PTSD and Substance Abuse
Post-traumatic stress disorder (PTSD) and substance abuse interact in complex ways. As an intense anxiety disorder, PTSD deeply affects a person’s sense of wellbeing. In order to cope with the feeling of unsafety and disturbance, many people with PTSD attempt to self-medicate with drugs or alcohol to alleviate their condition.1
The causal relation sometimes also works in the opposite direction: people who struggle with addiction are more exposed to risky situations in which they may experience or witness a traumatic event, after which they can develop PTSD.1
In order to help the person who is struggling with these issues, PTSD and substance abuse treatment often needs to take these relations into consideration and address them jointly.2
What Is PTSD?
Post-traumatic stress disorder (PTSD) is a mental health condition that develops after a person experiences or witnesses a life-threatening or traumatic event. Such events are natural disasters, terrorist attacks, wars, serious accidents, or assaults.3
PTSD does not necessarily develop immediately after these experiences. For the first few days or weeks after such an intense event, it is normal to have insomnia, nightmares, or feel anxious. However, if these symptoms persist for months after the event, if they get worse, or if they have a delayed start, this indicates that a person is suffering from PTSD.
The signs of PTSD are the following:3
- Reliving the event in the form of flashbacks, memories, or nightmares
- Avoiding certain situations that remind the individual of the traumatic event
- Experiencing negative feelings, beliefs, or moods: a person is more likely to see the world as a harder place to live in or people as less friendly or helpful; the person is also more likely to view themselves in a negative light
- Hyperarousal, which means feeling jittery, “keyed up,” having trouble concentrating, or experiencing panic attacks
Additional symptoms and behavioral consequences may include:
- The feeling of hopelessness
- Experiencing shame with no cause
- Feeling despair
- Substance abuse, especially cigarettes, alcohol, and marijuana
- Physical symptoms like heart pain, fatigue, or chronic muscle or joint pain
- Trouble with employment, school, or personal relationships
To be diagnosed with PTSD, a person must meet the following criteria, as laid out in the DSM-5:4
- At least one symptom must be re-experienced.
- There needs to be at least one instance of avoidance.
- There need to be at least two arousal or reactivity symptoms.
- There need to be at least two cognition and mood symptoms.
How Common Is PTSD?
Not everyone develops PTSD after a traumatic incident. Science still does not have a clear answer as to which factors and to what extent determine whether a person will develop PTSD. Like with other mental health and substance use disorders, it is probably a combination of genetics, environment, and experiences. Neuroscience has found that some people’s nervous systems could be more likely to develop PTSD if exposed to life-threatening danger. Nevertheless, it is important to note that PTSD is not a sign of weakness—it can happen to anyone.
The National Center for PTSD reports that at least 7 or 8% of people will experience PTSD at some point in their life.5 This applies to people of any age, gender, personal history, or job history. However, data suggests that some groups of people are at greater risk than others, such as women and war veterans, or first responders who may struggle with PTSD and addiction. The Anxiety and Depression Association of America (ADAA) notes that 7.7 million Americans older than 18 have PTSD, as do 67% of people who have been exposed to mass violence.6
How Are PTSD and Substance Abuse Related?
Mental health conditions can be closely associated with substance abuse. In order to cope with the unpleasant symptoms of PTSD, people might use alcohol, prescription drugs, or illicit drugs.
In some cases, this can lead to addiction. The American Society of Addiction Medicine (ASAM) defines substance abuse and addiction as a primary, chronic disease that changes the reward center of the brain.7 Drugs and alcohol change how neurotransmitters are released and absorbed by neurons, which increases a person’s sense of pleasure, relaxation or stimulation, and wellbeing. When the reward center gets triggered by dopamine, serotonin, and other neurotransmitters, the individual is likely to perceive the euphoria induced by drugs and alcohol as positive.
After compulsively consuming drugs to achieve a certain balance of neurotransmitters, the individual is likely to develop:8
- Physical dependence, which means the body needs the presence of the addictive chemical to feel normal.
- Tolerance to substance, which means they require larger doses to get the original level of intoxication.
When PTSD and substance abuse occur together, they are referred to as co-occurring disorders. The statistics of the VA shows that 2 out of 10 veterans in the United States have both PTSD and a substance use disorder (SUD).9 Veterans who abuse alcohol are more likely to binge drink when symptoms intensify than drink heavily but consistently. Veterans who have received a PTSD diagnosis smoke cigarettes at twice the rate of those who do not have PTSD – 6 out of 10 compared to 3 out of 10, respectively. Inpatient substance abuse treatment programs have reported that half their clients meet the criteria for PTSD alongside their SUD when they enter treatment.1
Which Substances Are Abused by People With PTSD?
