Mark your calendars for June 27th, observed as National PTSD Awareness Day. This date has been officially set aside by the United States Senate to increase understanding of a serious mental health condition that affects millions of Americans. It is also the culmination of other efforts highlighting the issue during all of June, which is designated as National PTSD Awareness Month by the National Center for Posttraumatic Stress Disorder.
“Today, my Administration pledges to continue fighting the stigma associated with mental health. Through enhanced research, greater access to evidence-based treatments, and continued love and support, we can improve the lives of those suffering from PTSD.”
~ President Donald Trump, for PTSD Awareness Day 2018
First Things First—What is PTSD?
“For anyone who wonders what it’s like to have a tragedy shatter your existence, this is what I would tell them: it’s like going through the motions of everyday life in a zombified state. It’s having outbursts of anger for what seems like no apparent reason, for even the smallest of offenses. It’s forgetting how to be your once-cheerful, perky self, and having to re-learn basic social skills…”
~ Sarahbeth Caplin, Someone You Already Know
Post-Traumatic Stress Disorder is an unhealthy and lasting reaction to any physically or emotionally painful event. PTSD is evidenced by uncomfortable psychological symptoms that disrupt everyday life.
- Reliving the traumatic event through nightmares, flashbacks, or hallucinations
- Avoiding any memories, people, places, or things that trigger memories of the trauma
- Excessive emotional arousal, evidenced by irritability, anger, restlessness, hatred, insomnia, hyper-alertness, or an inability to concentrate
- Persistent negative or painful emotions, such as shame or guilt
Examples of Trauma
“Unlike simple stress, trauma changes your view of life and yourself. It shatters your most basic assumptions about yourself and your world – “Life is good,” “I’m safe,” “People are kind,” “I can trust others,” “The future is likely to be good” – and replaces them with feelings like “The world is dangerous,” “I can’t win,” “I can’t trust other people,” or “There’s no hope.”
~ Dr. Mark Goulston, MD, Post-Traumatic Stress Disorder for Dummies
PTSD results from unprocessed or unresolved emotions following a traumatic event that threatened the person’s life or safety—or even merely had the POTENTIAL to cause harm, such as:
- Physical or sexual abuse or assault – A recent tragic example of this would be Austin Eubanks, a survivor of the Columbine school shooting who struggled for years before dying of a heroin overdose in May 2019.
- Serious accidents
- Car crashes
- Witnessing death, especially that of a close friend or family member
- Significant injury or illness— to one’s self or to a loved one
- Combat or wartime experience—Among military vets, PTSD was once known as shell shock, combat neurosis, and battle fatigue
- Natural disasters – earthquakes, tornadoes, hurricanes, floods, etc.
PTSD in America: The Statistics
“I have met many, many severely-distressed people whose daily lives are filled with the agony of both remembered and unremembered trauma, who try so hard to heal and yet who are constantly being pushed down both by their symptoms and the oppressive circumstances of post-traumatic life around them.”
~ Carolyn Spring
To start with, trauma is much more common than you might think. 60% of American men and 50% of women experience one or more traumatic events at some point during their lifetime. But there are significant differences in the types of trauma experienced by the sexes
- Men most often experience suffer trauma involving accidents, physical assault, natural disasters, or combat. They are also much more likely than women to actually witness death or serious injury.
- On the other hand, women are more frequently the victims of sexual assault, domestic violence or sexual molestation during childhood.
In any given year, between 3% and 4% of US adults suffer symptoms of PTSD. Per the Veterans Administration, that works out to roughly 8 million people annually. Approximately 1 out of every 11 people within the general population will develop the disorder during their lifetime.
Of special relevance, some occupations put workers at elevated risk of witnessing or experiencing violence, accidents, death, or natural disasters:
- Police officers – Up to 34% of officers exhibit symptoms of PTSD.
- Military—Among veterans, the lifetime prevalence of PTSD is 31% for males and 27% for females. It is even higher for those who served in a combat zone.
- Paramedics – One study found that 94% show moderate PTSD symptoms.
- Firefighters –As much as 37%
- Healthcare professionals – Doctors have the highest suicide rate in the US
- Divers – Up to 70%
The Effect of Childhood Trauma
“We are all just one event or trauma away from suffering from Post-Traumatic Stress Disorder.”
~ Donna Kasubeck
A 2012 study found that early childhood trauma strongly influences the likelihood of developing addiction or depression as an adult. Adverse Childhood Events change the areas of the brain responsible for emotional regulation and impulse control.
