PTSD and Addiction

Last Updated:

January 15th, 2024

Coping with PTSD is tough, and it often comes with an added hurdle – the likelihood of co-occurring addiction. The combination intensifies the difficulty of recovery, forming a challenging cycle where each issue reinforces the other. Tackling both demands comprehensive support, but rest assured, help is available, providing you with the best possible chance of overcoming both issues.

What is PTSD?

Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can develop in individuals who have experienced or witnessed a traumatic event. PTSD is a recognised psychiatric diagnosis, and treatment may be needed in order to make a full recovery.
PTSD can manifest at any age following exposure to distressing events. Recognising symptoms and seeking timely treatment for individuals affected by this disorder is crucial.

Are there different types of PTSD?

There are several types of PTSD, and they can manifest in different ways based on the nature of the traumatic experience and individual differences. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines the following types of PTSD:

Acute Stress Disorder (ASD)
Acute Stress Disorder (ASD), distinct from PTSD emerges within three days to four weeks after a traumatic event, marked by symptoms like intrusive thoughts and emotional distress. If these persist beyond the initial four weeks, a reevaluation may lead to a PTSD diagnosis, which denotes a more chronic condition lasting months or years. Recognising ASD early is crucial for targeted intervention, aiming to prevent the development of enduring PTSD. Swift support and mental health services during the initial weeks post-trauma play a pivotal role in mitigating long-term impacts on an individual’s well-being.
Normal Stress Response
The Normal Stress Response is a common and adaptive reaction to trauma, where individuals may initially experience stress and anxiety symptoms that naturally decrease over time. These transient reactions, such as heightened arousal and irritability, are typical and do not meet the criteria for PTSD. Recognising the temporary nature of these responses is crucial, as they often resolve as individuals process and adapt to the traumatic experience, distinguishing them from more persistent mental health conditions like PTSD.
Uncomplicated PTSD
Uncomplicated PTSD represents the most prevalent form. Individuals with this subtype primarily exhibit symptoms directly tied to the traumatic event but do not display additional characteristics like dissociation or avoidance. This form of PTSD is characterised by the persistence of trauma-related symptoms without the complexity of additional psychological features, making it a distinct and more straightforward presentation within the spectrum of PTSD.
Comorbid PTSD
Comorbid PTSD refers to the coexistence of Post-Traumatic Stress Disorder with other mental health disorders such as depression, anxiety, or addiction. This concurrent occurrence adds complexity to the clinical presentation, as the interplay of these conditions can influence the overall mental health landscape.
Dissociative Subtype
The Dissociative Subtype of PTSD is characterised by symptoms of dissociation, where individuals may feel detached from their own body or emotions. This subtype is linked to more severe PTSD symptoms, highlighting the impact of dissociative experiences on the overall clinical presentation.
Delayed-Onset PTSD
Delayed-Onset PTSD occurs when symptoms of Post-Traumatic Stress Disorder do not manifest immediately after a traumatic event but emerge months or even years later. This delayed onset adds a temporal dimension to the diagnosis, emphasising that PTSD symptoms can unfold over an extended period following the traumatic experience.
Complex PTSD (C-PTSD)
Complex PTSD (C-PTSD) is a term applied to a more severe and chronic manifestation of PTSD that typically arises from prolonged or repeated exposure to trauma, often occurring within interpersonal relationships. Beyond the core symptoms of PTSD, individuals with C-PTSD also experience disturbances in self-identity, affect regulation, and interpersonal relationships, illustrating the complex and multifaceted nature of this condition.

Why is addiction likely to co-occur with PTSD?

While not everyone who has PTSD automatically has an addiction (and vice versa), addiction and PTSD are sometimes diagnosed as a dual diagnosis, and several factors contribute to this comorbidity:

Self-medication hypothesis

Individuals with PTSD may turn to substances as a way to cope with the distressing symptoms of the disorder. Substances like drugs or alcohol can provide temporary relief from anxiety, nightmares and intrusive thoughts associated with PTSD. This avoidance behaviour can contribute to the development and maintenance of addiction.

Neurobiological changes

Both addiction and PTSD involve changes in the brain’s reward and stress systems. The use of substances can impact the brain’s reward pathways, leading to addiction. Trauma, on the other hand, can alter stress response systems, making individuals more vulnerable to both PTSD and substance use disorders.

Impact on coping mechanisms

Trauma can disrupt an individual’s ability to cope with stress in adaptive ways. Substance use may be perceived as a way to regain a sense of control or numb the emotional pain associated with traumatic experiences. Although this method could work temporarily, it limits learning healthier coping mechanisms, which could be learned independently or within rehabilitation centres.

Cycle of dysfunction

The co-occurrence of addiction and PTSD can create a cycle of dysfunction where one condition exacerbates the other. For example, substance use may lead to risky behaviours, increasing the likelihood of re-experiencing trauma and vice versa.

Social isolation

Both addiction and PTSD can contribute to social isolation. Individuals with PTSD may withdraw from social interactions due to hyperarousal or hypervigilance, while addiction can lead to social withdrawal as a result of substance use. This isolation can further perpetuate the cycle of co-occurring disorders.

Alcohol Use Disorder (AUD) and PTSD

While many have PTSD and drug addiction, when reviewing the research on PTSD and alcohol addiction, it becomes apparent that there is a strong comorbidity between the two.

