An overdose is a traumatic experience, capable of damaging your health and even ending your life. Some overdoses are accidental, the result of an error in dosage, or a dangerous combination of substances. Others are intentional, reflecting an attempt at suicide or murder. An accidental overdose occurs when the user disregards the directions on the bottle, either because they don’t understand them or they are taking more than prescribed. A drug overdose can happen to someone looking to alter their body and mind or in a clinical setting if a health professional makes a mistake when administering a drug. Having a large amount of drugs in the body poisons and overwhelms it and can cause damage or even death. As the opioid crisis persists, overdose remains one of the leading causes of injury-related death in the United States, surpassing vehicle crashes and even firearms. This fatality statistic captures only one part of the impact of overdoses in the United States.

Emotional Trauma of Overdose

Overdose leaves a distressing impact on survivors and their families. They must recover physically as well as cope with the emotional trauma of overdose. The trauma can be deep, especially for someone who may have witnessed or intervened in an overdose situation. The symptoms can vary depending on whether the individual who overdosed survived. Some people experience flashbacks, remembering and reliving the terrifying experience. Others obsess over what could have happened had the survivor died. Another frequent feeling is a sense of hyper-vigilance, constantly worrying when it might happen again. Shock, anger, fear, resentment, guilt, and hopelessness are all normal feelings after experiencing or witnessing an overdose. At Boardwalk Recovery Center, we assist clients and their families in processing these feelings to heal and move past the overdose.

Physical Effects of Overdose

How the body responds to a drug depends on the individual, the quantity, and the type of drug consumed. Most people who experience an overdose will recover without permanent injury or disability but some drugs can cause temporary or permanent organ damage; the liver and the kidney are the organs most commonly affected. If the brain or heart is affected by overdose the effect is usually permanent. Once drugs are in the body they travel to different sites of action where they cause a wide variety of effects. While there is a multitude of reactions happening inside of the body, the external effects are just as influential.

PTSD and Overdose Trauma

A study led by researchers at the Johns Hopkins Bloomberg School of Public Health linked drug overdose to post-traumatic stress disorder (PTSD). The study included 380 female sex workers in Baltimore City and showed that treatment programs see a significant mental health component in overdose victims and their families. Researchers discovered that more than half of the study’s participants reported symptoms of PTSD in the six months after experiencing or witnessing an overdose and after accounting for other traumas they may have experienced. The findings from this study were published in the International Journal of Drug Policy, influencing and informing overdose treatment programs on how to treat all aspects of clients’ illnesses.

Study participants were asked if they had experienced an overdose themselves or witnessed a fatal or non-fatal overdose in the past six months. Participants then answered a 20-item questionnaire that evaluates PTSD symptoms in 4 separate domains outlined in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5):

1. Intrusion – which involves re-experiencing the event through unwanted memories, nightmares, or flashbacks

2. Avoidance – which includes intentionally trying to avoid trauma-related thoughts, feelings, and external reminders

3. Cognition/mood – which involves negative thoughts and feelings that were brought on or worsened by a trauma

4. Arousal/reactivity symptoms – which involve irritability, aggression, and hypervigilance.

People who experienced an overdose reported symptoms in all four areas, but those who had witnessed an overdose primarily indicated symptoms in the intrusion and arousal/reactivity domains. The results indicated that more than half of the participants had recently witnessed an overdose, with close to a third witnessing a fatal overdose and about half witnessing a non-fatal overdose. Nearly a third of these participants had experienced a recent overdose themselves. Additionally, more than half (199/380 participants) met the cutoff for a provisional diagnosis of PTSD using the criteria from the 20-item questionnaire. It is important to note that the effects of some drugs, such as cocaine and other stimulants, can mimic the agitation of the arousal and reactivity area. Overall, most participants reported symptoms in each PTSD domain.

The researchers found that even after accounting for other types of traumas experienced by this population, overdose trauma was still closely linked with PTSD symptoms. For instance, 66% of these women had been homeless in the past six months, 66% had gone hungry at least once a week, 44% reported client violence, 22% reported intimate partner violence, but overdose trauma was most intensely linked with PTSD symptoms. Co-author Susan Sherman, Ph.D., MPH principal investigator of the EMERALD study acknowledged that “existing measures for PTSD don’t always accurately represent the effects of overdose traumas on populations that have high rates of cumulative trauma, like street-based female sex workers.” The paper’s primary author, Kristin Schneider, Ph.D., states that “for every overdose fatality, there are even more non-fatal overdoses.” Schnieder shares that it has been “unclear what mental health toll these events take on survivors and witnesses, particularly in the vulnerable and marginalized populations that overdose often affects.” Further research and public awareness are needed concerning the mental health toll taken on individuals who experience or witness an overdose.

Healing Psychological Trauma

The researchers believe that a focus linking overdose trauma to PTSD can help guide treatment paradigms for individuals who experience substance abuse and drug overdoses, as well as those who witness them. Although incredibly important, the treatment for overdose has been focused on saving lives, but in addition to physical harm, treatment for overdose should also be addressing the tremendous psychological harms that arise with overdose to help everyone involved fully recover from the trauma. Boardwalk Recovery Center stays up to date on current research, allowing our staff to treat addiction and reduce the risk of physical harm, as well as address psychological consequences.