PTSD and substance use often are closely connected, but many people may not be aware of this. Here is some information from our IOP workbook, inspired by the amazing work Seeking Safety by Lisa M. Najavits.
- You are not alone! For people with substance abuse, PTSD is one of the most common dual diagnoses. Among women in treatment for substance abuse, 30-59% have current PTSD. Among men in treatment for substance abuse, 11-38% have current PTSD.
- There are many reasons why people with PTSD abuse substances. Some may do so to access feelings or memories, or to do the opposite–to escape from feelings and memories. Others may abuse substances to get through the day; to compensate for the pain of PTSD; to commit “slow suicide;” because they grew up with substance abuse in the family; or because they aren’t able to take care of their bodies.
- People with PTSD and substance abuse tend to abuse the most dangerous substances: cocaine and opiates.
- Two main themes of both PTSD and substance abuse disorder are secrecy and control. Secrecy means you may feel ashamed and wish to keep your problems a secret (e.g., the traumas you experienced, the amount of your substance use). Control refers to the idea that with trauma and substance abuse, you feel out of control. In PTSD, a terrible even occurred that you neither chose nor wanted. In substance abuse, you have lost control over your ability to stop using. Learning the skills of honest and regaining control and thus important for healing.
- Each of the disorders makes the other more likely. If you have PTSD, you are at increased risk for substance abuse. If you have substance abuse, you are at increased risk for trauma. It is thus important to try to keep yourself safe to prevent further trauma and substance abuse.
- The relationship between PTSD and substance abuse is complex. Using substances can either increase or decrease the PTSD symptoms. Yet abstinence from substances can also increase or decrease PTSD symptoms. Try to notice the patterns that occur for you. Getting to know the relationship between the two disorders in your life can help you cope better with the recovery process.
Why do PTSD and substance abuse occur together? Four patterns are common:
- PTSD can lead to substance abuse. To overcome the terrible symptoms of PTSD, you may use substances to “self-medicate” to try to feel better. For example, you may have begun using alcohol to get to sleep at night.
- Substance abuse can lead to PTSD. If you abuse substances, you may be vulnerable to dangerous traumatic situations because your guard is down or your self esteem is low. For example, getting drunk at a bar and going home with a stranger who assaults you.
- PTSD and substance abuse may have both occurred together. Some people grew up in a home where family members abused substances and also hurt each other.
- PTSD and substance abuse can be connected in a “downward spiral.” PTSD can lead you to use substances; by abusing substances you are at increased risk for more trauma; if more trauma happens, you may use more substances to cope; and so on.
The big picture priorities for treatment are to eliminate substance use, learn to manage PTSD, and become safe.
You can heal from both PTSD and substance abuse!
See our post on EMDR and how it helps heal PTSD.