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PTSD and Addiction: How Trauma Can Fuel Substance Abuse

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You witnessed a traumatic event and turned to drugs to quiet the nightmares, stop the edginess, and numb the fear. But you’ve noticed that they’re only getting worse.

Could drug use make PTSD symptoms worse? How are PTSD and substance abuse related?

Keep reading to learn about four key aspects of the relationship between PTSD and addiction, and what treatment options and therapies are available for PTSD and substance misuse.

Table of Contents

What Is the Relationship Between PTSD and Addiction?

PTSD (Post-Traumatic Stress Disorder) is a mental health condition triggered by experiencing or witnessing a traumatic event. These typically include:

  • Military combat
  • Physical/sexual assault
  • Accidents or natural disasters
  • And more

PTSD can often cause:

  • Negative changes in moods/thoughts (guilt, detachment)
  • Intrusive memories (nightmares, flashbacks)
  • Heightened alertness (hypervigilance, irritability, sleep issues)
  • Avoidance of reminders of trauma (triggers)
  • Plus many others

Studies show that individuals with PTSD are 2-3 times more likely to have a substance use disorder, and around 58% of those diagnosed with lifetime PTSD also have SUD.

If you’re stuck in a cycle of PTSD and substance misuse, contact Robin Recovery today to discuss how we can help you manage co-occurring and dual-diagnosis disorders and start your journey to a new, healthier you.

4 Key Aspects of the Relationship Between PTSD and Addiction

#1: Self-Medication

Many with PTSD choose to self-medicate, meaning they use substances to cope with the psychological symptoms they’re experiencing.

Alcohol, opioids, and other drugs are often used to:

  • Reduce intense emotional pain
  • Create a sense of detachment
  • Calm hypervigilance
  • Decrease anxiety levels
  • Fall asleep faster
  • Prevent or avoid nightmares
  • Escape flashbacks and intrusive thoughts

Substances don’t treat PTSD; they only temporarily suppress symptoms while reinforcing the individual's dependence on them.

#2: Mutual Maintenance

PTSD and addiction may perpetuate each other over time. PTSD symptoms can lead to constant reliance on substances for relief. However, they may actually worsen PTSD symptoms by:

  • Increasing emotional instability
  • Lowering stress tolerance
  • Impairing coping skills

They may also intensify anxiety, depression, and irritability.

This means that PTSD symptoms may become more frequent and more severe over time. As these symptoms worsen and become harder to manage, many people will use more substances to find relief.

This increase can raise the risk of additional trauma by causing greater impaired judgment, which may lead to more risk-taking behaviors resulting in:

  • Accidents
  • Violence
  • Unsafe environments

These riskier behaviors may cause re-traumatization and even exposure to new traumatic events.

#3: Shared Risk Factors & Brain Chemistry

PTSD and substance use disorder both share common risk factors and overlapping brain changes.

Shared Risk Factors

Exposure to trauma/high-stress environments can lead to an increased risk for developing PTSD and using substances as a coping mechanism; examples are:

  • Violence
  • Abuse
  • Combat
  • Accidents

Prolonged chronic stress may alter brain function and increase the likelihood of developing both conditions; stress can be a trigger for PTSD and can also be a reason for substance use.

Affected Shared Brain Systems

Amygdala - This is the part of the brain that controls fear and threat processing. It can be overactive in PTSD, leading to a heightened fear response, and has been linked to stress-triggered addiction cravings.

Prefrontal cortex: This handles decision-making and impulse control and may be underactive or impaired, causing lower impulse control and emotional regulation issues, contributing to risky behavior and substance dependence.

Hippocampus: This region of the brain is the memory-processing center. It may make it difficult for people with PTSD to tell the difference between past and present and may impact traumatic memory processing.

Reward system: Dopamine production happens here. PTSD can disrupt normal reward processing, reducing the ability of sufferers to feel pleasure naturally. Substance use artificially increases dopamine levels, leading to increased reliance.

Stress-response system (HPA Axis): This controls the body’s reaction to stress. It may be overactive or dysregulated in individuals with PTSD, leading to drug use to suppress the stress response and creating a long-term imbalance in stress regulation.

#4: High Co-Occurrence

Substance use disorder and PTSD are one of the most common dual-diagnosis pairings. Estimates suggest that around 40-50% of people with PTSD also experience SUD. PTSD is twice as common in women as in men. It’s estimated that about 1 out of 3 veterans with PTSD also has a substance addiction.

