Post-Traumatic Stress Disorder (PTSD) and Addiction

A common phenomenon in mental health medicine is something called dual diagnosis; this occurs when a patient has both an addiction (usually to a substance) as well as a co-occurring mental health condition including depression, bipolar disorder, or post-traumatic stress disorder (PTSD).  This article will specifically address the relationship between addiction and PTSD.

What is Post-Traumatic Stress Disorder?

As the name suggests, PTSD starts with a traumatic event.  The diagnostic criteria are described below.

1. The person must have genuinely believed that he/she or someone he/she was with was likely to die or experience a very serious injury.  During the event, the person may have felt horrified, powerless, and terrified; children may respond with agitation and disorganization. 
2. Memories of the event are causing “intrusive recollection.”  The person may have persistent distressing thoughts or dreams about it; they may behave as if they believe the event is likely to be repeated, and they may respond with similar physical and emotional reactions when confronted by people, places, or things that remind them of what happened.
3. The person frequently attempts to forget or avoid such thoughts and emotional reactions.  They may not participate in activities that could job memories of the event; they may have difficulty envisioning future plans for marriage, career, or family; they may feel emotionally detached from others and have difficulty developing relationships; they may block memories and be unable to describe their trauma in detail; they may feel little interest in activities that they once enjoyed.
4. The patient’s waking moments are characterized by extreme arousal.  They may have problems focusing, be highly irritable, startle easily, have trouble sleeping, and be highly vigilant in most situations.
5. The above symptoms persist for more than a month after the event has occurred.
6. The person’s functioning at work, home, or in social situations has been disrupted as a result of disturbances that last (a) up to 3 months (acute) or (b) more than three months (chronic).

Who can get PTSD?

Anyone can develop PTSD; perhaps the largest group of people who are known to experience PTSD are veterans of war.  However, others can include the victims of rape, crime, domestic violence, and terrorist attacks; people who have witnessed others die from an unexpected illness, accident, or other event; individuals who were hospitalized with a very grave illness quickly and unexpectedly; women who went through a highly traumatic birth experience; and many, many others.

What is the relationship between addiction and PTSD?

For some addicts, substance or behavioral addictions may begin in an attempt to cope with and escape from the intrusive thoughts and memories related to the traumatic event (see criterion #3 above).  Instead of attempting to deal with the trauma, which realistically is very difficult for any human being to do without a support system and the help of a therapist and psychiatrist, the person turns to addiction to try to remain somewhat functional.

What are the long-term outcomes if not treated?

The National Center for PTSD estimates that as many as a third of survivors of trauma abuse alcohol, especially if they are still experiencing health problems or pain as a result of the traumatic event.  Research on a number of different groups has offered information on possible outcomes.  Among veterans of the Vietnam war aged 65 and above, a PTSD diagnosis with depression and/or substance use issues was correlated with increased risk for binge drinking as well as suicide attempts.  Female victims of sexual abuse and other sexual trauma are at an increased risk for developing a substance abuse disorder compared to women in the general population.

What should I do if I think that addiction and PTSD are problems for me or someone I know?

Before effective treatment can begin, you should have these conditions diagnosed by a psychiatrist.  If you live in an area of the country with insufficient mental health services, you can discuss your concerns with your primary care physician.  Veterans can receive free health services at local Veterans Administration hospitals, and others may be surprised to learn that their insurance coverage for addiction and other mental health conditions was improved by the Mental Health Parity and Addiction Equity Act.  Depending on the situation, the doctor may recommend therapy or medications for either condition and possibly residential or outpatient rehab for the addiction. If you are having problems persuading another person to consider help, an intervention may be the necessary next step.  Whatever you do, do not ignore the problem and allow it to get worse.