PTSD and Addiction: How They Are Diagnosed and Treated

Post-traumatic stress disorder, or PTSD, is a mental health condition that impacts approximately 6% of people in the United States at some point in their lives.¹ PTSD also frequently co-occurs with substance use disorders, with roughly half of all people with PTSD also meeting the criteria for a substance use disorder, according to past estimates.^2,3

Continue reading to learn what post-traumatic stress disorder (PTSD) is, the symptoms and causes of PTSD, how PTSD and substance use disorders relate, and what treatment is available for these co-occurring disorders.

What Is PTSD?

PTSD, or post-traumatic stress disorder, is a mental health disorder in which a person may develop a characteristic set of debilitating symptoms after experiencing a traumatic, dangerous, or frightening event.^4,5

Most everyone feels scared or nervous in the aftermath of a traumatic event.⁵ When a person is in any type of frightening situation that causes them to feel fear, the body goes through a “fight-or-flight” response in an effort to protect themselves from harm.⁵

For many, these feelings of fear are short-term, but for some people, the symptoms go on for several months, or even years, even in the absence of a current threat.⁵

What Are the Symptoms of PTSD?

The symptoms of PTSD will vary from one person to another, with different people predominantly developing:

• Emotional or behavioral issues.
• Anhedonia or dysphoric moods.
• Arousal.
• Dissociative states.
• Or some combination of these symptoms.

While only a professional can diagnose someone with PTSD, knowing the symptoms of PTSD can help you determine if it’s time for you or a loved one to seek help.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), several points of clinical assessment contribute to the diagnosis of PTSD. These diagnostic criteria are outlined as follows:⁶

Criteria A – Exposure to death, a threat of death, serious injury, or sexual violence through 1 (or more) of these ways:⁶

• Direct exposure to a traumatic event
• Being a witness to the traumatic event
• Hearing about the traumatic experiences of a close friend or family member
• Being exposed repeatedly to details of a traumatic event, such as through work as a medical professional, or as a firefighter or police officer, for example

Criteria B – Displaying 1 (or more) intrusion symptoms related to the traumatic event:⁶

• Intrusive memories of the trauma
• Nightmares related to the traumatic event
• Flashbacks of the traumatic event recurring
• Emotional distress when exposed to reminders of the event
• Having physical reactions after exposure to reminders of the event

Criteria C – Exhibiting at least 1 of these avoidant behaviors:⁶

• Efforts to avoid trauma-related thoughts or emotions
• Efforts to avoid external reminders related to the trauma

Criteria D – At least 2 of the following negative changes in mood and cognitions associated with the traumatic event that began or got worse after the trauma:⁶

• Being unable to recall key points of the traumatic event
• Having overly negative thoughts about oneself, or about the world in general
• Heightened sense of blaming oneself or others for causing the trauma
• Negative affect
• Decreased interest in activities
• Feeling isolated
• Having difficulty showing positive affect

Criteria E – At least 2 of the following changes in arousal and reactivity that began or got worse after the trauma:⁶

• Aggression or irritability
• Engaging in high-risk or destructive behaviors
• Hypervigilance
• Exaggerated startle response
• Having problems concentrating
• Sleep disturbances

Criteria F – Symptoms of PTSD from criteria B, C, D, and E have lasted for at least 1 month.⁶

Criteria G – The disturbance causes distress or the inability to function in normal roles in school, work, or home.⁶

Criteria H – Substance use, medication reactions, or other types of illness are not the cause of the disturbance.⁶

Common Causes of PTSD

Several factors can contribute to an individual’s risk of developing a mental health condition such as PTSD. Though many people will not develop PTSD after experiencing a traumatic event, a person may be more likely to develop PTSD if they:^5,6

• Experience particularly severe trauma, personal injury, or interpersonal violence.
• Witness other people getting hurt or see a dead body.
• Have experienced childhood emotional issues, including prior exposure to trauma, at a very young age (i.e., by age 6).
• Feel helpless or extreme fear during the event.
• Have limited sources of social support.
• Have additional events occur after the traumatic event, such as losing a home or having a loved one die.
• Already have a history of mental illness or substance misuse.
• Experienced dissociation during the traumatic event that persists afterwards.

