Post-traumatic stress disorder (PTSD) is a mental health disorder that occurs when a person experiences (directly or indirectly) or witnesses, a traumatic event, or series of events. People who suffer from PTSD often suffer for many years, if not an entire lifetime, after these traumatic events occur. During periods of high anxiety and stress, many PTSD sufferers turn to drugs or alcohol, as a means of numbing emotional pain, or escaping reality.
People seeking treatment for drug or alcohol addiction often find it difficult to recover, because their substance abuse is related to undiagnosed or untreated PTSD. When someone struggling with substance abuse also has mental health disorder, it is known as a co-occurring disorder.
Co-occurring disorders are difficult to treat because one disorder can mask the other. Just as an addict may face a more difficult recovery if their PTSD is not addressed, someone hoping to confront issues surrounding PTSD may disregard drug or alcohol use because they believe the activities to be unrelated.
In the past, mental health disorders like PTSD and substance abuse may have been treated separately. Often one disorder was thought to be a more significant issue, and was treated first, before the other disorder. Today, it is understood that both disorders must be addressed in tandem to ensure long-term recovery.
PTSD is often about power. Traumatic events, or a series of traumatic events, can leave a person feeling powerless and out of control. This feeling can manifest itself during dreams and other flashbacks. The helplessness felt by an individual during these flashbacks can lead to debilitating anxiety and stress.
When PTSD is allowed to fester or go unresolved, unhealthy reactions are likely to occur. These reactions may include violent outbursts or panic attacks. Reactions in public or in front of family members can lead to feelings of guilt and shame, and eventually to depression and substance abuse.
A leading cause of PTSD is military combat. In fact, Post-traumatic stress disorder has been separately known as “shell shock” or “combat fatigue,” after each of the World Wars. A veteran may experience PTSD after service that involves gruesome battlefields, battlefield injury, or capture by the enemy. Soldiers are built up to be confident and have pride, for success in battle, and the realities of war can leave them feeling helpless and unable to control their actual environments.
PTSD rates are high among rape victims, genocide survivors, and people imprisoned for political or ethnic reasons. Any sexual, psychological or physical abuse can lead to PTSD. Anyone who has to work in an environment that includes injuries, death, or destruction (police officers, firefighters, medical personnel) is susceptible to developing PTSD. Post-traumatic stress disorder can also be caused when someone lives through the death of a loved one, or lives through a natural disaster.
A diagnosis of PTSD is made after an individual shows symptoms for at least one month, following a traumatic event, or series of events. Symptoms may not occur right away, and may not appear until months or years later. In general, PTSD symptoms fall into three categories:
- Re-experiencing trauma through nightmares, flashbacks, or other recollections
- Avoidance of people, places, activities, or items that serve as a reminder of trauma
- Hyperarousal, hyperanxiety, irritability, or anger
Substance abuse is considered an avoidance symptom, as drugs or alcohol are used to numb pain or provide an escape from reality.
Besides drug or alcohol addiction, unresolved PTSD can lead to other serious disorders, such as:
- Attention Deficit Disorder
- Chronic Pain
- Chronic Diseases such as Diabetes and Hypertension
The body releases endorphins during a traumatic event. These endorphins are released to alleviate pain and regulate mood. Once the effects of these disorders wear off, endorphin withdrawal can set in. Endorphin withdrawal can produce a crippling sickness similar to that of heroin or any other addictive substance.
Someone living with PTSD may turn to drugs or alcohol to replace the sensation that the body’s natural endorphins had previously produced.
Approximately 70% of US adults have experienced trauma
Almost 20% of these adults go on to develop PTSD
Around 8% of US adults have PTSD at any given time
Women are about twice as likely as men to develop PTSD
* Source – http://www.ptsdunited.org/
Sometimes referred to as a dual diagnosis, co-occurring disorders are diagnosed in patients who suffer from both substance abuse and a mental health disorder such as PTSD.
