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Co-Occurring Disorder: Addiction and PTSD

Post-traumatic stress disorder (PTSD) is a mental health condition that may develop in someone who has experienced a traumatic event.1, 2 While everyone has different experiences with trauma, the Substance Abuse and Mental Health Services Administration (SAMHSA) describes trauma as a harmful or life-threatening event or circumstances with lasting effects on an individual’s mental, physical, social, emotional, or spiritual wellbeing.14

Research shows a strong association between PTSD and substance misuse (including drug and alcohol use disorders).2 When someone struggles with both a mental health condition like PTSD and a substance use disorder, they are said to have co-occurring disorders.3 PTSD and substance use disorders commonly co-occur; past estimates indicate that roughly half of those seeking treatment for SUD also met criteria for current PTSD.4  PTSD itself may be particularly prevalent among certain groups. Veterans, police officers, firefighters, first responders, healthcare professionals, journalists, and therapists are at increased risk of experiencing the traumatic events that could lead to PTSD development.5

While PTSD and substance use disorders can be devastating, they are also treatable conditions. Understanding what PTSD is, how it may co-occur and interact with problematic drug and alcohol use, and how to find a rehab that offers integrated treatment for both mental health and substance use disorders can help you on your way to recovery.

What is Post-Traumatic Stress Disorder (PTSD)?

PTSD can affect people in various ways and may be difficult to identify without medical guidance. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines several criteria on which a diagnosis of PTSD is made, with several of them involving initial exposure to death or the threat of death, serious injury, or sexual violence. The first group of criteria can include:7

  • Experiencing a traumatic event yourself.
  • Witnessing a traumatic event occurring to others.
  • Learning that the event happened to a close family member or friend.
  • Repeated exposure to traumatic events (i.e. first responders collecting human remains).

Other potential symptoms of PTSD used as diagnostic criteria include:7

  • Recurrent intrusive memories of the event that cause distress.
  • Recurrent distressing dreams related to a traumatic event.
  • Experience flashback in which you think the traumatic event or events are occurring.
  • Intensely adverse psychological or physiological reactions to internal or external cues or triggers that symbolize or resemble aspects of the traumatic event.
  • Avoidance or memories or external reminders of the traumatic event (crowds, driving, loud noises).
  • Increase negative thoughts or feelings (feeling guilt or shame about the event).
  • Social withdrawal.
  • Hyper-vigilance.
  • Exaggerated startle responses.
  • Difficulties concentrating.
  • Sleep disturbances.

How Substance Use and PTSD are Linked

While those struggling with substance use are at increased risk for PTSD, the exact reasons as to why remain complex.7 Research has suggested many theories as to why PTSD and SUDs so often co-occur, particularly in certain high-stress occupations:1, 7

  • Self-Medication Theory: Commonly attested by treatment professionals, the self-medication theory suggests that an individual struggling with the symptoms of PTSD may attempt to use substances, like drugs or alcohol, to alleviate the symptoms. As the PTSD symptoms worsen, so too does the substance abuse, potentially resulting in a SUD diagnosis.7
  • High-Risk Hypothesis: Conversely, the high-risk hypothesis suggests that those with a SUD tend to live a high-risk lifestyle, potentially exposing them to traumatic events that may result in PTSD.7
  • Susceptibility Hypothesis: This hypothesis suggests that the increased anxiety and poor coping skills that commonly associated with substance use disorder could leave one more vulnerable to PTSD after experiencing a traumatic event.7
  • Genetic Factors: There is evidence to suggest that certain biological factors, such as genetics, can contribute to the development of both PTSD and substance use disorder.1,7

Overall, the exact relationship between PTSD and substance abuse is complex and will likely vary from person to person. It’s best to reach out to a doctor or medical professional if you believe you are experiencing symptoms of PTSD or substance abuse.

PTSD and Substance Abuse in Veterans

Co-occurring PTSD and substance abuse is incredibly common in veteran populations, as veterans with SUD diagnoses commonly meet the criteria for co-occurring disorders like PTSD, depression, and anxiety.8 Veterans who have an SUD are three to four times more likely to also be diagnoses with PTSD or depression.8 While the direct link between PTSD and substance abuse is varied and complex, veterans seem to be particularly susceptible to both conditions.

Luckily, there are many rehabs with veteran-specific programs that can help you find sobriety. Many of these programs can be accessed through the Department of Veterans Affairs (VA) health network.9 Private rehabs may also offer treatment for substance abuse and PTSD. Private PTSD and substance abuse rehabs can be accessed by using private insurance, or by using one’s VA insurance if the rehab is part of the VA’s Community Care Network.10 It’s best to reach out to a VA representative to start the process of finding rehab, or to visit an online treatment directory.

