Post-Traumatic Stress Disorder and Addiction
After any terrifying event, such as a natural disaster, military combat, or auto accident, the mind and body need time to recover from the shock and regain a sense of stability. However, some people who survive a traumatic experience do not recover completely. Instead, they are left with memories and emotions that manifest themselves through anger, fear, intense anxiety, and flashbacks to the incident. These symptoms are so overwhelming that they intrude on the individual’s thoughts and interfere with daily activities. Many of these people turn to drugs or alcohol as a way to manage their fears or flashbacks, but substance abuse only worsens the problem.
This condition, known as post-traumatic stress disorder (PTSD), affects up to 8 million people in the United States in any given year, according to the National Center for PTSD. Military members, first responders, civil servants, and other individuals who frequently face violence or injury are especially vulnerable; however, PTSD can affect anyone who has experienced or witnessed a traumatic incident. Identifying the problem and seeking support are the keys to escaping the persistent fear, anxiety, and substance abuse that often characterize PTSD.
What Is Post-Traumatic Stress Disorder?
Post-traumatic stress disorder is a diagnosable mental health condition that is characterized by symptoms that are often intrusive in the person’s life and ability to function on the job, at home, and in relationships with other people. Caused by experiencing or witnessing a life-threatening event (e.g., terrorist attack, physical or sexual assault, natural disaster, war experiences, etc.), a person may be unable to process the event and function without a range of symptoms triggered by memories of the experience.
Why do some people develop PTSD after a trauma, while others live through shocking or frightening experiences without repercussions? People with PTSD usually felt a sense of powerlessness during the event that left them with persistent feelings of fear, anger, and helplessness. After the incident, they may live with guilt, remorse, or rage over not being able to stop the event. For example, adults who were physically or sexually abused as children may continue to have PTSD symptoms for decades after the abuse occurred, notes the organization Adults Surviving Child Abuse.
People who struggle with post-traumatic stress disorder may be so impacted by the event or events that they feel uncomfortable, unhappy, on edge, and/or disconnected most of the time. They may find it difficult to manage simple tasks without unexpectedly rearranging their daily routine in an attempt to mitigate their symptoms. Many struggle with relationships with others, their ability to remain employed, their sense of self and purpose, and substance abuse as a result of the disorder.
“I always thought that PTSD meant panic attacks, essentially just being unable to handle it when anything happened that reminded you of whatever you were trying to forget,” says one firefighter. “But it wasn’t like that for me. I felt nothing – and I mean, nothing. I could barely talk to my wife. My kids would want to play and I just didn’t have the energy. I didn’t have the energy for anything. I couldn’t find the point in anything. Everything just felt hard, like it was a huge effort.”
Who Is Affected by PTSD?
According to the National Center for PTSD, between 7 and 8 percent of the population in the United States will develop PTSD at some point in their lives. In a given year, an estimated 8 million American adults will have PTSD symptoms. This number represents only a small percentage of those who have survived a trauma, but for those who live with this condition, the impact on their lives is enormous.
There is no time limit for PTSD symptoms — the triggering incident may have occurred recently or in the distant past. Adult survivors of child abuse, military veterans, or individuals who lost loved ones to accidents or homicide can be affected by PTSD for decades after the event.
Marianne, a 32-year-old schoolteacher, had to take a leave of absence from her job in order to cope with the repercussions of abuse she experienced as a child. When one of her students was sexually abused by her stepfather, Marianne began to have flashbacks to her own past, which triggered panic attacks. To suppress those memories, Marianne began drinking heavily and using marijuana. Soon she was faced with the choice of going to rehab or losing her job. “I realized that I was still living with a tremendous guilt over not being able to stop him from raping me,” Marianne says. “After all these years, I still felt like I must have done something to provoke him. Now I know that the sexual abuse wasn’t my fault, but it took a lot of work and therapy for me to get to that point.”
