Treating a dual diagnosis of PTSD and substance abuse requires an integrated treatment plan. Both issues need to be treated simultaneously for treatment to be successful.
With a proper diagnosis and a comprehensive treatment plan, individuals can work to overcome underlying issues and begin on a path to real recovery.
What Is Post-Traumatic Stress Disorder (PTSD)?
Post-traumatic stress disorder, or PTSD, is a mental health disorder related to stress and trauma. It occurs after an individual experiences, witnesses, or is somehow affected by a traumatic event.
The individual may be unable to process or overcome the stress related to the event, resulting in a pattern of pain, avoidance, anxiety, and depression.
Certain experiences — such as assault, rape, chronic abuse, wartime experiences, and natural disasters — are common triggers for PTSD. However, any traumatic event can be related to the development of the disorder. Friends or family members of an individual who was involved in a highly traumatic event can develop PTSD, even if they weren’t present for the actual traumatic occurrence.
Feelings of stress and anxiety are expected after a traumatic event. These are normal. When an individual experiences symptoms of PTSD immediately after a traumatic event and up to a month after it, it is called acute stress disorder. PTSD is diagnosed when the symptoms persist for over a month.
In many instances, an individual may feel shame about the traumatic incident or about their inability to cope with its aftermath. For this reason, many individuals suffer with PTSD without treatment.
Who Is Affected by It?
Approximately 8 million American adults suffer from some form of PTSD.
The disorder affects about 5 to 10 percent of men, and 7 to 14 percent of women, in the U.S. It can affect people of all ages, including children.
Are There Different Kinds?
Some people in the medical field consider complex post-traumatic stress disorder (also known as chronic post-traumatic stress disorder) to be a separate condition from general or acute PTSD.
General PTSD is usually caused by a single traumatic event or occurrence. Chronic PTSD may be caused by ongoing or repetitive exposure to stressful events. People who may suffer from chronic PTSD include a firefighter who continuously faces life-threatening danger on the job, an individual who is in an abusive relationship for a long time, and someone who has a very severe long-term illness and deals with it on a daily basis for years.
While the symptoms of complex or chronic PTSD are similar to those of general PTSD, those who deal with chronic PTSD may exhibit more dissociation from their trauma as well as from other aspects of their lives. These dissociative tendencies may be part of the reason chronic PTSD is often misdiagnosed as borderline personality disorder (BPD).
What Are the Symptoms of PTSD?
According to the American Psychiatric Association, there are five major components to PTSD:
- Experiencing a traumatic event
- Re-experiencing the event
- Attempting to (mentally) avoid the event
- Suffering from the experience of reliving and attempting to avoid the event
- Experiencing an increase in anxiety-related arousal symptoms
While the above five components may be helpful in identifying the big picture in the cycle of PTSD, many people who suffer from the disorder are unable to identify these behaviors in themselves. These are some of the more recognizable symptoms of PTSD:
- Having nightmares, bad dreams, or repetitive bad memories about the traumatic event
- Experiencing “flashbacks” and feeling as though one is experiencing the trauma all over again
- Losing awareness of the present time and present surroundings
- Feeling disassociated with current events and surroundings
- Intense emotional feelings when thinking about the event
- Experiencing physical sensations, like a rapid heartbeat or breathlessness, when thinking about the traumatic event
- Avoiding having to talk or think about the event
- Avoiding anyone or anything that could serve as a reminder of the event
- Losing interest in social activities or events that used to bring joy
- Being unable to remember certain aspects of the traumatic event
- Feeling numb, detached, or pessimistic
- Being unable to feel or express positive thoughts or moods
- Sleeping problems, such as being unable to fall asleep or sleep through the night
- Outbursts of anger or irritation
- Experiencing hypervigilance (excessive awareness of surroundings) or feeling easily startled and on edge
Why Is It Often Misdiagnosed?
There are many reasons why PTSD is often not diagnosed or misdiagnosed.
Again, one of the symptoms of PTSD may be avoidance of thinking about, or talking about, the traumatic event that triggered the disorder. Because of this, many people with PTSD may be unwilling to share their experiences with a medical professional in order to get diagnosed or treated.
Among many groups that commonly experience trauma, such as those in the military or police force, there may be a stigma against seeking mental help or admitting to suffering from PTSD. Many who have experienced sexual abuse or violence may be scared or reluctant to share the experience that triggered their disorder.
