By: Billie Sterling-Lewis
June is PTSD Awareness Month in the United States. June 26 is also the International Day Against Drug Abuse and Illicit Trafficking. With these two important observances taking place this month, it is fitting to examine the connection between Post-traumatic Stress Disorder (PTSD) and Substance Use Disorders (SUDs).
There appears to be a strong bidirectional relationship between PTSD and SUDs. The World Health Organisation (WHO) notes that approximately 70% of the global population will experience a traumatic event in their lifetime, while about 6% will develop PTSD. PTSD is a mental health condition that may develop after witnessing, directly experiencing, learning about, or having repeated exposure to a traumatic event. These events may involve actual or threatened death, serious injury, or sexual violence.
PTSD is commonly comorbid with substance use disorders, as many persons living with PTSD use substances to cope with the emotional and psychological effects of trauma. The reverse is also true. Not only do some people use substances to cope with trauma, but individuals with substance use disorders also appear to be at a greater risk of experiencing single or repeated traumatic events. This co-occurring diagnosis disproportionately affects women more than men.
Some of the most common forms of trauma associated with PTSD include loss and grief, sexual and physical abuse, natural disasters, and military trauma. Trauma and PTSD can present differently from person to person, but what often remains consistent is a disruption in one’s sense of safety and emotional regulation. Therapists frequently observe symptoms such as anxiety and hypervigilance, sleep disturbances including nightmares, flashbacks, emotional and relational dysregulation, irritability, avoidance behaviours, and chronic emotional pain.
For many people, symptom reduction becomes the main reason for the introduction to, or continuation of, substance misuse. Individuals with unresolved trauma may use psychoactive substances to alleviate emotional pain, reduce mood disturbances, improve sleep, and escape distressing memories. Due to their psychoactive effects on the brain, many substances can temporarily produce the desired relief, whether through chemical effects or perceived emotional relief.
Unfortunately, this temporary relief can reinforce substance use behaviours and create the illusion that healthier coping strategies require more effort and consistency to achieve the same level of comfort. Over time, the brain begins to associate substance use with relief from trauma symptoms. This reinforcement
creates a deceptive cycle in which trauma-related thoughts, feelings, and behaviours continue to fuel substance misuse, while the misuse itself further reinforces the underlying trauma symptoms.
On the other hand, substance use disorders can increase the likelihood of exposure to traumatic experiences through impaired judgment, unsafe environments, violence, accidents, and interpersonal conflict. As a result, trauma and substance misuse often become deeply interconnected and self-perpetuating.
What does this mean for treatment? In treatment, comorbid PTSD and SUDs are not viewed as one condition being more important or more severe than the other, but rather as different sides of the same coin. Older schools of thought suggested that therapists could not address PTSD until substance use was first managed. We now understand this differently. PTSD and SUDs often require a multidisciplinary and integrated approach to treatment. Addressing these complexities begins with understanding the client on every level and recognising how trauma and substance use interact within their lived experience.
When seeking help for substance use disorders, exploring one’s trauma history can be beneficial. Recovery and post-traumatic growth are possible. With consistency, patience, support, and the appropriate therapeutic approaches, individuals can experience a reduction in PTSD symptoms and relapse triggers, making long-term recovery and maintained sobriety feel more attainable.