There is a clear link between substance use disorders (SUD) and post-traumatic stress disorders (PTSD) in the United States. Currently, millions of U.S. citizens have a SUD that affects how they function daily. A 2018 national survey showed that about 20.3 million individuals, aged 12 or older, struggled with substance use within the past year. According to the survey, approximately 70% of adults in the United States have had at least one traumatic experience during their lifetime. What is the connection between these all-too-common situations? Trauma is a huge risk factor in almost all substance use disorders. Years of reputable research demonstrate that there is a prominent link between experiencing a traumatic event and having a SUD. Exploring the connection between substance use and trauma allows physicians and treatment centers to better care for people with co-occurring disorders.

It’s important to note that people with SUDs are also more likely to have exposure to traumatic events or PTSD in their lifetimes. These people are more likely to use substances as a coping mechanism, sparking a harmful cycle of substance abuse. Those diagnosed with PTSD are up to 3 times more likely to abuse substances.

When a person is experiencing distress caused by the combination of traumatic stress and substance use, they will often have other psychological or physical problems. Up to 50% of adults with co-occurring alcohol use and PTSD also have one or more other serious psychological or physical conditions, including anxiety disorders, mood disorders, diabetes, heart disease, and chronic pain.

Correlation Between PTSD and Substance Abuse

Decades of research provide a handful of hypotheses to explain the connection between those diagnosed with PTSD and substance use.

The self-medication hypothesis suggests that individuals with PTSD use substances to cope with or counteract their symptoms.
The susceptibility hypothesis proposes that people who use substances are more susceptible to developing PTSD after exposure to trauma than those who do not use them.
The high-risk theory explains that substance abuse may heighten the risk of exposure to a traumatic event. That is, individuals using drugs or alcohol are more likely to put themselves in a high-risk situation compared to those not using illicit substances. The high-risk theory also accounts for the dampened sensitivity to danger and response to cues in an unsafe environment.

Current research backs up the self-medication hypothesis, with some support for the high-risk theory. There was no evidence in the study to support the susceptibility hypothesis.

Signs of PTSD and Substance Abuse

PTSD is an anxiety disorder caused by a traumatic experience in a person’s life, such as military combat, sexual abuse, or car accidents. All traumatic experiences are unique and personal to the individual. The relationship between trauma and substance abuse disorders spans traumas, types of substances, and populations of people. According to the National Center for PTSD, approximately 8 out of every 100 Americans suffer from Post Traumatic Stress Disorder. Some of these people may have the same symptoms as others, while others may not. Common symptoms of PTSD include flashbacks of the traumatic event, uncontrollable thoughts, nightmares, and lashing out at those around them. While symptoms may vary, the early signs of PTSD are often expressed similarly. Signs of PTSD include attitude and behavioral changes like becoming easily irritated and angry, having trouble sleeping and concentrating, feeling numb to the outside world, avoiding people, places, or activities that you used to enjoy regularly, or experiencing flashbacks and nightmares.

There are common indicators of substance abuse and addiction. Individuals abusing drugs and alcohol may show the following signs and symptoms:

Being defensive when asked about substance use
Changes in spending habits and financial troubles
Abrupt changes in behavior
Decreased appetite and weight loss
Lack of motivation and poor work performance
Appearing sickly, such as bloodshot eyes and changes in skin tone

PTSD and Substance Abuse in Veterans

Substance abuse and addiction are frequently connected to co-occurring disorders like PTSD, depression, and anxiety. Individuals seeking treatment for PTSD are nearly 15 times more likely to also receive a substance use disorder diagnosis. People suffering from trauma sometimes attempt to self-medicate, making it common that those with PTSD also abuse substances. The tendency to abuse substances stems from the person with PTSD wanting to numb and mitigate their symptoms when they arise. Interestingly, those with both PTSD and SUD are more likely to abuse alcohol rather than drugs. Research has also shown that veterans and service members tend to be a commonly diagnosed population with binge drinking.

Although PTSD can affect any population, men actively serving in the military and veterans often suffer from PTSD in high proportions. Individuals who have fought in war make up one of the highest risk groups for both PTSD and addiction. According to the U.S. Department of Veteran Affairs, veterans who are in treatment for a SUD are often diagnosed with PTSD. The National Vietnam Veterans Readjustment Study, conducted in the 1980s, reported that 74% of Vietnam Veterans with PTSD also had a substance use disorder. It is difficult for those who have never served in the military to comprehend the emotional stress, physical demands, and mental strain of combat. For some veterans, the things that have been seen cannot be unseen, and if trauma is not addressed it can spill over into a SUD. In particular, the population of service members that were deployed overseas to Iraq and Afghanistan is at a higher risk of developing PTSD. Between 2004 and 2010, approximately 16% of veterans had an untreated SUD, and 8% needed treatment for serious psychological distress (SPD). Data from a survey that used a current national sample of veterans estimated that the rate of lifetime PTSD was 8%, while approximately 5% reported having current PTSD. Furthermore, around 20% of veterans with PTSD also have a co-occurring SUD.

Trauma from the battlefield may not be the only traumatic experience this population endures. Sadly, many veterans have been sexually assaulted or harassed during their military service. Men and women who have experienced sexual abuse have higher rates of alcohol and other substance use disorders. According to the VA, about 20% of female veterans have experienced sexual trauma while in the military. These women are at increased risk for alcohol use disorder. The VA provides opportunities for veterans to seek treatment for any trauma and co-occurring SUDs.

Treatment For PTSD and Substance Abuse

Recovery is possible. Historically, people with co-occurring SUD and PTSD have had fewer treatment options in the past, but progress is being made. Previous methods attempted to separate the treatment of substance use and trauma disorders, focusing on one disorder at a time. Now that we know more about how trauma affects the risk of substance use disorders, treatment centers are using this knowledge to promote the treatment of both disorders at the same time. The 2017 Veterans Administration/Department of Defense Clinical Practice Guideline for PTSD recommends that evidence-based treatments for PTSD and SUD, including psychotherapy and medication, be made available to veterans at the same time. The VA’s guideline for PTSD treatment says that having one disorder should not delay a veteran from receiving treatment for the other. This standard has been widely practiced by other organizations treating other populations for substance use and trauma.

There is no one ideal type of program to treat co-occurring PTSD and SUD. A collaborative approach that involves trauma and addiction expertise is necessary. At Boardwalk Recovery Center, our staff psychologists have different specialties; some with expertise in trauma therapy, and all of them have addiction experience. We can deliver care for all aspects of a client’s substance use disorder. The ability to treat both the SUD and any underlying trauma that could be contributing to the disorder has shown positive effects in client treatment. Our staff has been trained to use a trauma-informed care framework to supplement treatment for those struggling with any disorder. Leading with an empathetic approach and a recovery mindset is critical. Establishing the standard in treatment centers to be trauma-informed helps produce the best results for the individuals suffering with SUDs.