PTSD is often associated with feelings of being out of control in a situation that threatens one’s safety or the safety of others. David, a successful loan officer, developed PTSD at the age of 54 after surviving an armed robbery at the bank where he worked. Although he was always in control in his career, he found himself completely helpless and terrified as he watched three of his coworkers shot and fatally wounded. The grief, rage, and guilt that he experienced led him to abuse prescription painkillers and tranquilizers.
“I kept seeing the incident in my mind, over and over again,” David says. “I beat myself up for surviving it, for not being able to save my friends. It got so bad that I almost overdosed on painkillers and alcohol one night. I ended up in the ER, where I talked to a social worker who helped me see that I’d been living with PTSD, and that I didn’t need to suffer anymore.”
PTSD in Military Members and First Responders
While 7-8 percent of the general population experience PTSD, the Veterans Administration estimates that 11-20 percent of military members who took part in Operations Iraqi Freedom or Enduring Freedom developed the condition. Similarly, about 12 percent of veterans who served in the Gulf War struggle with PTSD in a given year. About 30 percent of veterans who served in the Vietnam War are believed to have lived with PTSD at some point in their lives.
The numbers are similar among first responders, according to Clinical Psychiatry News – and the numbers shift dramatically after exposure to a significant trauma. Among New York police officers, the rate of PTSD rose from 7 percent to 24 percent after the terrorist attacks on the World Trade Center on September 11, 2001. Comparatively, the rate of PTSD among police officers in San Francisco at the same time remained level.
Increased exposure to trauma is correlated with an increased risk of developing PTSD; thus, military personnel who are deployed to a combat zone for multiple tours and first responders who work in a high-crime area may be at higher risk.
For first responders and members of the military, the development of post-traumatic stress disorder and addiction to drugs or alcohol often go hand in hand. Routine exposure to traumatic events and life-threatening situations can translate into significant mental health symptoms and, in turn, an increased urge to drink or get high in order to escape those symptoms. Unfortunately, the use of drugs and alcohol is relatively normal in both communities, and signs of a potential problem may go unnoticed until symptoms become severe.
Said one police officer, “We’d meet for a beer after a shift, drink when we were off work, drink at work parties, or going to the game. Drinking was just normal so if one guy or another drank a lot, nobody really saw it as a problem. It was just him, just how it was.”
Drinking to manage difficult emotions, however, is a significant problem, especially when police officers, firefighters, military personnel, and others who are first on the scene in a crisis use alcohol – or other drugs – as part of their process to deal with the trauma they encounter on the job.
When people who are in the business of helping people in crisis are in crisis themselves, the harm caused by PTSD and substance abuse, occurring alone or together, can impact an entire community directly. For first responders and military veterans struggling with symptoms of PTSD and/or drug and alcohol abuse or addiction, the best course of action is early identification and treatment.
Rates of Substance Abuse and PTSD
Drugs and alcohol are often used as a form of self-medication to control the anger, irritability, and fear caused by PTSD. A study published in the European Journal of Psychotraumatology confirms that there is a close relationship between PTSD and substance abuse. In this study, 426 individuals with a substance use disorder were screened for PTSD. The results were then compared with a control group of individuals who did not abuse drugs or alcohol. The study found that 36.6 percent of individuals who abused substances had signs of PTSD, compared to only 10.2 percent of the sober control group.
Rates of substance abuse disorders may be higher among first responders and military members as compared to the general public, given the highly stressful nature of their jobs. In one region, experts estimate that about 25 percent of first responders struggle with substance abuse as a way to cope with the stressors of the job. In another small study, it was found that about 37 percent of participants knew firefighters who had resigned in the two years prior to the study due to problems with alcohol abuse or addiction.
For military members, the numbers are similar when it comes to rates of substance abuse and addiction. One study found that about 39 percent of about 600 veteran participants coming back from Afghanistan or Iraq were living with an alcohol abuse problem, and 3 percent were likely struggling with drug abuse or addiction. In that same study, it was estimated that about 14 percent were living with post-traumatic stress disorder. Another study that looked at more than 650,000 active duty members found that rates of substance use and abuse as well as major depression were increased in this group.
Turning to alcohol and other drugs to escape stress, anger, guilt, fear, and other difficult emotions is not an uncommon response in any population, but among first responders and military personnel, it may serve as an attempt to avoid dealing with the problem.