Symptoms of substance abuse may mask mental health disorders, and vice versa, making treatment of either more difficult.
Certain patterns may emerge that are typical to co-occurring disorders. Here are two such patterns:
- Decreased Mental Health Despite Treatment – Treatment of a mental health disorder includes the development of important coping skills. When an individual turns to drugs or alcohol to treat symptoms of PTSD, they are making the development of coping skills more difficult. Substance abuse interferes with a person’s ability to form satisfying, personal relationships, or enjoy the benefits of self-reflection.
- Substance Abuse Issues that are Resistant to Treatment – Mental health disorder symptoms that persist after substance use has ceased should serve as a red flag. Some treatment centers lack the resources or competence to treat both substance abuse and mental health disorders. Peer groups that insist in total abstinence may frown upon any and all substance use, including medications prescribed to treat the mental health disorder.
Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse.
Thirty-seven percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.
Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.
* Source – Journal of the American Medical Association – http://nami.org
Historically it was assumed that either substance abuse or the mental health disorder needed to be treated first, prior to the treatment of the other disorder. Today, an integrated approach to treatment, where both substance abuse and disorders like PTSD are treated at the same time, has been shown to be most effective.
Key Features of Integrated Treatment
In shared decision making, the client plays a major role in determining the treatment goals, treatment procedures, and path to recovery.
Both mental health and substance abuse treatment services are provided by the same person or team. The result is one set of goals, one treatment plan, and one relapse plan.
Treatment must be comprehensive, covering the wide range of services required in the treatment of both disorders.
For people who have not sought out treatment on their own, there should be assertive community outreach that engages shelters, hospitals, law enforcement, or other community leaders.
With a progressive reduction of negative consequences, people are allowed to use their chosen substances while managing some of the harm that these substances do.
An approach that focuses on a long-term perspective appreciates how unique each person’s recovery will be, and the variety in rate of recovery.
Treatment must meet the client at his or her current stage of motivation. In a motivation-based treatment scenario, the stages of motivation are engagement, persuasion, active treatment, and relapse prevention.
A highly individualized approach to each client must be taken, because of the differences between patients with similar co-occurring disorders. One client struggling with both prescription drug abuse and PTSD may have more challenges associated with chronic pain in their workload, while another may be living with a family member closely associated to the source trauma.
Specialized Treatment Strategies for PTSD and Addiction
Concurrent Treatment of PTSD and Substance Abuse Disorders Using Prolonged Exposure (COPE) – Prolonged exposure therapy forces the patient to remember and revisit the source of trauma. The patient learns to confront and deal with the memory, and is discouraged from avoidance. COPE has been shown to both improve PTSD and curb substance abuse.
Integrated Cognitive-Behavioral Therapy (non exposure) – Because the memories of trauma can be painful, and a trigger for other dangerous behaviors, this alternative to exposure approach focuses on education, anxiety reduction, and the development of coping skills. This approach has a lower attrition rate, and is also supported by empirical study.
Eye Movement Desensitization and Reprocessing (EMDR) – Treatment for emotional pain is assumed to take many months, or many years. EMDR has been shown to improve PTSD over a period of a few 90 minute sessions. It is believed that eye movement is related to how a person deals with memories. Through training, the right patient may be able to retrain the brain to experience these memories differently. Only patients with a certain readiness to work with a therapist will benefit from EMDR.
Physical Exercise – One of the allures of substances like opiates, or alcohol, is the pleasure sensation that is chemically stimulated in the brain, especially for those suffering with anxiety and depression. Exercise and physical activity can also stimulate the release of similar chemicals.
Peer Groups and Family Counseling – Just as with any substance abuse treatment, family counseling, group therapy, or 12-step groups, provide support for people who have co-occurring disorders.
Balanced Anti-Addiction and Psychotherapeutic Medication – There are a growing number of medicines that have been proven to combat addiction. Antidepressants or anti-anxiety drugs are effective in regulating the moods of people suffering from PTSD.