The National Child Traumatic Stress Network estimates that 1 out of every 4 American children will experience at least one ACE. Relevantly, research shows that for every ACE experienced or witnessed, the risk of beginning substance use jumps by as much as 400%. This means children with 5 or more ACEs are up to 2000% more likely to drink or use drugs than a child who has experienced none.
Substance abuse also seems to increase teenagers’ PTSD vulnerability. Adolescents who use alcohol or drugs are twice as likely to suffer PTSD following trauma, compared to youths who abstain from use.
The type of ACE also seems to matter:
- 14% of children start drinking or drink heavier and their parental divorce, and 13% begin or consider using drugs.
- Boys living in single-parent homes use marijuana and alcohol at higher rates.
- They also have higher rates of “acting out” with antisocial behaviors.
- 5% of boys and 14% of girls self-report experiencing some form of Childhood Sexual Abuse.
- CSA is strongly associated with heavy and/or hazardous drinking, marijuana use, illicit drug abuse, and the nonmedical misuse of prescription medications.
More about Sexual Trauma, PTSD, and Substance Abuse
“When the survivor’s substance abuse begins, it may well be the very first time that he or she has been able to block out the emotional pain of sexual abuse…I believe that most of the attempts to deaden the pain occur on an unconscious level. The survivor is only aware that it feels good not to think about the abuse for just a little while.”
~ Carlton Munson and Sandra L. Knauer, Recovering from Sexual Abuse, Addictions, and Compulsive Behaviors, “Numb” Survivors
Did you know that some kind of sexual abuse happens every 98 seconds in this country? Tragically, 94% of women who have been sexually assaulted will develop symptoms of PTSD.
Sexual assault can happen to ANYONE—female or male, gay or straight, young or old—and it takes many forms:
- Child sexual abuse or molestation
- Sexual assault
- Intimate partner sexual assault
- Exploitation by a trusted professional
- Harmful use of digital technology
- Revenge Porn
- Sexual harassment
There is an undeniable link between PTSD resulting from sexual trauma and subsequent substance abuse.
- Survivors of sexual assault/abuse who have PTSD are 13 times more likely to struggle with alcohol dependence or addiction.
- This is not surprising, because their overall rate of substance use and abuse is 26 times higher.
- 3 out of every 4 women s checking into rehab have a personal history of sexual abuse.
To cope with emotional pain and escape from uncomfortable feelings and memories, up to 80% of survivors turn to alcohol and drugs.
Do YOU Have PTSD?
“I didn’t know there were very real reasons why I felt so bad, hopeless, and afraid most of the time. What I did know was that I wasn’t normal…I loved the feeling drugs and alcohol gave me—the soft white glow of the drug-induced high became my obsession. I only felt OK when I was under the influence.”
~ Lisa M. Najavits, Recovery from Trauma, Addiction, Or Both: Strategies for Finding Your Best Self
The National Center for PTSD has a checklist that asks 20 questions about stress-related problems. Respondents are asked to rate how much each problem has bothered them within the past month. Scores range from 0 (Not at all) to 4 (Extremely). The higher the overall score, the more likely a PTSD diagnosis is appropriate.
How much were you bothered by:
- Repeated, unwanted, and disturbing memories of the stressful experience?
- Repeated, disturbing dreams of the stressful experience?
- Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually reliving it)?
- Feeling very upset when something reminded you of the stressful experience?
- Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?
- Avoiding memories, thoughts, or feelings related to the stressful experience?
- Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?
- Trouble remembering important parts of the stressful experience?
- Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)?
- Blaming yourself or someone else for the stressful experience or what happened after it?
- Having strong negative feelings such as fear, horror, anger, guilt, or shame?
- Loss of interest in activities that you used to enjoy?
- Feeling distant or cut off from other people?
- Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?
- Irritable behavior, angry outbursts, or acting aggressively?
- Taking too many risks or doing things that could cause you harm?
- Being “super alert” or watchful or on guard?
- Feeling jumpy or easily startled?
- Having difficulty concentrating?
- Trouble falling or staying asleep?
How PTSD Contributes to Addiction
“…that was the first time I started to see how the trauma had triggered serious drinking. I wish I knew then what I know now – that the alcohol kept me numb. I was on autopilot, trying to get through by pushing down feelings that tried to surface. I can see now that it doesn’t work, but at the time, it was all I knew.”
