Early sobriety is difficult enough, but for those with co-occurring PTSD it can feel overwhelming. Without your substance of choice- typically used for self-medication – symptoms can be raw, powerful and intrusive. Do not despair; you can and will get better with proper guidance, lifestyle changes and professional care. I am often asked, “How do you deal with the PTSD?” I have distilled the essence of early treatment to a basic three S’s – sleep, safety, and sobriety. You cannot move forward without being sober, in a relatively safe setting and without getting uninterrupted quality sleep. Here are a few do’s and don’ts that might provide a basic framework for you and prove useful.
Things to Do:
1. Do attend recovery support meetings and stick with your treatment plan.
2. Do find meetings that you are comfortable with; LifeRing, if available in your area, is sometimes a desired alternative to traditional meetings.
3. Do work with a psychiatrist familiar with both conditions and be assertive if the medications are too potent or insufficient. There are safe anti-craving medicines that may help you stay sober during those fragile first 90 days.
4. Do get quality sleep! I cannot emphasize how vital that is. There are non-addictive medicines that facilitate sleep- Doxepin or Mirtazapine, for example, as well as medicines that block nightmares. A little known secret is an old anti-hypertension medicine, Prazosin, which is remarkably helpful in easing night sweats and nightmares. The VA has been using this for years with excellent results.
5. Do develop regular sleep patterns in a darkened, quiet room with no distractions. Don’t watch the news or violent movies or play intense video games just prior to sleeping.
6. Do rule out sleep apnea; your sleep quality and health may be harmed if your breathing patterns during sleep are poor. The evaluations are simple and affordable.
7. Do get moving! Daily aerobic movement will help with depression, anxiety and anger. Break a sweat- safely, of course – once daily for at least 20 minutes. It will help in more ways than I can explain in a brief article; the positive evidence is overwhelming.
8. Do learn and practice yoga breathing. Knowing that you can calm down with a few paced, fully exhaled breaths can be a lifesaver. I also highly recommend a mindfulness discipline. Many forms of Yoga, Tai Chi, meditation and Chi Quong are invaluable to many.
9. Do clean up your diet. I strongly recommend the healthy diet of your preference- not for weight loss necessarily – but for mood management. Surges of insulin can set off anxiety or panic. If possible consult with a nutritionist and/or use a fitness diet app. Stay away from Rockstar and similar ‘energy’ drinks.
10. Do consider a canine adjunct- service dogs can enhance your recovery and perceived safety.
11. Do find a qualified psychotherapist. A psychologist, social worker or other specially-trained allied professionals can help you deal with PTSD. Be certain your provider is licensed. Look for trusted recommendations but remember to be assertive and insist on a provider who makes you feel safe. There are many approaches and techniques with many confusing acronyms and promises. If the clinician promises a ‘cure’ or insists on their own agenda, technique or pacing, find another provider. The key is quality of relationship; your perceived safety is paramount.
1. Don’t avoid or deny PTSD: Dealing with denial is not limited to addiction; trauma survivors want to avoid remembering or acknowledging they were overwhelmed by events. Remember, PTSD is not indicative of ‘insanity’ or ‘weakness’; at its core it is A NORMAL REACTION TO ABNORMAL EVENTS.
2. Don’t procrastinate: Those who begin working on trauma issues within the first six months of sobriety are much more likely to stay sober.
3. Don’t ruminate: “I just need to figure things out.”- occurs most often alone, and at night. PTSD is not ‘solved’ by thinking; in fact it gets worse when you overthink it.
4. Don’t isolate: “I don’t trust anybody and nobody can understand me”. This is simply not true. You are not alone and you should not remain alone, isolated, silent and miserable.
5. Don’t be discouraged with setbacks or relapse; relapse can be part of your emotional recovery. Do not become discouraged. Getting flooded happens. Your job is to learn to prevent those triggers from controlling your life.
6. Don’t hesitate to utilize higher levels of care, if needed. If you relapse in both the addiction and emotional domain you might need higher levels of structure, support and care. Finding the right setting or system can be difficult but you must persist and insist. These conditions, while not ‘curable’ are very treatable and your quality of life will improve.
7. Don’t grab on to newly-hyped treatments: hallucinogens, exorcisms, surgeries or supplements may do far more harm than good. Look for credible evidence, even if the technique claims it is evidence based. Medical marijuana, for example, has testimonial support but the evidence is not yet solid, and it poses a risk for dependence, relapse and mood disruption.
8. Don’t continue with techniques, methods or groups that cause emotional ‘flooding’. Recovery is not an epiphany with Hollywood drama and a flood of tears. It is a process.
9. Don’t lose hope. Never give up. Whereas many addiction treatment models place emphasis on ‘surrender’, the goal of your PTSD recovery is finding your voice and your power- safety, articulation and empowerment, not control is the goal.
Dealing with the aftermath of trauma in concert with an addictive disorder can be perplexing to you as well as your providers. Never lose faith in your own resilience, learn to derive a narrative and remember that PTSD recovery is a process, not an absolute. Your symptoms can become strengths in terms of wisdom and supporting others who struggle. Work on acceptance as well as forgiveness – it will get better!
Jerry Boriskin, Ph.D., C.A.S. has more than thirty-five years of experience as a licensed clinical psychologist, PTSD specialist, certified addiction specialist, and program consultant. He worked in South Florida for 17 years and developed residential programs for co-occurring PTSD and addictions. He is currently working with VA Northern California returning to his roots as a clinician treating combat veterans with complex PTSD. www.jerryboriskin.com/blogs