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How Can PTSD Lead to Substance Abuse in Veterans?

People with a post-traumatic stress disorder (PTSD) diagnosis may turn to drugs or alcohol to cope with the symptoms. Military veterans experience high rates of PTSD in large part due to their dangerous work.1 This means that some of our service members who have PTSD might also develop a substance use disorder.

In this article, you’ll learn:

  • What PTSD is.
  • Why some who suffer from PTSD, including veterans, turn to substance abuse.
  • Who suffers from PTSD.
  • How to treat PTSD and substance abuse.

What is PTSD?

Post-traumatic stress disorder (PTSD) may happen when someone experiences trauma first-hand or witnesses a traumatic event. These events can include:8

  • A serious accident.
  • War or combat.
  • Natural disaster.
  • Terrorist attack.
  • rape or other violent assault.

Not everyone who experiences a traumatic event will develop PTSD. Medical professionals will diagnosis someone based on symptoms that:2

  • Last for over a month.
  • Creates significant problems in a person’s social or professional life.
  • Are not related to medication, substance use, or other illnesses.

Symptoms of PTSD can include:8

  • Intrusive thoughts. This can include unexpectedly remembering the traumatic events, bad dreams, or flashbacks.
  • Not going certain places, interacting with some people, participating in certain activities, etc., because they trigger memories of the trauma.
  • Negative thoughts and emotions, including guilt, embarrassment, shame, anger, and others.
  • Decreased interest in things that used to bring the person joy.
  • Acting out, such as through angry outbursts or being self-destructive.
  • Having trouble sleeping and/or concentrating.

PTSD & Substance Abuse

man in military uniform crouched over helmetSomeone who has post-traumatic stress disorder (PTSD) is 80% more likely to also have at least one other mental disorder—which can include depression, anxiety, substance abuse disorders (SUDs), and others.2

There are a couple of different theories about why this happens.

Self-Medication

The connection between PTSD and SUDs can come from a desire to self-medicate: One study found that 20% of people involved used drugs or alcohol in an attempt to relieve their PTSD symptoms. The same study found that men would self-medicate with substances more than women to “treat” their PTSD.3

Drugs or alcohol can become a coping mechanism for PTSD.

Susceptibility

Another theory, called the “Susceptibility Hypothesis”, states that some people, based on their life experiences, can be more susceptible to their experiences and the environment—and traumas—to which they are exposed.4

For instance, factors that may influence whether a person develops PTSD or how a person reacts to their PTSD symptoms can include:2

  • Emotional issues from childhood.
  • Poverty/socioeconomic status.
  • Experiencing trauma at some point in their life.
  • Gender.
  • How bad the trauma is.
  • Distressing reminders or loss related to the trauma.

If you are more susceptible to your environment and experiences and you are present for a traumatic event, the chances of you developing PTSD may be higher.4

Veterans, PTSD, and Substance Abuse

Military veterans who are diagnosed with a substance use disorder (SUD) often also have post-traumatic stress disorder (PTSD). 74% of Vietnam veterans with a SUD diagnosis from the Department of Veterans Affairs (VA) also had a PTSD diagnosis,5 while 63% of Iraq and Afghanistan war veterans with a SUD diagnosis from the VA also had a PTSD diagnosis.6

Veterans who experience war during their service are more likely to develop PTSD. This can be due to:7

  • Stress from being in a war zone.
  • Being wounded in action.
  • Becoming a prisoner of war.

One study cited that among military veterans, three specific subsets of people may experience the more pronounced stress from war zones. These are:7

  • Women who may also experience sexual assault and harassment while in a war zone.
  • Ethnic minorities (nonwhite) individuals whose life—before, during, and after the war—has been affected by racism.
  • Veterans with physical disabilities from war.

Who Develops PTSD?

Although the conversation around post-traumatic stress disorder (PTSD) often refers to military veterans, the mental disorder does not discriminate: Anyone can get PTSD. It affects roughly 3.5% of the adults in the U.S. Women are 2 times as likely to have PTSD than men. 8

There’s also a substantial connection between PTSD and substance use disorder (SUD).

