Coming Through the Storm: Stopping the Cycle of PTSD and Addiction
Trauma rattles your world, and replaces the daily and mundane with the terror of the unknown. Long after the initial event, post-traumatic stress disorder (PTSD) invades the cracks of your brain, and shades the world in black and red. Many people understandably try to dull this heightened new world with alcohol or other drugs. However, in many cases all that does is add addiction to the pain of trauma.
PTSD and addiction problems have consistently been linked together in connotation and anecdote, and increasingly through clinical trials. In fact, one study found that 40 percent of inpatients receiving treatment for substance abuse also met criteria for PTSD.[1. DANSKY, B.S.; ROITZSCH, J.C.; BRADY, K.T.; AND SALADIN, M.E. Posttraumatic stress disorder and substance abuse: Use of research in a clinical setting. Journal of Trauma and Stress 10:141–148, 1997] Society has developed techniques for understanding and treating PTSD, as well as substance abuse. However, psychotherapy approaches for co-occurring PTSD and addiction are less well developed and not as universally applied.[2. American Journal of Psychotherapy, Vol. 60, No. 4, 2006 335 AJP Friedman, 2001.]
PTSD, Addiction, and Uncontrollable Trauma
PTSD in conjunction with alcoholism is most commonly connoted with the image of combat veterans who return home and resort to nursing their internal battle scars with drugs and alcohol. Although post-combat PTSD comorbid with alcoholism is indeed prevalent, many victims of domestic or sexual abuse also develop PTSD co-occurring with alcoholism. In particular, women exposed to childhood rape often report turning to substance abuse and alcoholism as a way to self-medicate the PTSD following their trauma.[3. EPSTEIN, J.N.; SAUNDERS, B.E.; KILPATRICK, D.G.; AND RESNICK, H.S. PTSD as a mediator between childhood rape and alcohol use in adult women. Child Abuse and Neglect 22:223–234, 1998. FOA, E.B., AND ROTHBAUM, B.O. Post-trauma]
Because the scars of PTSD often manifest behaviorally and in many iterations, they can be difficult to recognize and diagnose at first. This is especially true in non-combat cases of PTSD, where friends or family are less aware of the victim’s history of trauma.
According to the American Journal of Psychotherapy in 2006, PTSD is diagnosed based on the presence of three main symptoms:
- intrusive re-experiencing (unwanted trauma memories, reminders, and flashbacks)
- avoidance of reminders of past trauma and emotional numbing
- hyperarousal and hypervigilance
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Learned Helplessness: The Internal “Why Not?” Narrative of Substance Abusers
A person can experience two kinds of trauma: controllable or uncontrollable trauma. The grouping of symptoms that follow experience with uncontrollable trauma is called “learned helplessness effects.”[4. SELIGMAN, M. Learned Helplessness: On Depression, Development, and Death. San Francisco: W.H. Freeman & Co., 1975.]
Learned helplessness is a symptom of a wide swath of psychological disorders, from depression to PTSD to personality disorders to substance abuse and reckless behavior. It feels to the victim that they have no agency in the world—that their actions are of no consequence.
When a person experiences trauma from the world that feels uncontrollable, it triggers or exacerbates this feeling of having no agency or control: resulting in the victim dissociating from the narrative of their life, making poor choices, and instigating a self-destructive pattern of behavior. “Why not?” is a problematic internal narrative for the PTSD victim whose helplessness blossoms into a destructive emotional cycle that relies on substance abuse.
Another characteristic that denotes cases of PTSD is avoidant behavior. Although everyone can have periods of introversion, avoidant behavior is recognizable by severe emotional numbing and social detachment. A PTSD victim with avoidant symptoms might have difficulty understanding or expressing their emotions, especially those such as close friendship and intimacy. This can be difficult for loved ones, to feel that their friend or spouse is distant and incapable of vulnerability and trust.
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Building Trust and Starting on the Road to Recovery
Living with someone who is caught in the volatile cycle of PTSD and addiction can be emotionally exhausting—the emotional flux and substance abuse can seem random and confusing. Additionally, PTSD is often overlooked at treatment facilities, where the focus may be treating the more “surface” problem of substance abuse. However, it’s important for both family members and treatment facilities to understand and address the interrelation of the afflictions. In fact, left unchecked, PTSD can interfere with the substance abuser’s recovery by keeping them locked in an emotional cycle that makes them feel dependent on drugs and alcohol.
By working to understand the emotional cycle that correlates to PTSD and substance abuse, families and therapists can work toward a personalized, synthesized treatment for their loved one’s comprehensive well-being.
Alta Mira is an addiction recovery program which specializes in co-occurring mental health disorders such as PTSD. If you or a loved one are suffering from the combined weight of PTSD and addiction, please reach out to us today.