4 Undeniable Signs of Post-Traumatic Stress Disorder (PTSD) and Substance Use

Post-traumatic stress disorder (PTSD) has existed as a part of human biology since early in our evolution. As the U.S. Department of Veterans Affairs (VA) eloquently puts it, “Attacks by saber tooth tigers or twenty-first-century terrorists have probably produced similar psychological sequelae in the survivors of such violence.”

However, as the VA states, PTSD was not validated by the medical community until 1980 when “the American Psychiatric Association (APA) added the term to the third edition of its Diagnostic and Statistical Manual of Mental Disorders.”

When talking about PTSD and addiction, we like to focus on two main aspects.

The first aspect is using substances when you are currently affected by unrelated PTSD, meaning your PTSD originated from other previous environmental factors. More generally, we will ask questions including:

• What is PTSD?
• Who suffers from Post-Traumatic Stress Disorder? (Including events that influence Post-Traumatic Stress Disorder)
• What are the signs and symptoms?
• What are the negative effects of substance use when suffering from Post-Traumatic Stress Disorder?

The second aspect is how substance use disorders (SUD) and related environmental factors can influence Post-Traumatic Stress Disorder to develop. Questions derived from this aspect include:

• How does substance use influence the development of PTSD?
• How is substance-influenced PTSD treatable?

What Is Post-Traumatic Stress Disorder (PTSD)?

Before we go any further, let’s first define what post-traumatic stress disorder (PTSD) is. According to the APA, Post Traumatic Stress Disorder “is a psychiatric disorder” that causes “disturbing thoughts and feelings related to [an] experience that last long after [a] traumatic event has ended.” A requirement for the diagnosis of Post Traumatic Stress Disorder is direct, indirect, or repeated exposure to a traumatic event.

Of those who have Post-Traumatic Stress Disorder, it is not abnormal to see changes in the brain’s neurological, cognitive, and structural capacity. From the article, “Traumatic stress: effects on the brain,” published in Dialogues in Clinical Neuroscience, changes to these three capacities of the brain ultimately affect a person’s memory and stress response.

Post-Traumatic Stress Disorder is far from being the only condition of its type. Related conditions include:

• Acute Stress Disorder
• Adjustment Disorder
• Disinhibited Social Engagement Disorder
• Reactive Attachment Disorder

According to the APA, acute stress disorder is similar to Post-Traumatic Stress Disorder in that it is caused by traumatic events; however, it lasts a fraction of the time of Post-Traumatic Stress Disorder , occurring between “three days and one month after the event.” About half the people with acute stress disorder go on to have Post Traumatic Stress Disorder.”

Adjustment disorder is a response to stressful life events rather than traumatic events. The emotional and behavioral response due to adjustment disorder is more extreme than that of someone not experiencing it.

Disinhibited social engagement disorder derives from child neglect and deprivation having happened before the age of two. A child who does not receive basic stimulation, affection, or consistent attachment prevents them from positive social engagement later in life. One way this disorder manifests is through a child’s behavior, being incapable to socially or culturally understand others’ actions and behaviors.

Reactive attachment disorder is similar to disinhibited social engagement disorder in that it occurs in children who were neglected or deprived. This disorder causes a child to be withdrawn and unresponsive to others when distressed.

Who Suffers from Post-Traumatic Stress Disorder?

There is not one single type of person that has PTSD; instead, it is caused by outside factors in which any person has the potential of being afflicted. This psychiatric disorder is triggered by traumatic events, such as:

• Natural disasters
• Serious accidents and injuries
• Terrorist acts
• War or combat
• Sexual abuse and violence
• Physical abuse and violence
• The death of a loved one

Experiencing trauma is common. As stated by the VA, “about 6 of every 10 men (or 60%) and 5 of every 10 women (or 50%) experience at least one trauma in their lives.” Experiencing trauma, however, does not mean it will develop into PTSD. As estimated by the VA:

• About 7-8% of the population will have PTSD at some point in their life
• About 8 million adults have PTSD during a given year
• About 10% of women develop PTSD at some point in their life
• About 4% of men will develop PTSD at some point in their life

What Are the Signs and Symptoms of PTSD?

There are four main categories of symptoms of Post-Traumatic Stress Disorder. How greatly these symptoms affect the person afflicted varies.

#1. Intrusion

Intrusion signifies intrusive thoughts due to Post-Traumatic Stress Disorder, which manifest as:

• Repeated, involuntary memories
• Distressing dreams
• Flashbacks of the traumatic event
• Visual hallucinations

#2. Avoidance

Avoidance signifies avoiding potential reminders of a traumatic event due to Post-Traumatic Stress Disorder. People with PTSD might avoid:

• People
• Places
• Activities
• Objects
• Situations
• Remember or thinking about the traumatic event
• Talking about the traumatic event or their feelings regarding it

#3. Alterations in Cognition and Mood

Alterations in cognition and mood signify a wide range of effects on a person’s emotional and behavioral state. These include:

• The inability to remember the traumatic event
• Negative thoughts and feelings leading to ongoing and distorted beliefs about oneself or others
• Distorted thoughts about the cause or consequences of the event
• Blaming oneself or another
• Fear, horror, anger, guilt, shame, and lessened interest in activities
• Detachment, estrangement
• Inability to experience positive emotions

#4. Alterations in Arousal and Reactivity

Alterations in arousal and reactivity signify heightened, erratic behaviors toward otherwise everyday occurrences. Instances of this include:

• Irritability
• Anger
• Outbursts
• Reckless behavior
• Self-destruction
• Paranoid of one’s surroundings
• Trouble concentrated or sleeping
• Nervous or on edge

How PTSD Can Lead to Substance Use

PTSD and substance use tend to exist concurrently due to the effect either has on the brain’s chemistry. Substance use, such as drinking heavily, using drugs, or smoking, is a way some try to manage their PTSD; however, those that practice these coping mechanisms have a higher chance of developing PTSD or worsening existing PTSD.