  • One study found that 46.4% of people with lifetime PTSD diagnoses also had symptoms of or were diagnosed with a SUD.9
  • Another study detailed that 27.9% of women with a lifetime PTSD diagnosis also had a SUD. 51.9% of men with a similar prognosis also had a SUD.10

Treating PTSD & Substance Abuse at the Same Time

Co-occurring disorders, dual diagnosis, or comorbidity are terms for when someone has 2 or more mental disorders—such as post-traumatic stress disorder (PTSD) and a substance use disorder (SUD)—at the same time.

Diagnosing and treating PTSD and SUD concurrently (at the same time) is important to overall success, continued sobriety, and recovery.11

Veterans’ Affairs (VA) and other professionals recommend a handful of evidence-based therapies to treat concurrent PTSD & SUDs, including:12

  • Prolonged exposure (PE). Over time, this approach shows those suffering from PTSD that their trauma-related memories don’t have too be painful.
  • Cognitive processing therapy (CPT). By gauging and shifting the negative, intrusive thoughts that followed a traumatic experience, people with PTSD may be able to change how they feel about the trauma.
  • Group therapy. It can be difficult to relate to other people after a traumatic event that leads to PTSD. Group therapy creates an environment for people with similar experiences to heal together.
  • Psychotherapy and medication, depending on the substance being abused.
    • Prolonged exposure therapy supplemented with the use of naltrexone was found successful for the treatment of PTSD and alcohol use disorder.13
    • Some medications that treat anxiety or other stress-related symptoms—like SSRIs (selective serotonin re-uptake inhibitors) and SNRIs (selective norepinephrine re-uptake inhibitors) can be used with PTSD.14

Experiencing trauma can be debilitating for many people, and having PTSD is not uncommon after a traumatic event.

For veterans, you can reach out to the VA for PTSD help in your area. If you are or know a veteran that has PTSD and a substance use disorder, the VA has resources for treatment as well. Here at Recovery First, we offer a program specifically for veterans dealing with PTSD and addiction.

For military veterans and civilians alike, know that there is treatment, like that listed above, that can help.

Resources:

  1. U.S. Department of Veteran Affairs. (2019). PTSD and Substance Abuse in Veterans.
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Arlington, VA, U.S.: American Psychiatric Publishing, Inc.
  3. Leeies, M., Pagura, J., Sareen, J., & Bolton, J.M. (2010). The use of alcohol and drugs to self-medicate symptoms of posttraumatic stress disorder. Depression and Anxiety, 27(8), 731-736.
  4. University of Manitoba. (2012). Term: differential susceptibility hypothesis.
  5. Kulka, R. A., Schlenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., & Weiss, D. S. (1990). The National Vietnam Veterans Readjustment Study: Tables of findings and technical appendices.
  6. Seal, K. H., Cohen, G. Waldrop, A., Cohen, B. E., Maguen, S., & Ren, L. (2011). Substance use disorders in Iraq and Afghanistan Veterans in VA healthcare, 2001-2010: Implications for screening, diagnosis and treatmentDrug and Alcohol Dependence, 116, 93-101.
  7. Friedman, M.J., Schnurr, P.P., & McDonagh-Coyle, A. (1994). Post-traumatic stress disorder in the military veteran. Psychiatric Clinics of North America, 17(2), 265-277.
  8. American Psychiatric Association. (2017). What is posttraumatic stress disorder?
  9. Back, S. E., Waldrop, A. E., & Brady, K. T. (2009). Treatment challenges associated with comorbid substance use and posttraumatic stress disorder: Clinicians’ perspectivesAmerican Journal of Addiction, 18. 15-20.
  10. Kessler, R. C., Sonnega, A., Bromet, E. J., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey.Archives of General Psychiatry, 52, 1048-1060.
  11. National Institute on Drug Abuse. (2018). Comorbidity: substance use disorders and other mental illnesses.
  12. U.S. Department of Veterans Affairs. (2019). Treatment of co-occurring PTSD and substance use disorder in VA.
  13. Foa, E. B., Yusko, D. A., McLean, C. P., Suvak, M. K., Bux, D. A., Oslin, D., O’Brien, C. P., Imms, P., Riggs, D. S., & Volpicelli, J. (2013). Concurrent naltrexone and prolonged exposure therapy for patients with comorbid alcohol dependence and PTSDJournal of the American Medical Association, 310,488-495.
  14. Berenz, E. C., & Coffey, S. F. (2012). Treatment of co-occurring posttraumatic stress disorder and substance use disordersCurrent Psychiatry Reports,14,469-477.