems.
PTSD and Addiction: Statistics and Facts
Many studies have shown a strong relationship between post-traumatic stress disorder and substance use disorder in men and women, in both military and civilian populations. One study found that people with PTSD were 14 times more likely to have a substance use disorder (SUD) compared to people without trauma-related stress. On the other hand, 30-60 percent of people seeking addiction treatment have PTSD.
PTSD in Military Men and Women
- 20 percent of war veterans with PTSD have a co-occurring substance use disorder.
- One-third of veterans seeking treatment for addiction have post-traumatic stress disorder.
- 10 percent of soldiers who receive care at the Veterans Administration have alcohol or drug problems.
- Binge drinking is common in war veterans with PTSD.
- About 60 percent of veterans with PTSD smoke compared to 30 percent of veterans without post-traumatic stress.
Non-Combat PTSD in Civilians
- Nearly 90 percent of Americans are exposed to at least one traumatic event in their lifetime and more than 10 percent develop composite event PTSD; prevalence is highest following threat or injury to a loved one, witnessing dead bodies, witnessing physical or sexual assault, or being the victim of sexual or physical assault.
- Lifetime prevalence of PTSD is just under 7 percent in the United States with females showing a higher past year prevalence (5.2 percent) compared to males (1.8 percent) and more than 36 percent of sufferers having severe PTSD.
- PTSD following rape is common, especially if it involves a stranger and use of physical force or weapons
- Similar to trends in adults, PTSD in adolescents is higher in females (8 percent) compared to males (2.3 percent).
- Prevalence rates are high in countries with conflict and causes of PTSD are determined by political and cultural factors, with physical violence being a common inciting event in countries such as South Africa and death of a loved one in Europe and Japan.
- Up to 35 percent of patients diagnosed with cancer meet the criteria for full syndrome PTSD after completing treatment; some symptoms of PTSD are present in up to 80 percent of patients with recurrent cancer.
Substance Abuse in Individuals with PTSD: A Coping Mechanism
The interplay between PTSD and addiction is complex and multifaceted. Studies show that in the majority of people, PTSD precedes substance abuse. Why do people with post-traumatic stress disorder start abusing drugs and alcohol? Experts believe it is a coping mechanism and a means of escape. High levels of stress in a person with PTSD make it more likely for them to turn to drugs or alcohol. For example, post-traumatic stress disorder can result in insomnia and people with this condition may self-medicate with alcohol or drugs to try and fall asleep and stay asleep. Others with PTSD may turn to illicit drugs or alcohol to numb terrible memories, avoid unpleasant emotions, or deal with a mood disorder.
Increased susceptibility also plays a role and puts some people with PTSD at high risk of addiction. For instance, poor coping skills, genetics, biological vulnerability (family history of substance abuse), history of physical abuse or sexual assault, and prior exposure to combat or traumatic events can increase the likelihood of a person with PTSD developing an addiction to alcohol or drugs.
Commonly Abused Substances by People with PTSD
People with PTSD can become addicted to any mind-altering substance, but some addictions are more common than others. Here are some of the most commonly abused substances by people who are struggling with the aftereffects of trauma.
In both male and female veterans and civilians, the most prevalent substances of abuse are tobacco and alcohol, probably because they are easily available and relatively inexpensive. About 60 percent of veterans with PTSD smoke compared to 30 percent of veterans without post-traumatic stress disorder. According to the Veterans Administration, 60 to 80 percent of Vietnam vets who seek treatment for PTSD have problems with alcohol use. Dangerous drinking patterns in people with PTSD are the precursor to full-blown addiction. Studies show that comorbid alcohol use disorder and PTSD are highly prevalent in the U.S. veteran population. In civilians, PTSD and alcohol use often occur together and cause big problems for the affected person. PTSD increases a person’s risk of drinking problems and women are at greater risk than men. Victims of sexual abuse are at high risk of drug and alcohol problems compared to others. In fact, three out of four survivors of violent trauma report problems with alcohol.
Opioids are highly addictive drugs that are frequently prescribed to veterans with chronic pain. Studies show that war veterans with a diagnosis of PTSD or other mental health condition are more likely to receive an opioid prescription, more likely to receive higher doses of the medications, and more likely to receive early refills. People with PTSD can easily become addicted to the euphoric escape that opiates offer, leading eventually to addiction. Opiate addiction complicates PTSD treatment. Many of the symptoms of opioid withdrawal, for example, agitation, hypervigilance, and easily startled, are similar to post-traumatic stress disorder symptoms.