What Treatments Are Offered for PTSD and Addictions to Substances?

PTSD is typically treated with trauma-focused psychotherapies as a first line of defense; these include:

  • Cognitive Processing Therapy (CPT)
  • Prolonged Exposure (PE)
  • EMDR (Eye Movement Desensitization and Reprocessing)

Substance use disorders are treated with a mix of treatments, such as:

  • Behavioral therapies
    • Cognitive Behavioral Therapy (CBT)
    • Motivational Interviewing
    • Contingency Management
  • Medication-Assisted Treatment (MAT)
    • Individuals withdrawing from certain substances may be prescribed medications to help reduce cravings and prevent relapse.
  • Detox and Ongoing Support
    • Many sufferers participate in a medical detox, which can help manage withdrawal symptoms safely.
    • Long-term care options are typically available for those who want extra ongoing support in their recovery, such as:

Treating both PTSD and addiction at the same time with concurrent treatment or dual diagnosis may reduce both drug use and the severity of PTSD symptoms, improving the chances of remaining in treatment and reaching long-term recovery.

Robin Recovery can treat both PTSD and substance use disorder together.

Therapies for PTSD and Substance Abuse

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy is a structured, goal-oriented type of psychotherapy that focuses on the connection between thoughts, emotions, and behaviors.

When used for PTSD, CBT helps patients:

  • Identify distorted or unhelpful thoughts 
  • Challenge their emotional beliefs, like guilt and self-blame
  • Learn coping skills for stress and anxiety
  • Implement techniques to reduce avoidance behaviors
  • And more

In substance abuse treatment, it helps individuals:

  • Identify what triggers their addiction
  • Learn healthier coping mechanisms
  • Manage cravings

CBT works well for both PTSD and SUD because it reduces reliance on substances as coping mechanisms. It also addresses negative thought patterns that drive both conditions and improves emotional regulation and decision-making.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is a form of psychotherapy designed specifically for treating trauma-related disorders. It uses bilateral stimulation to affect how the brain stores and processes traumatic memories.

EMDR works by the patient recalling an upsetting memory while following a therapist-guided stimulus, such as eye movements, tapping, and sounds.

These actions aim to lessen the emotional intensity of the memory while helping the brain reprocess the event in a less distressing way.

When used for PTSD, EMDR targets traumatic memories and their associated false beliefs, and may help decrease the vividness and emotional charge associated with those memories, reducing flashbacks, nightmares, and anxiety.

In SUD treatment, EMDR addresses any underlying trauma that drives the addiction. It helps reduce emotional triggers that can lead to relapse and can be used in dual diagnosis treatment alongside therapies for drug misuse.

EMDR works for both substance abuse and PTSD because it targets the root cause (the trauma) rather than only the symptoms, reducing the need to numb emotions with drugs, and helps break the connection between triggers and substance use.

Medication-Assisted Treatment (MAT)

Medication-assisted treatment is the use of FDA-approved medications combined with behavior therapy and counseling, and has been designed to treat addiction. MAT works by normalizing the brain chemistry that was disrupted by substance use and allows individuals to function more normally and engage more effectively in therapy.

As a dual-diagnosis treatment, MAT reduces substance use so that PTSD can be treated more effectively. This may create a sense of emotional stability and mental clarity. It also decreases cravings, meaning that patients are less reliant on substances to treat anxiety.

MAT supports long-term recovery because it’s typically used as part of an integrated treatment plan. It may be especially helpful when combined with trauma-focused therapy and behavioral interventions.

Support Groups and Peer Programs

Support groups and peer programs are non-clinical support systems that involve people with similar experiences, such as PTSD, addiction, or both. They can be peer or professionally facilitated. Several types of peer support groups may be helpful for people with PTSD and addictions; these include:

A group peer support setting like Dual Recovery Anonymous gives those with co-occurring PTSD and SUD a strong social support network, which has been linked to better recovery outcomes. Being around others who share their struggles may increase engagement with people and teach them how to build trust. These programs offer long-term recovery support because people can keep attending them for as long as they need, which helps maintain sobriety and emotional stability.

Receive Compassionate Care for Both PTSD and Addiction at Robin Recovery

If you’re ready to start your road to recovery for PTSD and addiction, Robin Recovery has the compassionate care you need. Our dual diagnosis programs are evidence-based and offer medical stabilization and emotional support. 

We offer a variety of treatment programs, including outpatient programs, detox, and counseling and therapy. Contact Robin Recovery in Columbus, OH, to get started on your recovery journey today.