Why It’s Important to Treat PTSD and Substance Abuse Together

ptsdcanadianPost-traumatic stress disorder (PTSD) can develop after an individual has been exposed to a traumatic event such as death, serious injury or a threat of harm to oneself or others. When exposed to such events, it is normal to feel intense fear, helplessness and horror but in most cases, these feelings are eventually resolved. But, this isn’t always the case.  Some people experience long-lasting intrusive symptoms such as disturbing flashbacks, heightened states of arousal, mood disturbances and avoidance of memories about the event. These are the symptoms associated with PTSD.

PTSD is more common than you might think. It is estimated that 1 in 10 Canadians will experience PTSD at some point in their lives. Some groups of individuals may be more likely to be exposed to certain traumatic events and therefore more likely to develop PTSD.  For example, military members are more likely to be exposed to traumatic events such as witnessing harm to others or experiencing a threat to one’s life.  Many veterans returning from Iraq and Afghanistan report being shot at, knowing someone who has been injured or killed or having to handle dead bodies. Such experiences can have a lasting impact on an individual’s mental and emotional well-being.

ptsd1In addition to disturbing psychological symptoms, individuals that have experienced past trauma are also more likely to use alcohol or drugs. In fact, there seems to be a bidirectional relationship between substance use and PTSD. People that use substances may be doing so in an attempt to cope with the negative feelings and intrusive symptoms. However, substance abuse also makes people more likely to experience trauma in the first place. Compared to either disorder alone, combined PTSD and substance use is associated with poorer mental and physical health functioning, as well as increased levels of psychological distress.  These harmful consequences of the concurrent disorders can be quite pervasive and often impact person’s work, relationships, and outlook on life.  For these reasons, it is important that those dealing with a concurrent addiction and PTSD get the help they need before their issues progress and become much worse. 

There are several treatment options available to individuals experiencing addiction and co-occurring PTSD, including medication and psychological treatments. In the past, treatment focused on addressing the substance use, before proceeding to work with the trauma that the person has experienced. However, people struggling with both disorders, recognize that their drinking or drug use is closely related to the PTSD and it is difficult to address one without the other. Some critics of this historical approach also suggest that addressing only the substance use can lead to an increase in some symptoms of the PTSD while the person has not yet gained the necessary tools to help them cope with such symptoms.

In recent years, integrated treatment has been more widely used. This treatment model acknowledges the undeniable connection between substance use and PTSD. Therefore, both are addressed at the same time, often within the context of the same treatment program. Substance use in this case, is seen as a coping strategy that people use in an attempt to control or ease the symptoms of their PTSD. If given different tools early on in treatment, it is less likely that that the PTSD will compromise the person’s recovery from the addiction. This approach seems to be favored not only by the clinical community but also by individuals struggling with both disorders. Previous research demonstrates that when asked which model of treatment they would prefer, people with combined PTSD and substance use disorder overwhelmingly prefer the integrated approach.

Although the relationship between PTSD and substance use is a complex one, effective treatment programs help the individual recognize and manage their triggers, symptoms and develop a long-term plan for behaviour change. Integrated and comprehensive programs will also support the client in identifying some of the strengths and resources they already possess and encourage clients to develop those skills further in their recovery. Those who complete such programs can expect to develop adaptive coping strategies, assertive communication skills, and can begin to repair the damage the concurrent disorders have caused in their work, family, relationships and quality of life.