Some people with PTSD begin using marijuana as a self-treatment option. However, the drug is a psychoactive substance that leads to intoxication, euphoria, hallucinations, and sensorimotor dysfunction. Individuals trying to cope with trauma by relying on marijuana may become emotionally or chemically dependent on the drug without realizing the harm it can cause. PTSD is a risk factor for marijuana use disorder. Studies show that a diagnosis of PTSD significantly increases the risk of using marijuana. Among veterans seeking care at VA facilities for co-occurring substance use disorder and PTSD, cannabis use is the most common disorder. In 2014, nearly 23 percent of veterans with PTSD and SUD had cannabis use disorder, up from 13 percent in 2002. Among other drugs, cocaine (15 percent), opioids (10-15 percent), and amphetamines (about 5 percent) are commonly abused by veterans with PTSD and SUD.
The Chemistry of PTSD and Addiction
According to the National Institute on Drug Abuse (NIDA), drug abuse may bring about symptoms of mental disorders and mental disorders can lead to drug abuse. For example, people with PTSD may self-medicate and come to rely on drugs and alcohol for temporary relief from their symptoms. Mental health disorders and addiction share common risk factors, such as genetic vulnerability and environmental triggers.
What happens in the brain and body of a person with PTSD? What causes a person with post-traumatic stress disorder to become dependent on drugs or alcohol? Alcohol, marijuana, benzodiazepines, and opioids are all central nervous system suppressants. They enhance the activity of a neurotransmitter called GABA in the human brain. GABA is a natural tranquilizer that reduces fear and anxiety. Some illicit drugs increase the amount of dopamine, a chemical that makes us feel happy. Neurotransmitters called endorphins are released in the brain during traumatic events to cope with the stress and provide a sense of wellbeing. Once the traumatic event is over, there is endorphin withdrawal.
Drugs and alcohol can temporarily mimic the effects of these natural feel-good chemicals in the body. Individuals with PTSD start using alcohol and drugs in order to obtain these positive effects and get relief from their symptoms. However, prolonged use of drugs and alcohol alters the structure of the neurons in the brain and causes permanent abnormalities in neurotransmission. Eventually, the person is unable to respond normally to these chemicals. With prolonged use, the individual becomes chemically dependent, requiring more and more drugs or alcohol to feel the same effects, eventually resulting in addiction.
Consequences of Substance Abuse by PTSD Sufferers
People with PTSD suffer from intense anxiety, nightmarish flashbacks, and disturbing memories that do not allow them to function normally. Many individuals with post-traumatic stress turn to alcohol or drugs to numb the symptoms and regain some control of their lives.
Central nervous system depressants like alcohol and opiates interfere with normal sleep patterns and worsen anxiety and depression.
Alcohol intoxication can worsen some of the symptoms of post-traumatic stress disorder such as irritability, anger, depression, and increased guardedness. Excessive alcohol prevents restful, refreshing sleep and may exacerbate nightmares.
When PTSD and addiction are present together in a person, treatment is complicated because each condition fuels and magnifies the severity of the other. In fact, the withdrawal symptoms of many illicit drugs, such as sleep disturbance, irritability, detachment, and concentration problems, closely mimic the symptoms of PTSD.
When someone uses drugs or alcohol to manage their PTSD symptoms, they end up in a vicious cycle, worsening the symptoms of the post-traumatic stress disorder. What are the consequences of addiction in someone who has PTSD?
- Enduring Tolerance: People with symptoms of PTSD abuse drugs or alcohol in order to forget about their problems, without realizing that they are exacerbating the symptoms in the long run. Increased use of drugs and alcohol is associated with chemical dependence so that the person needs more and more of the substance to obtain the same effect. This tolerance to the drug eventually leads to addiction where the person insists on using the drug despite the devastating effects.
- Withdrawal Symptoms: Repeated drug use makes it difficult for the brain to regulate neurotransmitters such as GABA and dopamine. This results in drug cravings and distressing withdrawal symptoms, such as irritability, insomnia, depression, and anxiety. As a person’s dependence on the drug grows, the onset of withdrawal symptoms further fuels cravings and loss of control.
- Long-Term Effects: PTSD and drug or alcohol addiction have a number of long-lasting effects on brain and body. In addition to unemployment, homelessness, poverty, failed relationships, and increased risk of suicide attempts, people with PTSD and addiction develop a variety of health and psychological problems. The coexisting disorders complicate treatment and prolong recovery.
Treatment of PTSD and Addiction
Treatment of dual diagnosis PTSD and addiction is complicated. Individuals with co-occurring substance abuse and post-traumatic stress develop tolerance and may experience withdrawal symptoms. The long-term effects of the drugs on the brain and body impede the treatment of PTSD in such individuals.