First, we will discuss the strong correlation between PTSD and substance use in people who served in the military and veteran civilians due to being a larger population suffering from both. According to the VA, co-occurring Post Traumatic Stress Disorder and SUD are common in veterans:

• More than 2 of 10 veterans with Post Traumatic Stress Disorder  also have SUD
• Almost 1 out of 3 veterans seeking treatment for SUD also have Post Traumatic Stress Disorder
• Veterans who smoke nicotine (6 of 10) are two times more likely to be diagnosed with Post Traumatic Stress Disorder than those who do not smoke (3 of 10)
• 1 in 10 veterans of Iraq and Afghanistan struggle with alcohol or drugs
• Veterans with Post Traumatic Stress Disorder and alcohol use disorder (AUD) tend to binge drink

On a broader note, in an article about “Substance abuse, memory, and post-traumatic stress disorder,” published by Neurobiology of Learning and Memory, nicotine, cocaine, and alcohol create “complex interactions” within the brain’s understanding of “drug action and learning,” posing that abused substances inhibit treatment for PTSD.

As noted by the VA in an article called the “Treatment of Co-Occurring PTSD and Substance Use Disorder in VA:”

• 46.4% of individuals with lifetime PTSD also met the criteria for SUD
• 27.9% of women with lifetime PTSD also had SUD
• 51.9% of men with lifetime PTSD also had SUD
• Women with PTSD were 2.48 times more likely to meet the criteria for alcohol abuse or dependence and 4.46 times more likely to meet criteria for drug abuse or dependence than women without PTSD

Types of Treatment for PTSD

PTSD is treatable. Those who go through treatment are able to eventually look past the disorder and live normal, happy lives. There are several types of treatments for PTSD. These types of treatments are trauma-focused psychotherapies. In layman’s terms, Trauma-focused psychotherapy is talk therapy, when you discuss the memory of a traumatic event and its effect on you with a medical professional.

Talk therapy utilizes several techniques for processing the traumatic experience. As provided by the VA, examples of talk therapy techniques include:

• Visualizing the traumatic memory
• Talking about the traumatic memory
• Constructively thinking about the traumatic memory
• Changing unhelpful beliefs about the trauma

Trauma-focused psychotherapies that have proven the most helpful to persons who have Post-Traumatic Stress Disorder include:

• Cognitive Processing Therapy (CPT)
• Prolonged Exposure Therapy (PE)
• Eye movement desensitization and reprocessing (EMDR)

CPT teaches you to recognize cognitive patterns in your thinking and to reframe negative thoughts about your trauma. If left untreated, these patterns prevent you from processing traumatic emotions and behaviors when actively suffering from Post-Traumatic Stress Disorder.

This type of treatment involves an active conversation with your medical provider, learning a deeper understanding of negative thoughts associated with your traumatic experience, and engaging in assignment-like activities.

PE teaches you to gain control over your Post-Traumatic Stress Disorder by coming face to face with your negative emotions regarding past trauma. Typically, PE is used in conjunction with CPT as a more physical means of treating PTSD.

For example, PE can utilize a virtual reality setting that mimics and allows you to re-enter when you first suffered the trauma. Where flashbacks and nightmares keep you locked into a negative remembrance of your trauma, PE helps you better visualize it for what it was when guided by a medical professional.

EMDR is a combination of PE with guided rapid, rhythmic eye movements. How does EMDR work? Eye movements lessen the emotional impact of past trauma while an EMDR therapist talks with you about your past trauma. Providing a secondary focus for you while undergoing past trauma will ease your transition of thoughts from one point of your trauma to the next.

Co-occurring Treatment of Post Traumatic Stress Disorder and Substance Use Disorder

PTSD and SUD are often co-occurring disorders. Treatment for co-occurring Post Traumatic Stress Disorder and SUD implements any or multiple of the three types of trauma-focused psychotherapies we previously discussed. Since PTSD and SUD can affect one another, treating both simultaneously is the most effective treatment.

When seeking treatment for co-occurring Post Traumatic Stress Disorder and SUD, seek help from family or friends while mediating possible treatment options with your provider. A collaborative approach that uses measurement-based care (MBC) helps you visualize progress and lessening of symptoms.

If you struggle with co-occurring Post Traumatic Stress Disorder and addiction, do not hesitate to find help. While there are many resources online that can help guide you through recovery and treatment, it is best that you seek professional help. Although at Real Recovery Sober Living, we do not specialize in treating co-occurring PTSD and addiction, we are more than happy to work with you to create a comprehensive plan around your recovery from addiction and treatment for PTSD.

Our facilities offer a structured, drug-free environment driven by our professional support staff who know first-hand what it is like to go through long-term recovery. At Real Recovery Sober Living, we pride ourselves on accountability, providing support for men who genuinely want to be sober and live a productive life post-treatment. Is a sober living home in your future? Find out if we are a match for you in your recovery by calling (727) 290-9156.