Addiction And Post-Traumatic Stress Disorder (PTSD): Managing Two Addictions At Once

By Michelle Rosenthal

Every “bad” behavior (e.g. an addiction) begins with a good intention. That is, the desire for something beneficial—to feel better, calmer, happier, etc. As the antidote to the disturbing effects of trauma, excessive engagement with alcohol or drugs can become a bid for sanity, safety and stability in a world where an inexorable trauma “craving” refuses to be satiated. For those carrying a dark history of survival, the lure of alcohol or drugs can seem a compelling way to counteract the drive of a troublesome habit we don’t usually discuss: trauma addiction. In such cases, the bad behavior indeed begins with good intentions.

Of course, posttraumatic stress disorder (PTSD) isn’t typically called a trauma addiction. Technically, it’s a mental illness that affects up to 20% of survivors who experience trauma. But haunting memories can activate addictive drives. Due to trauma-induced neurophysiological changes, many survivors unknowingly struggle with PTSD symptoms that create a sense of despair, hopelessness, powerlessness and anxiety, plus an ever-present sense of danger and utter lack of control. Coping with such a potent combination of daily post-trauma experiences they ache for relief and often find it in addictions.

While not all addicts are PTSD survivors and certainly not all PTSD survivors are addicts, a deeper understanding of the link between trauma and addiction, plus learning to identify the presence of PTSD and treatment options can provide a foundation that informs recovery.

The Link between Trauma and Addiction

According to the “PTSD and the Problem of Alcohol Abuse” jointly released by the National Center from Post-Traumatic Stress Disorder and the Department of Veterans Affairs:

1. Estimates suggest that 25-75% of violent trauma and abuse survivors experience issues and problems related to alcohol abuse.

2. 10-33% of people who have survived accidents, illness or natural disasters engage in alcohol abuse.

3. PTSD diagnosis increases a survivor’s risk of alcohol abuse.

4. Both male and female sexual abuse survivors have higher rates of alcohol and drug dependence than those who have not been abused.

The National Comorbidity Study concluded:

1. 52% of those diagnosed with lifetime PTSD have concurring alcohol abuse or dependence diagnoses (that’s twice the normal population)

2. 35% of that same population also has a drug abuse or dependence diagnoses (that’s almost three times the non- PTSD adult population)

With the connection between trauma and substance abuse firmly established, a question arises: How is PTSD clinically recognized and what can be done to reduce its effects? The answers lie in the Diagnostic and Statistical Manual (DSM V), survivors’ self- reporting and the large healing arena.

Signs and Symptoms of PTSD

In June 2013 the DSM V updated PTSD criteria to include the following basic categories of symptoms when they naturally occur (i.e. not driven by substance abuse or medical condition), have persisted for more than four weeks, and creates dysfunction in areas of the patient’s personal, professional and/or social life.

Exposure: Experience of a situation that threatens death, injury or sexual violence in ways that a survivor directly experienced the event, witnessed it in person as it happened to someone else, heard about the event happening to a close family member or friend, or experienced repeated and extreme interaction with details of the traumatic event (i.e. first responders).

Re-experiencing: Recurrent intrusive memories and thoughts about the event, dreams and nightmares with (thematically) related content, reactions (i.e. flashbacks) in which it feels like the event is happening in real time, enormous psychological and/or physiological distress brought on by external or internal cues that resemble aspects of the trauma.

Avoidance: Persistent circumvention of both internal and external cues that resemble traumatic content including thoughts, memories, locations, people and sensory stimulation.

Alterations: Changes in cognition or mood as evidenced by amnesia for an important aspect of the trauma, exaggerated and frequent negative beliefs about oneself, others and the world, distorted ideas about the cause or consequences related to the trauma that lead to self-blame or blaming others, consistent negative emotional perspective, lessened interest and participation in activities that previously engendered good feelings, a sense of detachment from oneself or others plus long-term inability to genuinely express positive emotions.

Arousal: Subsequent to the traumatic event, an increase in such behaviors as irritability, anger/rage, self-destructive tendencies, hypervigilance, exaggerated startle responses, concentration issues and sleep disturbances.

Though many aspects of PTSD may occur immediately following a trauma, some survivors experience delayed expression. In these cases the full spectrum of diagnosable criteria develops more than six months following the inducing event.

Accurately initiating an addict’s diagnosis may begin with a self- test (i.e. HealMyPTSD.com/do-I-have-ptsd) and then a referral for an appropriate diagnosis.

PTSD Treatment Options

Recovery from posttraumatic stress disorder varies due to personal histories, childhood programming, transgenerational effects, present-day support systems and willingness/readiness to engage in recovery processes. Finding long-term relief depends on developing a personalized program for defusing psychological, physical and emotional aspects of trauma.

Due to the enormous number of useful techniques for PTSD recovery the following list is only meant to be an introduction, not an exclusive or exhaustive list of options. Popular approaches fall into two categories:

Traditional—Evidence-based treatments predominantly focuses on psychological resolution of the trauma conflict including, talk therapy, (cognitive) behavior therapy, Dialectical Behavior Therapy, Acceptance and Commitment Therapy, (Prolonged) Exposure Therapy and Eye Movement Desensitization and Reprocessing.Alternative—Substantive experiential data supports these increasingly popular techniques that discharge blocked/held trauma energy in the mind and body and/or engage the subconscious mind in rewiring exercises. These programs can be more gentle as many do not require examination of specific trauma details which, for many survivors, can be retraumatizing. Popular approaches include hypnosis, Neuro-Linguitistic Programming, Somatic Experiencing, Emotional Freedom Technique, Thought Field Therapy, Tapas Acupressure Technique, and Tension and Trauma Releasing Exercises.

How Healing Happens

A PTSD diagnosis is not a life sentence. With technological advances in the field of science we continue to learn how trauma affects the brain, how those effects alter thoughts, feelings and behaviors, plus how the “fight/flight” survival response can be deactivated. The body and brain can indeed be rewired, reprogrammed and relieved of PTSD symptoms.

The most effective healing process combines elements of both traditional and alternative categories. On my radio show, Changing Direction, I have interviewed the top experts in trauma, PTSD and neuroscience. They all echo the same refrain, “Talking alone does not heal PTSD.” While traditional and evidence-based approaches are frequently and effectively the starting point for recovery, the addition of alternative practices allows a full mind/body approach to healing what is essentially, a wholly mind/body problem.

Michele Rosenthal is an award-winning PTSD blogger, award- nominated author, founder of HealMyPTSD.com, popular keynote speaker, post-trauma coach, host of Changing Direction radio, author of Your Life after Trauma: Powerful Practices to Reclaim Your Identity (W. W. Norton), and a former faculty member of the Clinical Development Institute for Timberline Knolls Residential Treatment Center