Post-Traumatic Stress Disorder (PTSD) and Addiction: Signs, Symptoms, and Treatment

What is Post-Traumatic Stress Disorder?

PTSD is classified as a trauma- and stressor-related disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which provides the criteria used by medical professionals to guide a diagnosis.² PTSD can develop as a result of being exposed to or experiencing one or more traumatic events, which may include combat, physical or sexual assault or abuse, an accident, a disaster, or other serious event.^1,2

However, not everyone who experiences a trauma develops PTSD.1 According to one study, around 90% of people experience a traumatic event but only about 10% develop PTSD.³ In 2020, around 13 million Americans had PTSD.⁴

Studies indicate that women are more likely to experience PTSD than men. This is, in part, due to the types of traumatic events that women are more likely to experience—such as sexual assault—compared to men. Veterans are also more likely to have PTSD than civilians and Veterans who deployed to combat zones are more likely to suffer from PTSD than those who did not.⁴

Risk factors that increase the likelihood of developing PTSD, include:¹

• Being exposed to prior trauma, especially in childhood.
• Suffering physical injury or being witness to the injury or death of another person.
• Feeling horror, extreme fear, or helplessness in a situation.
• Lacking social support after the trauma.
• Experiencing added stress after the trauma, such as the death of a loved one or loss of your home.
• Having a personal or family history of mental illness or substance misuse.

Signs and Symptoms of PTSD

The signs and symptoms of PTSD can vary in severity and from person to person.^2,5 While only a medical professional—including physicians, psychiatrists, and therapists—can diagnose someone with PTSD, knowing the symptoms can help you determine if it’s time for you or a loved one to seek help. Clinicians use the DSM-5 to determine whether you have PTSD. Symptoms, which must be present for at least 30 days and must cause significant distress or problems in daily functioning, fall into four categories, including:^1,2,5

• Re-experiencing and intrusion symptoms. This may involve having recurrent, unwanted thoughts and memories of the traumatic event, experiencing distressing dreams related to the event, or having flashbacks so vivid that it feels like you’re reliving the event. It may also include experiencing triggers—such as sights, smells, and sounds—that remind you of the event.
• Avoidance symptoms. Avoidance symptoms cause you to change your routine. You may stay away from places, events, people, or things that you associate with the traumatic experience. This may include avoiding crowds, driving, or leaving the house, for instance.
• Mood and cognition symptoms. You may experience lasting negative thoughts or feelings related to the traumatic experience. This may include blaming yourself for what happened or feeling like the world is unsafe and you can’t trust anyone. You may also feel detached or isolated from family and friends or lose interest in activities you once enjoyed.
• Arousal and reactivity symptoms. Arousal symptoms are often constant and involve being hyper-aware of your surroundings, which may lead to trouble concentrating or sleeping and being easily startled. You may feel irritable, experience angry outbursts, or behave recklessly.

Substance Use and Co-Occurring PTSD

There is a correlation between trauma and substance use as well as the presence of post-traumatic stress and substance use disorders.⁶ A co-occurring mental health and substance use disorder, also sometimes referred to as a dual diagnosis or comorbidity, means that an individual has a mental illness, like PTSD, and a substance use disorder (SUD).⁷ Estimates of co-occurring PTSD and SUD vary, with prevalence estimated in the range of 25% to 49%.⁸

Research indicates that there are several reasons why PTSD and SUDs occur together, including:

• Trying to reduce or avoid PTSD symptoms. Several studies indicate that PTSD can lead to the development of a SUD as some individuals may use drugs or alcohol to help alleviate anxiety and other PTSD symptoms or to avoid dealing with or reliving the trauma. And while some substances may temporarily reduce symptoms, drugs and alcohol can make them worse over time or contribute to the development of a SUD.^7,9
• Brain changes. The changes that occur in the brain of someone who has a mental health disorder like PTSD may enhance the rewarding effects of some substances, which makes it more likely that the individual will continue substance use.⁷
• Common risk factors. Some of the factors associated with an increased risk of SUD are the same factors associated with an increased risk of PTSD, including genetic vulnerabilities, acute stress, and trauma.⁷
• Risky behaviors. Substance use disorders may lead an individual to participate in risk-taking behaviors, which could increase the chances of experiencing a traumatic event.⁹

Military Members and Veterans with PTSD and SUD

According to the U.S. Veterans Administration, co-occurring PTSD and SUD is common among Veterans. More than 2 in 10 Veterans with PTSD also have SUD and nearly 1 in 3 Veterans, who seek treatment for SUD, also has PTSD.¹⁰