The co-occurrence of PTSD and alcohol use disorder (AUD) is a prevalent occurrence, as evidenced by comorbidity estimates ranging from approximately 30% to 50%. This indicates a substantial overlap between these two mental health conditions, suggesting that individuals with PTSD are at an increased risk of developing AUD.

In another study, it was observed that individuals experiencing both PTSD and AUD simultaneously were associated with higher levels of PTSD symptom severity, adding another layer to the complexity of this comorbidity. This suggests that the presence of both disorders may exacerbate the symptoms of PTSD, highlighting the importance of comprehensive and integrated approaches to treatment that address both conditions concurrently. Fortunately, there are avenues for treatment available.

PTSD and addiction treatment options

Addressing addiction in the presence of co-occurring PTSD presents a difficult challenge due to the interplay between these conditions. Individuals dealing with PTSD encounter distinct hurdles during their recovery journey, including difficulties in establishing trust, dealing with overwhelming emotions and reliving distressing memories.

UKAT has a track record of effectively treating addiction in individuals contending with co-occurring disorders, such as PTSD. However, the symptoms of PTSD must be stable enough to enable engagement in the rehabilitation process.

Before starting rehab treatment at UKAT, it is essential to consult with medical and mental health professionals to address and manage PTSD symptoms. This may involve a combination of therapy, medication, or both. Once PTSD symptoms are under control, the rehabilitation process can commence.

Several highly effective rehab therapies can also contribute to alleviating PTSD symptoms as a knock-on effect:

Dialectical behaviour Therapy (DBT): Originally designed for borderline personality disorder, DBT skills are versatile for managing intense emotions and enhancing interpersonal relationships. DBT equips individuals with skills to cope with stress, regulate emotions and improve relationships. It can assist those contending with PTSD and addiction in handling triggers and combating unhealthy coping mechanisms, such as substance use and addictive behaviours.

Group Therapy: For individuals concurrently dealing with PTSD and addiction, group therapy offers many benefits. This therapeutic approach encourages a sense of camaraderie and community among individuals facing similar challenges, providing essential emotional support. As participants share experiences and coping strategies, others can gain insights and practical advice. This communal aspect helps alleviate feelings of isolation and imparts valuable knowledge about the healing process.

What are the next steps?

If you or someone you care about is facing the challenges of PTSD and addiction, rest assured that assistance is within reach. Contact UKAT today to initiate the journey toward recovery. Our dedicated team is devoted to supporting you as you embark on the path to healing and the prospect of a renewed life.

Call us now for help
+44 2039 496 584

(Click here to see works cited)

  • Leeies, M., Pagura, J., Sareen, J., & Bolton, J. M. 2010. The use of alcohol and drugs to self-medicate symptoms of posttraumatic stress disorder. Depress Anxiety, 27(8), 731-736. doi: 10.1002/da.20677. PMID: 20186981.
  • Sherin, J. E., & Nemeroff, C. B. 2011. Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues Clin Neurosci, 13(3), 263-278. doi: 10.31887/DCNS.2011.13.2/jsherin. PMID: 22034143; PMCID: PMC3182008.
  • Thompson, N. J., Fiorillo, D., Rothbaum, B. O., Ressler, K. J., & Michopoulos, V. 2018. Coping strategies as mediators in relation to resilience and posttraumatic stress disorder. J Affect Disord, 225, 153-159. doi: 10.1016/j.jad.2017.08.049. Epub 2017 Aug 16. PMID: 28837948; PMCID: PMC5626644.
  • Hawn, S. E., Cusack, S. E., & Amstadter, A. B. 2020. A Systematic Review of the Self-Medication Hypothesis in the Context of Posttraumatic Stress Disorder and Comorbid Problematic Alcohol Use. J Trauma Stress, 33(5), 699-708. doi: 10.1002/jts.22521. Epub 2020 Jun 9. PMID: 32516487; PMCID: PMC7572615.
  • Blanco, C., Xu, Y., Brady, K., Pérez-Fuentes, G., Okuda, M., & Wang, S. 2013. Comorbidity of posttraumatic stress disorder with alcohol dependence among US adults: results from National Epidemiological Survey on Alcohol and Related Conditions. Drug Alcohol Depend, 132(3), 630-638. doi: 10.1016/j.drugalcdep.2013.04.016. Epub 2013 May 20. PMID: 23702490; PMCID: PMC3770804.
  • Bohus, M., Kleindienst, N., Hahn, C., Müller-Engelmann, M., Ludäscher, P., Steil, R., … Priebe, K. 2020. Dialectical behaviour Therapy for Posttraumatic Stress Disorder (DBT-PTSD) Compared With Cognitive Processing Therapy (CPT) in Complex Presentations of PTSD in Women Survivors of Childhood Abuse: A Randomized Clinical Trial. JAMA Psychiatry, 77(12), 1235-1245. doi: 10.1001/jamapsychiatry.2020.2148. PMID: 32697288; PMCID: PMC7376475.
  • Sloan, D. M., Beck, J. G., & Sawyer, A. T. 2017. Trauma-focused group therapy. In S. N. Gold (Ed.), APA handbook of trauma psychology: Trauma practice pp. 467–482. American Psychological Association. https://doi.org/10.1037/0000020-022