How Do Drugs and Alcohol Impact Post-Traumatic Stress Disorder?
When struggling with high levels of stress and/or the symptoms of an untreated mental health disorder like post-traumatic stress disorder, many people turn to alcohol or drugs in an effort to calm down and relax, forget the past, and attempt to escape any of the difficult feelings associated with trauma. Though the initial effect may be a sense of relief from symptoms, often drug and alcohol abuse becomes a problem of its own, creating a chronic abuse problem and/or addiction that further infects the person’s ability to function every day.
Veterans very often struggle with both post-traumatic stress disorder and a drug or alcohol abuse problem. According to the US Department of Veteran Affairs, it is estimated that more than 20 percent of veterans who are living with PTSD are also living with a substance abuse disorder. Additionally, about 33 percent of veterans who undergo treatment for a drug or alcohol abuse disorder are also living with PTSD. The VA also noted that binge drinking was a common problem among veterans who were living with PTSD.
“I had nightmares,” said one military veteran. “It got to where I didn’t want to go to sleep at night because I didn’t want to go through [it]. But I needed to sleep, so I would drink and I would drink some more until I would pass out. You don’t have nightmares when you’re passed out.”
Can PTSD Be Prevented?
Identifying and understanding protective factors could inform the development of preventive interventions and increase levels of support among those who may be at higher risk.
A study published in the journal Psychiatry Research found that the following factors assessed during police academy training were associated with lesser rates of PTSD after serving for two years:
- Less exposure to trauma in childhood or prior to service
- Positive sense of self-worth
- Belief that the world is benevolent place
- High levels of social support
- Lesser rates of exposure to trauma on the job
- Better social integration
Though not all of these factors can be controlled, an assessment during training can identify those who may be at greater risk of developing PTSD during the course of their careers. Increased access to support services can help to make sure that if the disorder does develop, individuals will have the treatment they need.
According to researchers, some early signs that may indicate that PTSD may become a problem include:
- Difficulty remaining asleep or falling asleep
- Having a hard time connecting with others emotionally
- Having a hard time being in a crowd
- Struggling with management of angry or emotional responses
- Having a hard time spending time with other people
If it is impossible to prevent PTSD, early identification of PTSD symptoms that leads to early treatment is recommended.
How Does Life Change for People Living with PTSD and Substance Abuse?
Living through a life-threatening event can be life-changing even when it doesn’t result in post-traumatic stress disorder. Sleepless nights, fear, angry outbursts, and wanting to avoid everything and everyone – especially those things that trigger memories of the event – are all normal. When they continue for months on end, however, and begin to make it more difficult to function from day to day, it can become a diagnosable disorder.
Similarly, though it is normal to have a beer every now and then, or drink a glass of wine or two with dinner – and it is even considered normal to occasionally have a few drinks at a time – when chronic, heavy use of drugs or alcohol begins to negatively impact a person’s life, it is time to seek treatment.
“It’s not something that happened overnight – at least not for me. It didn’t feel like it was one particular call that set me off. There were a lot of them that were tough. Some more than others, some that really just got me in my gut and wouldn’t let go. Until I finally realized I wasn’t handling it, I wasn’t handling anything. I was flipping out all the time, always pissed off, and I didn’t know why.”
Some signs that untreated substance abuse and post-traumatic stress disorder can impact a person’s life include:
- Increased problems with people at work
- Arguments or difficulties with a significant other
- Financial difficulties
- Drinking more than intended routinely and/or drinking to excess
- Difficulty keeping up at work or managing commitments
- Disappearing without explanation while on the job
- Extreme mood changes, including shifting from being sleepy to extreme activity
- Frequent physical symptoms that can indicate drug or alcohol use, like chronic nosebleeds, bloodshot eyes, flu-like symptoms, headaches, nausea and vomiting, etc.
What Substances Are Commonly Abused by First Responders and Veterans?