~ Dr. Lisa M. Najavits, Ph.D., Recovery from Trauma, Addiction, or Both: Strategies for Finding Your Best Self
The related illnesses of PTSD and Substance Use Disorder frequently co-occur, because PTSD sufferers will attempt to “self-medicate” with alcohol, illicit drugs, or misused prescriptions to numb emotional pain:
- Victims of sexual or physical abuse or assault are three times as likely to drink and/or use drugs.
- Over 70% of rehab clients have suffered trauma.
- Nearly 60% of PTSD patients develop SUD.
How Addiction Contributes to PTSD
“When you have a persistent sense of heartache and gutwrench, the physical sensations become intolerable, and we will do anything to make those feelings disappear…people take drug to make it disappear…”
~ Bessel A. van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
Two-thirds of traumatic experiences are preceded by substance use. Excessive drinking and drug use frequently lead to poor decisions and risky behaviors which too often results in new trauma:
- Drunk-driving—28% of fatal car accidents in the US involve alcohol. Drugs also play a part in 16% of all crashes.
- Sexual assault – 3 out of 4 of perpetrators and over half of the victims drank prior to the incident.
- 72% of rapes occur while the victim is intoxicated.
- Violence—Half of all assaults and homicides are committed when the offender, the victim, or both have been drinking.
- Domestic violence—Among female domestic abuse victims, 33% struggle with substance abuse, compared to just 16% of non-victims.
- In two-thirds of DV cases, batterers starting drinking before the assault.
- Self-harm – Alcoholics and drug addicts have a risk of attempting suicide that is six times greater than the general population.
- Child abuse—40% of offenders are under the influence of alcohol at the time of the incident.
These kinds of dangerous and destructive behaviors trigger a self-perpetuating cycle of new trauma and coping through self-medication.
Treating a Dual Diagnosis of PTSD and Addiction
“While psychological trauma is characterized by disruptions in a person’s sense of control, addiction can also be viewed as a disorder of control, or more accurately, an inability to control. The loss of control is insidious, often unrecognized by the addict until, in Alcoholics Anonymous terms, life becomes unmanageable.”
~ Dr. Bruce Carruth, Ph.D., LCSW, Editor, Psychological Trauma and Addiction Treatment
But there is good news.
Just as PTSD and SUD are linked, so is recovery from each. Specifically, many of the skills learned during recovery can be applied to both conditions, with results that are much more positive and powerful than when if are applied separately.
No matter which disorder came first, addiction and unresolved trauma can each cause and worsen the other, creating a never-ending downward spiral—trauma leads to self-medicating and coping with alcohol and drugs, which invariably leads to even more trauma.
But with the proper support and effective treatment, that downward spiral can be halted, and better yet, even reversed. With every new, healthy coping skill learned and practiced, a life that was once dysfunctional and unmanageable DOES get better. When past trauma is successfully processed, there is no longer a need to self-medicate. Happily, this also means a lot less new trauma.
There are several different treatment strategies that can help with comorbid PTSD and SUD, including:
- Dialectical Behavioral Therapy (DBT)
- Eye Movement Desensitization and Reprocessing (EMDR)
- Cognitive Behavioral Therapy (CBT)
- Individual Counseling
- Peer Group Therapy
- Medication Assistance
- Poetry Therapy
- Pet or Equine Therapy
These illnesses are so intertwined that even when someone checks into a drug or alcohol rehab program, they should also be thoroughly screened for a personal history of past trauma. This is known as a “trauma-informed approach”, a treatment strategy recognized by the Substance Abuse and Mental Health Services Administration. It focuses on the “Four R’s”:
- Realizing the profound impact of trauma and understanding the potential paths leading to successful recovery;
- Recognizing the warning signs and symptoms of unresolved trauma in clients and families;
- Responding by fully incorporating knowledge about trauma into clinical policies, procedures, and practices; and
- Actively avoiding re-traumatization.
There are six core principles that guide trauma-informed treatment:
- Trustworthiness and Transparency
- Peer support
- Collaboration and mutuality
- Empowerment, voice, and choice
- Cultural, Historical, and Gender Issues
These guiding principles help ensure that people in crisis due to PTSD receive individualized, evidence-based, and empathetic care that allows them to successfully and safely recover from both the trauma and the addictive disorder.
The Bottom Line about PTSD and Addiction
“Trauma is hell on Earth. Trauma resolved is a gift from the gods.”
~ Peter A. Levine
Unresolved trauma leads to problematic substance abuse, and vice-versa. Addiction and PTSD are serious illnesses that are complicated enough on their own, but when they present together, specialized treatment is absolutely necessary.
To find out more, or to get help for yourself or someone you care about, click here.