Don’t Fight This Battle Alone: PTSD and Addiction

PTSD used to be known, somewhat derisively, as “shell shock,” and people cruelly thought it was a mental disorder, even a sign of weakness. We know that it isn’t. It is a physical and chemical reaction to trauma, involving the whole body. This reaction is a normal result of being traumatized, and people get it for brief times depending on the situation — but what happens when that response doesn’t go away? That “fight-or-flight” response becomes a danger to a person’s physical and mental health.

PTSD is isolating. The DSM-V states that the following criteria are present in cases of PTSD:

• A Stressor: You experienced something that would pierce the psychic armor of any person. It’s difficult for us to imagine some of the horrific things that can happen in this world — to witness extreme violence or death in war, or to be faced with the kinds of situations that first responders deal with every day. Perhaps you were seriously injured or thought you were going to die, or you were sexually assaulted. It’s the wounds you can’t see that are the hardest to heal.

• Intrusion Symptoms: Your spouse tosses and turns all night because there is no rest in sleep when your nightmares replay the trauma and you can’t find the off button. Other nights, they pace the floor because they can’t sleep. Daylight isn’t a reprieve, when flashbacks or disturbing thoughts continue to follow them around. That’s one reason they may have turned to drugs or alcohol.

• Avoidance: Your loved one refuses to talk about their trauma. They say they want to protect you from the details, and they do, but it is also a coping mechanism that doesn’t work. Your family member was in a bad car accident and has developed PTSD driving phobia, and now he even refuses to get into a vehicle.

• Negative Alterations in Cognitions and Mood: He says he doesn’t remember what happened. Maybe he doesn’t, because his own mind is protecting him, or it’s because he is in a blackout from drinking the memories away. When you talk to him about it, he gets angry. Your daughter feels like the sexual assault was her fault. She can’t talk to you about it because she feels shame. Your loved one was the light of your family. Before. He or she was the life of the party, the one laughing in your home videos, and now this person is someone you don’t know. The optimist becomes a pessimist, but it is the disorder talking. The person you know is still there; their light is just shadowed by trauma.

• Alterations in Arousal and Reactivity: The sound of a car backfiring sends a big, strong man cowering in the corner because it brings back memories of his tour of duty. Your sister always has to keep an eye on every exit, and cannot focus on the project at hand. Their trauma has them constantly on alert, unable to relax or concentrate on what’s in front of them.

• Duration: You thought she would feel better by now, but she’s still sleeping all day, and her uniform has become a pair of torn sweatpants and a moth-eaten sweater. It’s been three months, and your husband seems to have turned into Dr. Jekyll and Mr. Hyde. He yells at the kids. He smacked his beloved dog, and your former loving relationship has become a desert. He may have carried people out of burning buildings on his strong shoulders, but this burden is a different kind of heavy.

• Functional Significance: She had big plans to start her own business. He wanted to coach his son’s little league. Now, they rarely leave the house. They refuse to come downstairs when you have company. Family dinners are minus one because your loved one isn’t hungry, or eats alone in front of the TV. Who they are is buried under the rubble of PTSD, but you can help them find who they were and bring them back with the help of caring, empathetic experts.

• Exclusion: Your loved one was a healthy, stable person before PTSD. Your doctor says there are no underlying conditions prior to the trauma. They are now using alcohol or drugs to self-medicate, when they really need a holistic treatment plan to help them deal with the trauma and the addiction.

While PTSD is not caused by substances, the anxiety it causes can often lead to substance abuse. One scientific study on PTSD and alcoholism found that when we experience trauma, our endorphin levels are kicked up to help deal with the stressful emotions, by basically numbing them. After the trauma, when endorphin levels settle back, our bodies actually go through a kind of endorphin withdrawal. But alcohol also increases endorphins, so it’s a place many turn to when trying to get back to that state of endorphin-fueled numbness, until addiction now becomes a problem as well. Addiction, coupled with PTSD as co-occurring disorders, will weave together to create a knot of psychic and physical challenges that can only be unraveled by treating both at once.