Individuals with a dual diagnosis of PTSD and substance abuse have special needs and require intensive support from addiction experts, psychiatric specialists, as well as family, friends, and peers. Perhaps the biggest hurdle for many people struggling with PTSD and addiction is that they are in denial or are reluctant to reach out for help. Shame and guilt are common in people who have gone through a traumatic event. Addictive behaviors can add to these emotions and make it even more difficult to get appropriate treatment.
Dual diagnosis is difficult to treat because it is impossible to know where certain symptoms are emanating from. For example, there is no way to know whether a person’s depression is attributable to PTSD or the drug. In addition, patients with a dual diagnosis are at high risk of suicide and require more intensive care.
It takes an integrated team of mental health professionals and addiction specialists to understand and treat addiction in people with PTSD. Individuals with these two conditions require comprehensive and customized treatment plans to address their unique needs. Not all drug rehabs are equipped to handle patients with a complicated dual diagnosis. Rehabilitation facilities that have centralized resources to treat both conditions under one roof are the most successful in treating patients with PTSD and substance abuse. Such facilities typically have healthcare professionals who have dealt extensively with individuals who are battling both post-traumatic stress disorder and substance use disorder.
Therapies Used to Treat Post-Traumatic Stress Disorder and Addiction
The most important feature of dual diagnosis treatment is that both diagnoses should be addressed simultaneously. This ensures that once treatment is completed, all issues have been addressed and the person does not relapse to harmful behaviors or self-medication with drugs and alcohol. Highly trained teams of professionals provide parallel treatment for PTSD and substance abuse through a number of different treatment modalities, including:
This treatment modality has proven efficacy in dual diagnosis treatment. The program typically consists of 16 sessions where the client unlearns preconceived notions and understands the relationship between feelings, thoughts, and behaviors. CBT is more than talk therapy. It requires the client’s active involvement in setting goals and following through with an eye on weekly progress.
This type of therapy is very effective for individuals with PTSD. Clients focus on and reprocess the traumatic event they experienced while tracking the oscillations of their eye movements. This helps reduce the terror associated with the event and changes the way a person views the memory, thereby reducing the stress from the event.
PE therapy involves re-experiencing the traumatic event by recalling feelings, memories, thoughts, and emotions. This addresses the avoidance symptoms of PTSD and desensitizes the individual. This mechanism addresses the underlying symptoms that drove a person to addiction.
This type of therapy is especially effective in people suffering from PTSD. By incorporating elements of cognitive behavioral therapy, it helps change negative thoughts associated with a traumatic event. The underlying principle of CPT is that negative emotions and behaviors are interconnected and replacing them with positive ones is the key to recovery.
Alcoholism and PTSD often go hand-in-hand. The 12-step approach has demonstrated efficacy in overcoming alcohol addiction. People who have experienced an intensely traumatic event often struggle with their spirituality and question their relationship with a higher power. When used in conjunction with other modalities, the 12-step format helps individuals with PTSD and alcoholism.
Anti-addiction medications, medications to make the withdrawal from drugs safer and easier, and drugs that control anxiety and depression are prescribed to assist people who are seeking help for PTSD and addiction.
People with PTSD and addiction dual diagnosis may benefit from alternative treatment modalities, such as relaxation techniques, guided imagery, breathing exercises, self-hypnosis, and yoga. These therapies help in controlling the intense symptoms of PTSD which are the underlying forces that lead a person to addiction.
Living a Life with Confidence: Overcoming PTSD and Substance Abuse
People with PTSD are struggling with intense emotions and memories and frequently feel disconnected from friends and loved ones who did not experience the same trauma. Violent outbursts, feelings of guilt and shame, panic attacks, and suicidal thoughts are not uncommon in such individuals. This puts PTSD sufferers at high risk of turning to alcohol or drugs for relief. Continued use of alcohol and drugs can end up in addiction. PTSD and addiction triggers can intensify each other and make both problems worse.
If someone with PTSD has become addicted to drugs or alcohol, they are not alone. Help is available for dual diagnosis PTSD and substance use disorders. Top-rated rehab centers offer customized treatment programs, care, and support to help an addict with PTSD to take the first step on the path to recovery. What is crucial is admitting there is a problem and seeking the appropriate treatment for it. It is critical that PTSD and addiction are treated simultaneously to undo the damage from both conditions. If a loved one has co-occurring PTSD and addiction, contact a specialized rehabilitation facility today.