Post-Traumatic Stress Disorder PTSD and Substance Use Disorder

HCCoalition Team
Jun 9
3 min read

Problems with substance use—drugs or alcohol—often go hand in hand with PTSD. The use of alcohol or drugs can put people in risky situations that can lead to traumatic events. At the same time, people may use drugs or alcohol to try to manage PTSD symptoms. The good news is that treatment can help. In fact, PTSD and substance use can be successfully treated at the same time.

Why do PTSD and substance use disorder often occur together?

PTSD and substance use frequently happen together, or "co-occur".

PTSD and Substance Use Disorder can happen together — Photo by Valerie Titova on Unsplash

In the U.S., over 4 out of 10 adults (or 45%) who have PTSD also have problems with drug or alcohol use. In the same study, Veterans who had PTSD at some point in their life were 2 times more likely to have problems with alcohol use and 3 times more likely to have problems with drug use than Veterans who did not have PTSD.

Research suggests that for most people who have both PTSD and problems with alcohol or drug use, PTSD develops first. Some people use drugs or alcohol to try to deal with PTSD symptoms. They might use drugs or alcohol to help them relax, feel more comfortable in social settings, or deal with thoughts and feelings they would rather avoid.

Using drugs or alcohol can also impair people's judgment, which can put them at risk for traumatic events like accidents or serious injuries. Experiencing these traumas can lead to PTSD.

How can co-occurring PTSD and substance use create problems?

Using drugs or alcohol can make PTSD symptoms worse. For example, although some people use alcohol to help them sleep, in reality, alcohol can make sleep less restful. Using drugs can increase irritable feelings and avoidance of emotions. Getting treatment for PTSD or using positive coping actions are better options than turning to alcohol or drugs.

When drug or alcohol use reaches the level of addiction, it is called substance use disorder (SUD). Substance use—especially when it rises to the level of addiction—can cause other problems, such as physical pain, medical problems, trouble in relationships, and difficulty keeping a job, staying in school, or meeting other responsibilities. People with both disorders (PTSD and SUD) also have a higher risk of depression, anxiety, and suicide. The toll of PTSD and substance use is heavy for individuals and society, but there are good treatments for both disorders.

What treatments are offered for PTSD and substance use problems?

It is important to know that treatment can help people with PTSD and substance use problems. Research shows that treating PTSD and substance use at the same time works to treat both conditions. This is called "concurrent treatment."

There are 2 ways to get concurrent treatment for alcohol or substance use and PTSD. Some people choose to do 2 different therapies—one for PTSD and one for substance use—at the same time, usually by different therapists. There is also therapy that combines—or integrates—treatment for both problems and is delivered by the same therapist in a single treatment.

PTSD treatments

For treatment of PTSD, trauma-focused psychotherapies are the most effective. This is true for people with and without substance use disorders. These treatments use different techniques to help people process their traumatic experiences. Those with the strongest evidence include Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), and Eye Movement Desensitization and Reprocessing (EMDR).

Substance use treatments

There are also effective treatments for substance use, including:

Motivational enhancement therapy, which uses strategies to improve people's readiness to change their behavior and enter treatment.
Cognitive-behavioral therapy, which seeks to help people recognize, avoid, and cope with the situations in which they're most likely to use drugs or alcohol.
Contingency management, which involves using rewards or privileges for staying drug- or alcohol-free, going to counseling sessions, or taking treatment medications as prescribed.
Relapse prevention, which helps with planning for and coping with things that might make a person want to return to using drugs and alcohol.

There are also medication options. Certain medications can reduce the pleasure of alcohol or drugs, reduce cravings, and also help withdrawal symptoms.

Integrated PTSD and SUD treatment

COPE (Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure) is a therapy that blends trauma-focused PTSD treatment with substance use treatment. Studies of COPE with Veterans and civilians have shown this integrated treatment improves PTSD symptoms.

SOURCE: PTSD.va.gov