A study that explored the prevalence rates of certain substances among people struggling with PTSD found that certain drugs were more present than others:10
- Heroin/opiates: 21.4%
- Marijuana: 19.4%
- Amphetamines 17.5%
- Benzodiazepines: 15.5%
Another survey examined how many people with substance abuse issues also had PTSD found that a range of 23 to 42% of those currently struggling with cocaine addiction also had a lifetime PTSD diagnosis.11
Cocaine appears to increase a person’s risk of developing PTSD after suffering a traumatic event. Opioids also put people at risk of developing PTSD, though at lower rates than cocaine. Withdrawal symptoms for both may include recurring PTSD symptoms or exacerbation of those symptoms.11
Why Is PTSD and Substance Abuse Treatment Important?
Even if they do not develop substance abuse problems, people who struggle with untreated PTSD for a long time may develop other health issues that result from consistent stress. Some of these conditions include:9
- Cardiovascular problems
- Heart attack
- Musculoskeletal problems and chronic pain
- Gastrointestinal disorders, including ulcers
Substance abuse has direct measurable impacts on the body. Although health effects depend on the type of substance, most long-term substance abuse that goes untreated typically harms multiple body systems. Some of these include an increased risk of the following conditions:12
- Cardiovascular damage and morbidity
- Lung disease
- Kidney failure
- Liver damage
- Other mental illnesses, like anxiety or depression
- Infectious diseases, especially HIV, pneumonia, tuberculosis, and hepatitis B and C
Dealing with substance abuse and mental health issues individually is difficult as it is. When the two co-occur, the path to recovery can become even more arduous. By seeking out treatment for co-occurring substance abuse and PTSD, you can maximize your chances of attaining a fulfilling, healthy lifestyle.
Frequently Asked Questions
Clinicians must first assess their clients for co-occurring disorders in order to treat both conditions appropriately.
In order to get the best treatment possible, it is recommended to work with a care team that includes physicians, pharmacists, counselors, and therapists in a rehabilitation program equipped to treat co-occurring disorders.
When it comes to types of PTSD and Substance Abuse Treatment, Exposure Therapy has been found to help PTSD very effectively, while Cognitive Behavioral Therapy has been found to work well for substance use disorders. Medical interventions may be necessary in cases when people are suffering from potentially life-threatening withdrawal symptoms or experiencing extremely uncomfortable symptoms.13
Co-occurring PTSD and substance abuse can make the symptoms of each worse.14 When a person uses alcohol or drugs to manage the symptoms of a mental disorder, the symptoms only become more severe. On the other hand, when a mental health problem remains untreated, so substance abuse usually intensifies.
The official policy of the National Center for PTSD is that patients with PTSD and SUD should be offered evidence-based treatment for both disorders.9 Having one condition should not be a barrier to receiving treatment for the other.;
Although researchers are still investigating which forms of treatment are the most effective for this combination of co-occurring disorders, prolonged exposure therapy seems to give the most promising results.1
1. Berenz, E. C. & Coffey, S. F. (2012).Treatment of co-occurring posttraumatic stress disorder and substance use disorders. Current psychiatry reports, 14(5), 469–477.;
2. Flanagan, J. C., Korte, K. J., Killeen, T. K., & Back, S. E. (2016). Concurrent treatment of substance use and PTSD. Current Psychiatry Reports, 18(8), 70.;
3. American Psychiatric Association. (2020). What Is Posttraumatic Stress Disorder?.
4. The National Institute of Mental Health. (2019). Post-Traumatic Stress Disorder.
6. Anxiety and Depression Association of America. (2020).Posttraumatic Stress Disorder (PTSD).;
7. American Society of Addiction Medicine. (2019).Definition of Addiction.
8. Substance Abuse and Mental Health Services Administration. (2020). ; Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet]. Washington (DC): US Department of Health and Human Services.
9. National Center for PTSD. (2020).Treatment of Co-Occurring PTSD and Substance Use Disorder in VA.
10. McCauley, J. L., Killeen, T., Gros, D. F., Brady, K. T., & Back, S. E. (2012). Posttraumatic Stress Disorder and Co-Occurring Substance Use Disorders: Advances in Assessment and Treatment. Clinical Psychology: a publication of the Division of Clinical Psychology of the American Psychological Association, 19(3), 10.;
11. Saunders, E. C., Lambert-Harris, C., McGovern, M. P., Meier, A., & Xie, H. (2015). The Prevalence of Posttraumatic Stress Disorder Symptoms among Addiction Treatment Patients with Cocaine Use Disorders. Journal of Psychoactive Drugs, 47(1), 42–50.;
12. National Institute on Drug Abuse. (2020). Drugs, Brains, and Behavior: The Science of Addiction: Addiction and Health.;
13. Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions. Frontiers in Behavioral Neuroscience, 12, 258.;