The Link Between PTSD And Substance Use Disorders

Post-traumatic stress disorder (PTSD) is an anxiety disorder that’s characterized by fear-based symptoms related to a past traumatic event, from vivid flashbacks and recurring nightmares to a near-constant sense of anxiety. It’s not uncommon for those with PTSD to turn to substances in an attempt to mitigate the distress they may be feeling as a result of the disorder. However, there may also be other reasons that PTSD and substance use disorders are frequently seen together. Let’s take a closer look at what PTSD is, its links to substance use issues, and the treatment options that are available for both conditions.

What is post-traumatic stress disorder (PTSD)?

Post-traumatic stress disorder is a mental illness that can develop after an individual experiences some kind of traumatic event. The fight, flight, or freeze response will kick in for virtually everyone during such an event, but most people recover from the fear and anxiety they experienced in that moment naturally over time. Those who continue to experience these feelings and related complications over the longer term, however, may eventually be diagnosed with PTSD. 

This condition is also more common in women (8%) than men (4%), a disparity that may be at least partially explained by the fact that women are more likely to experience traumatic events like sexual assault than men. Veterans—especially those who were deployed to combat zones—are also more likely to experience PTSD than civilians. Finally, it’s worth noting that some veterans groups in particular prefer to refer to the condition as PTS instead to help defeat stigma around it. They choose to call it an “injury” rather than a “disorder” to emphasize the fact that it can be effectively treated.

Symptoms of PTSD

Post-traumatic stress disorder has a fairly clear set of symptoms, though it may manifest for different people in somewhat different ways. Some of the most common include:

• Flashbacks to the traumatic event, which may also bring about physical symptoms such as heart palpitations and sweating

• Recurring dreams or nightmares about the event

• Consistent, frightening thoughts related to the event

• Avoidance of anything that reminds the individual of the event (people, places, things, feelings, thoughts)

• Becoming easily startled or even panicked by loud noises or other triggers

• A constant feeling of tension that rarely goes away

• Irritability

• Difficulty sleeping

• Memory loss, especially in relation to the event

• Self-esteem issues and other negative thoughts about the self or the world

• Feelings of guilt

• A loss of interest in activities previously enjoyed

Note that suicidal thoughts or behaviors may also be symptoms of PTSD, which is one reason that seeking treatment when you first suspect you may have this disorder can be essential. To receive a clinical diagnosis of PTSD, those who believe they may have the disorder must exhibit most of the symptoms listed above for more than a month. This disorder is treatable, usually through some form of psychotherapy. Medication may also be recommended in some cases.

If you or someone you know is experiencing suicidal thoughts or behaviors, seek help immediately. The National Suicide Prevention Lifeline can be reached 24/7 by dialing 988.

What is substance use disorder?

A substance use disorder (SUD) is a chronic mental illness rather than a matter of willpower—a common misconception. This category of mental health conditions is characterized by the chronic use of one or more substances (typically drugs or alcohol) that leads to impaired daily functioning or other significant issues. Their severity can range from mild to severe, with more infrequent episodes of problematic substance use often being classified as “substance misuse” instead. According to the Centers for Disease Control (CDC), one in seven people in the US aged 12 or older report experiencing a substance use disorder. 

Symptoms of substance use disorder

Symptoms can vary depending on the individual, the substances they’re using, and the severity of their dependence, but they may include:

• Unsuccessful attempts to reduce use of the substance(s)

• Trouble fulfilling responsibilities (work, school, etc.) because of substance use

• Continuing to engage in substance use even after it negatively affects relationships or causes harm

• Choosing to use substances in favor of other activities

• Engaging in reckless or illegal behavior

• Changes in appetite or sleep

• Changes in personality or attitude that cannot be otherwise explained

• Secretive behavior

• Visible irritability and rapid changes in mood

• Abruptly choosing new friends, activities, and favorite places, or social withdrawal

• Financial issues

Substance abuse disorders are treatable, but there’s no one-size-fits-all method. The most effective forms of treatment are typically customized to the individual, the severity of their disorder, their circumstances, and any comorbid conditions they may have. Detoxification may be recommended in some cases, and some form of individual and/or group psychotherapy is common as well. Medication may be used in certain situations too, and some may also benefit from longer-term inpatient recovery programs.

The link between PTSD and substance use 

An academic paper on the topic reports that those with PTSD are 14 times more likely to develop a substance use disorder than those who do not have PTSD. It also notes that veterans in particular are more likely to develop both PTSD and a substance use disorder—especially one related to alcohol. The paper outlines three possible theories for why these two disorders are so commonly linked.

1. Self-medication hypothesis

The symptoms of PTSD can be very challenging to deal with. Flashbacks and nightmares that consistently reinvigorate an individual’s memories of a traumatic event can be debilitating, and the near-constant anxiety can be exhausting. As a result, some people may turn to substances like drugs or alcohol to “self-medicate” and try to get relief from their symptoms. 

There’s also the matter of stigma to consider. Since mental health conditions and PTSD in particular still carry some level of stigma in the culture—perhaps more in certain communities than others—those experiencing PTSD symptoms may feel a sense of shame. This feeling may cause them to avoid seeking professional treatment and instead turn to substances to cope.

2. High-risk hypothesis

Another possibility put forth by the authors of the paper linked above is that those who already engage in frequent substance use or misuse or who may have a substance use disorder might be more likely to develop PTSD. Their reasoning is that those who are frequently under the influence of a substance may be more likely to find themselves in situations that could result in traumatic experiences. They may also be more likely to put themselves in dangerous environments or situations in order to obtain certain substances.

3. Susceptibility hypothesis

The third hypothesis is that chronic substance use may actually increase biological vulnerability to developing PTSD after being exposed to trauma. Chronic substance use can cause “increased anxiety and arousal” and often correlates with poor coping skills as well. As a result, an individual may be more at risk for developing post-traumatic stress disorder after a traumatic event than they would have otherwise been.

Seeking help for PTSD and/or substance use issues

It can be helpful to remember that both PTSD and substance use disorders are illnesses that can affect anyone, there’s no shame in experiencing or seeking support for them, and they’re both treatable. While it may be tempting to turn to substances to cope with symptoms of a mental health disorder like PTSD, it’s highly unlikely to meaningfully improve them over time. Instead, meeting with a qualified psychotherapist can be a helpful next step. They can offer you a safe space to tell your feelings about the trauma you’ve experienced and/or how it’s affecting you today, and they can provide you with healthy coping mechanisms so you can manage the symptoms.

Those who feel nervous about speaking with a counselor or who are experiencing feelings of shame related to seeking help may find online therapy to be a more comfortable treatment option. With a virtual therapy platform like BetterHelp, you can join sessions with a licensed therapist via phone, video call, and/or in-app messaging—all from the comfort of your own home or anywhere you have an internet connection. Research suggests that online therapy can “significantly improve” symptoms of PTSD, making it “a viable treatment alternative” to traditional in-person sessions.