If you are a veteran with PTSD and are in a crisis or emergency, please contact the National Center for PTSD’s crisis line at 1-800-273-8255.

How to Treat Co-Occurring Alcohol or Drug Addiction and PTSD

Similarly as to how there is debate about how PTSD and substance abuse affect each other, there’s also debate about how best to treat the conditions.2 Traditional views hold that one ought to treat the SUD first and focus on PTSD after.2 More recently, as medical understanding of these disorders has grown, evidence has emerged for an integrated approach to treatment; put in simpler terms, programs and therapies that simultaneously target and treat PTSD and SUD can have positive treatment outcomes.2 Particularly when it involves a combination of medications and behavioral/psychosocial therapies, integrated treatment for both PTSD and SUD has increasingly become the standard of care, and may even be preferred by the patients themselves.2

Co-Occurring Disorders Treatment Process

Treatment for co-occurring disorders can vary greatly depending on one’s needs. What treatment you receive depends on several factors, including the severity of one’s PTSD or SUD, previous rehab attempts, and your insurance coverage. While there is variance, you might expect one or several of the following treatment interventions:3, 11, 12

  • Detox: Detox is the process of clearing the abused substance(s) from your body. Detox involves support and medical interventions, when needed, to best manage unpleasant (and sometimes dangerous) withdrawal symptoms. Medical detox and withdrawal management can help stabilize people in the first part of recovery to ease their transition towards additional rehabilitation efforts.
  • Inpatient Rehab (Residential Rehab): Inpatient and residential rehab programs provide 24/7 medical supervision to address your substance use and mental health disorders simultaneously. You may receive a variety of treatment and therapies, ranging from behavioral to medication therapies. Inpatient programs can last a few weeks to a month or two, while residential therapies can last several months depending on one’s needs.
  • Outpatient Treatment: Outpatient treatment is sometimes considered a follow-up to a more intensive inpatient or residential program, though it may also serve as the initial point of treatment for some people. During outpatient treatment, you will be able to return to daily routines like work or school while attending therapy sessions as a rehab facility.
  • Medications: Some patients may benefit from medication-assisted therapy (MAT). MAT is usually done in combination with counseling and behavioral therapies, and will only use drugs that are approved by the FDA.
  • Trauma-informed therapy: Emerging research suggests that some patients struggling with PTSD and SUD may benefit from trauma-informed therapy, though there is still debate. While prolonged exposure therapy is traditionally considered a staple of PTSD treatment, there’s not much evidence that is effective in those struggling with PTSD and SUDs.7 As a result, non-exposure-based therapies may be more common.7 While studies are showing promising preliminary evidence for the efficacy of exposure-based integrated treatment for those with PTSD and SUDs, it’s best to coordinate with your treatment team to determine which treatment track will be best for you.

Does Insurance Cover Treatment for PTSD and Substance Abuse?

The Affordable Care Act (ACA) requires insurance providers to cover treatment for mental health disorders in some capacity.13 This includes treatment for PTSD and substance abuse, though your coverage may vary depending on several factors. One’s location, insurance plan, and the intensity and length of treatment could affect the extent to which one’s rehab is covered. It’s best to contact your insurance provider or check your coverage online before committing to rehab.

The VA and TRICARE (insurance for military service-members and their dependents) also offer coverage for treating PTSD and substance use disorders. However, coverage may vary, especially if you attend treatment at a rehab that is not in the VA’s health system or community care network. It’s best to contact your VA and TRICARE representative to determine the extent of your coverage.

Finding Treatment for PTSD and Addiction

If you are struggling with PTSD and substance abuse, it’s important to remember that there is help available. There are effective treatment options available for both conditions. Finding a treatment facility near you that offers integrated treatment for PTSD and addiction can be an important first step. If you are a veteran, first responder, or other at-risk group for developing PTSD, you may want to consider looking for treatment tracks tailored to your needs (i.e. Veterans-specific treatment, first responders treatment, etc.). Veterans should also consider contacting their VA representative for help finding a nearby VA rehab center.

American Addiction Centers (AAC) can also help. We operate several facilities across the country and are able to provide integrated treatment for co-occurring substance use and mental health disorders. AAC also operates a 24/7 detox and rehab hotline that can answer any questions about rehab and help you find rehab near you. Alternatively, if you would like to get started online, start the process by checking your insurance coverage instantly or texting our team.

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