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June 13, 2016

Why Is Substance Abuse Common with PTSD?

PTSDJami DeLoe once thought her biggest problem was drinking. That was before a diagnosis of “post-traumatic stress disorder,” or PTSD, which is the name given to a constellation of mental symptoms that can develop in some people after a traumatic event like war or child abuse.

“What I didn’t understand was that there was a direct link between my drinking and dealing with my PTSD symptoms,” DeLoe wrote in Healthy Place last fall. “I was self-medicating to control my symptoms without even knowing it.”

By using drugs or alcohol to dull the debilitating symptoms of PTSD, DeLoe was doing what many others in similar shoes do.

Substance Abuse and PTSD

Just how common is substance abuse with the “dual diagnosis” or co-occurring disorder of PTSD?

Roughly half of those who seek treatment for a substance use disorder (SUD) meet the criteria for a diagnosis of PTSD, according to a recent study published in Current Psychiatry Reports.

Among young people with PTSD, this link seems to get stronger: studies suggest that 59 percent of young people with PTSD subsequently develop a substance abuse problem, according to the National Child Traumatic Stress Network (NCTSN).

What Is PTSD?

Imagine experiencing something unbearably horrifying — something you should never have to suffer. (And, by its very definition, “trauma is unbearable,” according to Dr. Bessel van der Kolk, who is the founder and medical director of the Trauma Center in Brookline, Massachusetts and the author of the book The Body Keeps the Score.) Now imagine that the sights, sounds and smells of that event keep replaying themselves over and over long after that trauma is over.

PTSD is the replay of this same broken record.

Symptoms of PTSD

Not surprisingly, then, PTSD and its symptoms can cause enormous suffering and make life seem unmanageable, if not totally intolerable. Symptoms can include:

  • nightmares and flashbacks to the traumatic event
  • extreme anxiety
  • severe insomnia
  • panic attacks
  • hyperarousal to external stimuli (a sense of being on guard at every waking moment)
  • over-reactive emotional responses to comparatively minor situational triggers
  • post-traumatic changes in beliefs and thoughts about yourself and others
  • amplified guilt or shame
  • depression
  • trouble concentrating

Trauma, PTSD, and Alcohol

Such symptoms are especially difficult to cope with on one’s own, in the absence of effective medical treatment. That is why many who suffer from PTSD after a trauma turn to alcohol or drugs as a means of self-medicating. The question that remains is “why?”

When researchers at the University of Pennsylvania explored this question as it relates specifically to alcohol use, they found the answer had to do with the unique physiological and emotional impact of trauma. Within minutes of exposure to a traumatic event, levels of endorphins in the brain spike. They in turn release the body’s naturally occurring opioids, which help to dull and relieve pain. During the course of the event, these endorphins stay elevated as the body’s natural way of numbing painful physical and emotional sensations. In the aftermath of the trauma, these endorphins gradually recede back to normal levels.

The resulting “endorphin withdrawal” in the hours and days following an incredibly stressful event … “may produce emotional distress and contribute to other symptoms of PTSD,” the researchers explained in findings published in the journal Alcohol Research & Health. And, they continued, “Because alcohol use increases endorphin activity, drinking following trauma may be used to compensate this endorphin withdrawal and thus avoid the associated emotional distress.”

In other words, the hypothesis goes, alcohol compensates for the decrease in endorphin activity that occurs in the wake of a highly stressful event or trauma.

Trauma, PTSD and Other Drugs

The same explanation can apply to other forms of drug abuse that commonly occur with PTSD: some of the drugs most prone to abuse either also increase endorphin levels or pretend to. Opiate drugs, for example — whether prescription painkiller medications like oxycodone or hydrocodone or their illicit street version, heroin — in essence mimic the body’s natural endorphins and produce some of the same pain-relieving effects, only with much greater intensity. Still other stimulant drugs like cocaine and amphetamines boost endorphin levels in a key region of the forebrain now shown to control addiction.

Treatments for PTSD and Addiction

In the end, DeLoe was able to get much-needed relief for PTSD only after first addressing her drinking problem. She wants to share that same message of hope with others struggling with PTSD and addiction. Treatment can help make life manageable, tolerable and even joyful again. Often that starts with getting help for a substance abuse problem.