In general, women are more likely to develop PTSD, and certain genetic factors may also increase the risk of developing PTSD.⁵

People in certain professions, such as Veterans—particularly those who have been through combat—are more likely to develop PTSD than the general population.²

PTSD and Substance Use Disorder

It is common for PTSD and substance use disorder to co-occur in people, with some studies suggesting that people with PTSD may be up to 14 times more likely to have a substance use disorder than people without PTSD.²

Other studies indicate that lifetime rates of substance use disorder can range from roughly a third to more than 50% of people with PTSD.³

The fact that someone struggles with both PTSD and substance use disorder does not necessarily mean that one caused the other. Though it’s not always easy to determine the timing nor directional “cause” of both conditions, it is clear that mental health and substance use disorders prevalently co-occur, and that each can affect the course and prognosis of the other.⁷

In theory, there are three pathways that might underlie these types of co-occurrences:^7,8

1. Shared risk factors can lead to the development of both mental health disorders and substance use disorders.
2. A mental health disorder may contribute to the development of a substance use disorder.
3. Substance use may contribute to the development of a mental health disorder.

As an example of the second pathway mentioned above, some people with PTSD could initiate substance use as a means of “self-medicating” to manage some of their challenging mental health symptoms.²

Additionally, the same brain changes associated with mental illness development could themselves predispose people to eventually problematic substance use.²

Though the relationship between the conditions may vary from person to person, some studies suggest that PTSD often precedes the development of substance use disorder.²

On the other hand, other studies show that having a substance use disorder makes the development of PTSD more likely.² One theory is that a person’s use of substances creates higher levels of anxiety and arousal that make a person more vulnerable to developing PTSD in the face of a traumatic event.²

Despite the direction or causality of such co-occurrences being difficult to determine in many cases, effective treatment for both post-traumatic stress disorder and addiction should begin, regardless.

Treating PTSD and Addiction

An integrated approach to treating both PTSD and substance use disorder at the same time may be more preferable to patients and has been found to be consistently superior to a model of care that targets each condition separately.^3,7

Treating co-occurring disorders in an integrated, holistic manner with a combination of behavioral therapies and medications, can improve treatment outcomes and is increasingly becoming the standard of care for PTSD and SUD treamtent.^3,7

Common Medications Used in PTSD and Substance Use Disorder

Anti-depressants and other medications may be prescribed to treat PTSD. In particular, 2 SSRI anti-depressants are FDA-approved for the treatment of PTSD.³

Several medications are used in the treatment of substance use disorders that can help control cravings, block the euphoric effects of certain substances, and decrease the overall use of substances.⁷

Effective Therapies for PTSD and Addiction

In tandem with medication, behavioral therapies are commonly used during treatment. It is important to note that treating PTSD and a substance use disorder at the same time takes a trained clinician who understands both disorders and how one can impact the other.³

Some of the evidence-based behavioral therapy approaches used in this work are:

• Prolonged Exposure (PE): A therapy approach in which a person learns coping skills and the therapist slowly introduces stimuli that are associated with trauma, teaching the person to manage their anxious responses as they arise. The goal is to slowly get the person to where they can effectively manage trauma-related stimuli.⁹
• Cognitive Processing Therapy (CPT): This form of cognitive behavioral therapy (CBT) is used to treat co-occurring substance use disorders and PTSD. CBT works to change people’s thoughts around a traumatic event, and by changing thoughts, emotions can also change.^10,11
• Seeking Safety: Another behavioral therapy approach that helps patients learn coping skills for both PTSD and substance use disorders.⁷

Getting Help for Co-Occurring Post-Traumatic Stress Disorder and Addiction

If you or someone you care about is suffering from PTSD and substance use disorder, treatment is available.

At Sunrise House—an inpatient rehab in New Jersey—our compassionate and caring team employs effective treatment methods for co-occurring disorders.

Various levels of addiction treatment are available including:

• Medical detox.
• Inpatient rehab.
• Aftercare planning.

Additionally, we offer specialized programs such as our:

• Drug and alcohol rehab for Veterans and first responders.
• Substance use disorder treatment for LGBTQ+ patients.

To start the admissions process at Sunrise House, simply or call one of our admissions navigators at . We’ll answer your questions about using insurance coverage for rehab, or we can explore other ways to pay for rehab, such as flexible payment plans.