Some people may seek professional help but not tell the whole story or admit how much of an impact the traumatic event has had on their life and mental health. They may do this as a as a method of avoidance. This can lead to misdiagnosis.
What Are the Risks of Going Untreated?
If left untreated, many PTSD symptoms eventually get worse. Pain and avoidance can become a familiar part of an individual’s everyday life, influencing thought and behavior patterns.
Due to the ongoing symptoms and effects of PTSD, other mental health issues can develop. The person will then be dealing with co-occurring disorders or a dual diagnosis.
PTSD and co-current psychiatric problems are common. It’s estimated that approximately 80 percent of people who have PTSD will experience a co-occurring mental health condition at some point in their life. Research also suggests that a pre-existing mental illness may be a risk factor for developing PTSD.
Common co-occurring psychiatric problems associated with PTSD include depression, anxiety, and substance use disorders.
The presence of any co-occurring disorder complicates treatment. All issues need to be addressed as part of one integrated treatment plan.
How Common Is Substance Use Among People With PTSD?
Research indicates that approximately 45 percent of people with PTSD also struggle with a substance use disorder. Those with PTSD may be up to 14 times more likely to develop a substance abuse problem compared to someone who does not have PTSD.
It’s often suggested that those with PTSD, especially those who have not been properly diagnosed or treated, may be likely to self-medicate with drugs or alcohol in order to soothe their painful feelings or escape bad memories related to their trauma. Using substances in this way can quickly lead to a cycle of abuse that escalates into addiction.
Oftentimes, people who suffer from PTSD seek out substances that directly treat the symptoms they are experiencing as part of their disorder. For example, they may use alcohol or marijuana for their depressant effects in order to combat the feelings of hypervigilance or excessive situational awareness related to PTSD.
The risk factors for substance abuse and PTSD overlap somewhat, so those who are more likely to develop PTSD may already be more likely to abuse substances, and vice versa. The existence of one issue (either PTSD or substance abuse) increases the likelihood of the other issue developing.
How They Contribute to Each Other
Like PTSD, substance abuse will likely only worsen if left untreated. An individual may become more heavily dependent on substances to get them through the day and night, and they may turn to stronger doses or combinations of substances in order to maintain the desired level of euphoria.
Despite providing a short-term numbing effect, substance abuse will ultimately worsen the symptoms of PTSD over time. In return, the person may increase their substance abuse in an effort to self-medicate the worsening symptoms.
This leads to a dangerous cycle of increasing substance abuse and worsening PTSD symptoms, with each problem exacerbating the other.
How Are PTSD & Addiction Treated?
Treatment professionals have found that integrated treatment is necessary in cases of dual diagnoses. Trying to separate the problems and address them individually isn’t effective since they are closely related in terms of mental and behavioral patterns.
Depending on an individual’s history, substance of choice, and other factors, the treatment plan for co-occurring PTSD and substance use disorder will vary. Common elements of an integrated treatment plan to treat these disorders include:
- Exposure therapy. Various forms of therapy are used to address both addiction and PTSD, but exposure therapy has shown particular promise in addressing these co-occurring disorders.In sessions, the individual is gradually exposed to activities, scenarios, or objects that produce anxiety or fear; these may be imagined scenarios. Gradually, the person will begin to experience less fear or anxiety related to the triggering situation.
- Eye movement desensitization and reprocessing therapy (EMDR). This therapy is specifically designed to address trauma. Therapists guide patients through bilateral eye movements during sessions while they discuss their trauma, allowing them to reprocess the trauma in a safe environment. The goal is that the trauma will not have the same negative power over them at the end of the treatment series.
- Medication management. Depending on the substance of abuse, medications may be used during detox or part of the treatment process. They are often used in the form of medication-assisted treatment (MAT) for those who chronically abuse benzodiazepines, alcohol, or opioids.Medications may also be used to manage some symptoms of PTSD, such as anxiety or depression.
- Support groups. These can play a crucial role in recovery from both addiction and PTSD. Individuals can learn from others in the group and see that stability is possible on all fronts. They also have the opportunity to help others, which can fortify their standing in recovery.There are many support groups designed to help those struggling with addiction, such as Narcotics Anonymous and SMART Recovery. The National Alliance on Mental Illness offers information on local PTSD support groups.
Various other therapies and treatments may be used to fill out a care plan for those suffering from both PTSD and addiction. The key is that the plan is tailored to the needs of the individual, and it should be adjusted as the person progresses in recovery.