Dual-Diagnosis Treatment for Trauma and Addiction

A large percentage of people with substance use disorders suffer from post-traumatic stress disorder. Similarly, approximately 50% of individuals with PTSD end up developing addictions. Individuals who suffer from an addiction in addition to one or more additional mental health conditions, such as PTSD, are said to be “dual diagnosis.” Dual diagnosis individuals with comorbid conditions often suffer from more severe symptoms and face additional challenges while trying to recover.

Why are PTSD and substance use disorders so inextricably linked? The relationship between the two conditions stems from the fact that individuals with PTSD often go to great lengths to avoid or distract themselves from painful thoughts, moods, and memories. In fact, for people with PTSD, alcohol and drugs can sometimes appear to make them mentally healthier. 

They may, for a period of time, find it easier to handle triggering situations, social interactions, and everyday tasks. Alcohol and other drugs are, in this sense, effective tools for numbing pain. With time, however, recreational drugs cease to be effective and ultimately bring their own set of painful consequences.

Is Drug Abuse an Obstacle to PTSD Treatment?

It can’t be denied that drugs and alcohol are effective tools for reducing anxiety, depression, and even the symptoms of post-traumatic stress disorder. It should come as no surprise that individuals with mental health disorders are frequently drawn to drugs and alcohol. However, even though these substances may temporarily relieve symptoms of mental illness, they always end up making symptoms worse in the long run.

Individuals who self-medicate by treating their symptoms with drugs and alcohol are less likely to seek actual treatments for their PTSD. Alcohol, opioids, cocaine, and other drugs may temporarily numb pain and help people forget their traumatic memories, but these substances are mere bandaids. 

Ultimately, it is best not to avoid the pain. In fact, the most effective evidence-based PTSD treatments specifically involve a degree of emotional pain. Exposure therapy, for instance, involves learning to gradually accustom oneself to triggering experiences or situations. Unfortunately, the longer a person goes without seeking actual PTSD treatment, the worse their PTSD will get.

In some cases, people do engage in PTSD treatment but continue to abuse drugs and alcohol. For these individuals, their substance abuse is likely to nullify the potentially beneficial effects of PTSD treatment. Drugs and alcohol can make psychiatric medications less effective. 

They disrupt sleep, reduce cognitive ability, and make it more difficult for people to manage their own moods. Even when people take part in therapeutic interventions for their PTSD, continual substance abuse is likely to impede any progress they might otherwise make.

How Does Substance Abuse Affect PTSD Symptoms?

Drugs and alcohol do not directly lead to the development of PTSD. However, the behaviors that people engage in while abusing drugs or suffering from addiction can lead to PTSD. Substance abuse causes people to engage in reckless and risk-taking behavior. It thereby exposes people to dangerous situations that can be potentially traumatic. For individuals with pre-existing PTSD, these upsetting situations can cause them to be re-traumatized.

Certain substances like alcohol and benzodiazepines can cause people to become less inhibited, which can result in them dealing with conflicts or other dangerous altercations. These substances are widely associated with various forms of assault, including sexual assault. Furthermore, disinhibiting substances can cause people to dissociate and feel disoriented. 

As a result, they may find it difficult to assert themselves, defend themselves, or even understand what is happening to them. The fact that these drugs lead to black-outs and inhibit memory formation can make traumatic events even more difficult to process.

However, even when substance abuse does not directly lead to traumatic or triggering situations, drugs and alcohol make mental illness worse in the long run. Drug and alcohol abuse worsens depression, anxiety, and trauma-related symptoms. Furthermore, when people experience withdrawal effects, these symptoms tend to become even more severe. 

Over the long term, substance abuse causes people to lose important components of their lives. Substance abuse can cause people to suffer from performance problems at work or school, which can cause them to lose their jobs or stagnate. Addiction can also wreck relationships with close friends and family members, either by creating the conditions for conflict or simply by fostering social isolation.

 As other complications increase, like legal, financial, and health problems, an individual’s support system tends to decrease in size at the same rate. As a result, they tend to be ill-equipped to deal with the more severe PTSD symptoms that accompany substance abuse.

Trauma and Addiction Statistics

The link between trauma and addiction extends beyond PTSD. In fact, recent studies have shown that trauma can lead to substance use disorders even for individuals who do not meet the clinical criteria for a PTSD diagnosis. These studies showed that stress and trauma that accumulates over time has a severe impact on addictions later in life. 

The researchers term this a “dose” or “building block” effect of stress load. They found that among adolescents receiving treatment for substance abuse, more than 70% of them had been exposed to stress and trauma over a considerable period of time.

The relationship between addiction and adverse childhood events (ACEs) is well-established. These experiences include abuse, poverty, traumatic experiences, neglect, and malnutrition. A large body of research has shown that children who suffer from one or more of these experiences are likely to suffer from a wide range of behavioral problems, physical health issues, mental health problems, and addictions later in life. 

This is in part due to the fact that adverse childhood events impact brain development, causing structural and functional changes on the neuronal level that last throughout adulthood. Children who have been sexually abused have a particularly high risk for developing alcohol use disorder later in life.

Given the relationship between trauma and addiction, it should come as no surprise that veterans are particularly susceptible to addiction. 75% of veterans who suffer from post-traumatic stress disorder also suffer from a substance use disorder. 33% of veterans who are in treatment programs for addiction also meet the conditions for PTSD.

Certain substances are also more linked to PTSD than others. PTSD has a dramatic effect on alcohol consumption in particular, for instance. People with PTSD have double the likelihood of developing an alcohol use disorder compared to the rest of the general population. Individuals who use cocaine and opiates are also more likely to report having suffered from traumatic experiences compared to other drug users.