The Link Between PTSD and Substance Abuse

ptsd and addiction

According to TIME Magazine, the “vast majority” of those who struggle with addiction have also suffered significant traumatic events in their past. Moreover, many who are battling addiction are simultaneously suffering from post-traumatic stress disorder (PTSD). In fact, 55 to 66 percent of people with addictions also suffer from PTSD, or did at some point.

Research reveals that there is a strong trend toward simultaneous occurrence or comorbidity of PTSD and substance use disorders (SUDs) across a diverse set of settings and populations. In fact, patients with PTSD are two to four times more likely to be struggling with addiction than are their peers without PTSD.

The Facts About PTSD

According to the National Institute on Mental Health (NIMH), PTSD will affect about seven or eight people out of 100 during their lifetime. PTSD is a disorder brought on by experiencing one or multiple traumatic or life-threatening events. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), violence and trauma are harmful, costly, and commonly experienced by both children and adults in America. Trauma and violence recognize no boundaries when it comes to gender, age, race, socioeconomic status, sexual orientation, or ethnicity.

SAMHSA’s definition of individual trauma hinges on events that are physically or emotionally harmful or life threatening, and that leave a lasting negative problem for the person’s physical, mental, emotional, social, or spiritual well-being and functioning. Given that at least 15 to 25 percent of women will, at some time in their lives, experience sexual abuse (and many men will too), 18.9 percent of men and 15.2 percent of women in the US will experience a natural disaster in their lifetime, and domestic violence among American women happens at up to 44 percent, depending on how it’s defined, it’s easy to see why PTSD is so common—even among those who haven’t served in the military.

Furthermore, think tank RAND has found that 18.5 percent of veterans returning from deployment reported symptoms consistent with depression or PTSD. That’s no surprise, because dangerous situations trigger the brain’s “fight-or-flight” response to threats. During a “fight-or-flight” response, the amounts of chemicals in the brain actually change, and blood pressure, body temperature, heart rate, and respiration all rise rapidly. Attention and focus are sharpened as adrenaline runs through the body, preparing it to act to defend itself.

This is a healthy response to danger when danger is present. However, PTSD can cause this stress response to linger long after any danger has passed. This is what causes the physical symptoms of PTSD, such as rapid heart rate, and the feeling of re-experiencing events even years later.v

A PTSD diagnosis follows symptoms that are serious enough to interfere with daily life and persist for a month or longer. There are four categories of symptoms that occur with PTSD:

  • Avoidance: avoiding people, places, or things that remind you of the trauma
  • Re-experiencing: nightmares, flashbacks, and frightening thoughts
  • Arousal and reactivity: exaggerated startle response, trouble sleeping, angry outbursts, being “on edge”
  • Cognition and mood symptoms: negative self-image, distorted feelings of guilt, loss of interest in activities previously enjoyed, memory issues

Watch veterans with PTSD describe their experiences and how they deal with them on Make The Connection for more details.

PTSD and Substance Abuse

The American Society of Addiction Medicine (ASAM) defines addiction as a disease of the brain caused by chronic drug or alcohol use that changes to brain chemistry and the circuitry of the brain relating to chemicals—changes that result in compulsive abuse of the drugs or alcohol. People with addictions are unable to control whether, how much, or how often they use alcohol or drugs despite negative behavioral, emotional, interpersonal, physical, and social consequences.

Addiction and PTSD are both complex problems to treat; together, the intricacies of the relationship between the two can complicate treatment. Addiction and PTSD work together in a cyclic way. Alcohol and drugs can help people suffering painful PTSD symptoms to escape temporarily, feel less anxious and happier, and just enjoy a distraction. On the other hand, the high levels of stress that are part and parcel of PTSD make drugs or alcohol appear to be an attractive way to escape.

Stress causes higher levels of adrenaline and lower levels of GABA (gamma-aminobutyric acid) in the brain. GABA has a tranquilizing effect in the brain—one that some substances such as alcohol, benzodiazepines, and opioids can mimic for a short time by suppressing the central nervous system. These substances also raise dopamine levels in the brain. Dopamine is a neurotransmitter, or brain chemical, that causes feelings of happiness. In a normally functioning brain, dopamine levels are fairly stable over time; in an addicted person, as the effects caused by abused substances wear off, dopamine levels drop and sadness follows.

Over time, with chronic substance abuse, it is more and more difficult for the brain to regulate levels of adrenaline, dopamine, and GABA naturally. This is at the root of cravings and withdrawal symptoms, including anxiety, insomnia, depression, and irritability, and makes recovery more difficult. Dependence and painful withdrawal symptoms frequently cause a loss of control, as chronic stress becomes a coping mechanism.

Drugs and alcohol are never more than a temporary respite from the symptoms of PTSD and the anguish caused by traumatic memories. In fact, as their effects wear away, PTSD symptoms and stress levels often get worse. Abusing alcohol or drugs also increases risk-taking behaviors and interferes with your ability to make smart decisions, leaving you at a greater risk for suffering more trauma—for example, being victimized by crime or being involved in an accident. Withdrawal symptoms can also make PTSD symptoms worse, and may make them persist longer, according to the US Department of Veterans Affairs (VA).

Finding Treatment for Co-Occurring Addiction and PTSD

When addiction and PTSD co-occur, integrated, simultaneous treatment is critical to success. In cases with significant drug dependence, medical detox is frequently the first phase of treatment. A medical, supervised approach is important to ensure withdrawal symptoms are as minimal as possible.

A treatment center with expertise in treating co-occurring disorders is just as important. Such a center will offer a range of treatment options for people with PTSD and addictions. Cognitive Behavioral Therapy (CBT), can assist in better stress management techniques and offer help enhancing self-esteem, dealing with potential triggers, and addressing negative self-talk. Listening to others with the same problems can also be useful.

Exposure therapy can help people with PTSD learn to face traumas and fears without experiencing debilitating symptoms. In conjunction with these other treatments, medications can also be helpful in reducing depression and anxiety symptoms and improving sleep.

Contact Casa Palmera today if you are experiencing challenges related to PTSD and addiction. Our trained specialists will help you access the support and treatments you need to recover, and get back into life.


This blog is for informational purposes only and should not be a substitute for medical advice. We understand that everyone’s situation is unique, and this content is to provide an overall understanding of substance use disorders. These disorders are very complex, and this post does not take into account the unique circumstances for every individual. For specific questions about your health needs or that of a loved one, seek the help of a healthcare professional.