The risk of lifetime PTSD is only slightly more common among Veterans than civilians—with 7 out of every 100 Veterans developing PTSD compared to 6 out of every 100 in the general population.¹¹

It’s similar for the prevalence of SUDs among the Veteran population compared to civilians. More than 1 in 10 Veterans have been diagnosed with a SUD, which is only slightly higher than the general population. However, when looking at male Veterans aged 18-25, the rates of SUDs are higher compared to civilians.¹²

Despite the negative effects that PTSD and SUD has on the lives of military personnel and Veterans, many are reluctant to seek treatment. Studies indicate that there are a number of barriers to substance use disorder care among military personnel and Veterans, including limited access to treatment—particularly mental health services—for Veterans living in rural areas, gaps in insurance coverage, stigma, fear of negative consequences, and a lack of confidential services.^12,13

Military personnel and Veterans with co-occurring PTSD and addiction require treatment from providers that are skilled at treating both disorders. The U.S. Department of Veterans Affairs can assist you in finding resources. Additionally, American Addiction Centers (AAC) understands the specific challenges faced by military members and Veterans, and many of our treatment centers offer programming specifically tailored to the unique needs of Veterans and their families.

Treatment for PTSD and Addiction

Integrated treatment, which involves treating PTSD and addiction at the same time, is now the standard of care for people struggling with co-occurring disorders.¹³ Integrated treatment for comorbid SUD and PTSD has been found to be consistently better, producing more positive outcomes, compared to treating each disorder separately.¹⁴

Prior to starting treatment, you will receive a thorough assessment to determine your diagnoses and inform your individualized treatment plan. Co-occurring disorder treatment may comprise a variety of interventions, which may be delivered in an inpatient or outpatient setting.¹⁵ Integrated treatment occurs along a continuum of care and may include:

Medications.

Your physician may prescribe medications to help with your PTSD symptoms and/or substance use disorder. Antidepressants such as SSRIs (selective serotonin reuptake inhibitors) are currently the preferred initial class of medications to treat PTSD. Other medications may be used on an off-label basis.^15,16

Additionally, your doctor may prescribe medications for addiction treatment to ease cravings and reduce your desire to use substances, specifically alcohol and opioids.¹⁶

Medications used in the treatment for alcohol use disorder may include acamprosate to promote abstinence or disulfiram to deter alcohol use.¹⁴

For the treatment of opioid use disorder, healthcare professionals may use medications that include:¹⁷

• Buprenorphine to treat withdrawal symptoms and reduce cravings.
• Methadone to help ease withdrawal symptoms.
• Naltrexone to block the effects of opioids.
• Lofexidine to help reduce withdrawal symptoms.

Psychotherapies.

There are several types of therapy available to treat PTSD. They typically occur along with behavioral therapies you may be receiving to address your SUD. These therapies may take place in individual and group settings and may include trauma-focused therapies, such as:

• Exposure based-therapies such as prolonged exposure (PE). PE involves repeated exposure to the situation, either imagined or simulated, through techniques such as visualization and discussion, with the guidance of a therapist.^10,14
• Eye movement desensitization and reprocessing (EMDR). EMDR helps you process and integrate the trauma with the assistance of a trained therapist.^10,18
• Cognitive processing therapy (CPT). CPT aims to help you make sense of the world and your experiences by working with your beliefs regarding safety, trust, power, esteem, and intimacy.¹⁹
• Concurrent Treatment of PTSD and SUDs using Prolonged Exposure (COPE). COPE is an integrated therapy involving trauma-focused PTSD treatment with SUD treatment.²⁰
• Seeking Safety (SS). SS addresses PTSD and SUD at the same time, helping you develop healthier coping skills for both disorders.¹⁷

The behavioral therapies for SUD that may be used in tandem include:¹⁷

• Cognitive-behavioral therapy (CBT). CBT addresses maladaptive thoughts and behaviors and works to help you change them.
• Dialectical behavior therapy (DBT). DBT reduces self-harm.
• Contingency management (CM). CM offers rewards for positive behavioral outcomes, like negative drug tests.

If you or a loved one are struggling with PTSD and addiction, call AAC at . Speak to a caring and knowledgeable admissions navigator, who will listen to your story, answer your questions, and explain your options, and help you begin your journey to recovery.

It is never too late to seek help for PTSD or PTSD and co-occurring substance use. People can and do recover from PTSD and SUD with proper treatment.

Frequently Asked Questions About PTSD and Addiction