As stated above, alcohol is a common substance of abuse among veterans who struggle with PTSD, especially in the form of binge drinking. Other common drugs of abuse may include:
- Marijuana, either for “medical” use or for recreational purposes
- Prescription painkillers, especially if the veteran or first responder experiences pain due to an injury incurred in the line of duty
- Prescription sedatives, especially if the person is prescribed anti-anxiety medications for the purposes of managing anxiety or panic attack symptoms
- Sleeping pills, especially if the person is prescribed the drugs due to difficulty falling asleep or staying asleep
Says one first responder, “I always had a beer when I watched the game or with the people I worked with after a shift, but a few months after Katrina, I started drinking a lot more. No matter how much I drank, I couldn’t stop the shaking, waking up in the middle of the night and not being able to go back to sleep. I got a prescription for Ambien to help me sleep and one for Xanax for the panic attacks. I was taking them a handful at a time to go to sleep, to deal with the attacks, and drinking on top of it. When they stopped working and I couldn’t get the doctor to give me a higher dose, I drank more and started smoking weed but kept taking the prescriptions. I still had the panic attacks and couldn’t sleep through the night but now I couldn’t stay awake through a shift either or sit down to a normal dinner with my family. I was a mess.”
What Are the Best Ways to Treat PTSD?
Effective treatment for PTSD starts with an evaluation and diagnosis. Though symptoms often begin within three months of the trauma, signs of the disorder may not become an issue for years, making it more difficult to pinpoint the cause without a comprehensive evaluation.
In order to be diagnosed with PTSD, clients must:
- Have a minimum of one re-experiencing symptom
- Have a minimum of one avoidance symptom
- Have a minimum of hyperarousal one symptom
- Exhibit any of the above symptoms for longer than one month to the degree that it makes it difficult to manage at work, attend to daily life, spend time with friends, and have healthy relationships
Once PTSD is diagnosed, comprehensive treatment can and should begin right away. Everyone is different, but many people will require both psychotherapy and medications in order to see long-term progress in treatment. Some aspects of effective treatment may include:
- Cognitive Behavioral Therapy (CBT): Learning how to reframe the triggering event and/or feelings caused by it through talk therapy or cognitive restructuring can help the client to learn how to move forward and manage previously uncontrollable reactions.
- Exposure therapy: A type of CBT, exposure therapy seeks to help the client revisit the trauma through retelling, drawing, writing, and going to the location of the event with the goal of regaining control over the fear and stress caused by the memory.
- Stress reduction: Learning how to lower overall levels of stress and use anxiety-reduction techniques can help the client to manage symptoms and change thoughts about the trauma that may be inaccurate.
- Medication: Zoloft, an antidepressant, and a daytime dose of Minipress for those who already take the drug at night may be appropriate for some clients seeking treatment for PTSD. Other medications are being studied for use in the treatment of PTSD, including propranolol, a beta blocker, and D-cycloserine.
- Holistic treatment options: Yoga, meditation, nutritional therapy, exercise management, acupuncture, and other holistic measures may be helpful in managing stress experienced after a trauma and can help to manage PTSD symptoms.
- Treatment for co–occurring disorders: If substance abuse is a problem, as it often is for those living with PTSD, treatment will be most effective when it includes care for any co-occurring substance abuse issue. Detox may be necessary in some cases. Therapy, as well as group support for continued sobriety, is essential, as ongoing use of drugs or alcohol can exacerbate symptoms related to PTSD.
- Aftercare and support: Acute care in the initial weeks of treatment will include a heavy focus on therapy and ongoing medical monitoring to find the right dosage and combination of medications for stabilization in recovery. Following treatment, it is important for clients to continue to engage in ongoing support and aftercare in order to manage medications, address any new challenges that arise, and continue to make progress in keeping PTSD symptoms from intruding on the person’s daily life.
How Is Substance Abuse Best Treated?
Each person has unique experiences that led to the abuse of drugs and alcohol, and that substance abuse problem will in turn create a host of varied issues and consequences in the person’s life. The unique nature of each person’s experience requires that any effective substance abuse program offers a fresh eye and thorough diagnosis for each client. This ensures that each person who walks through the door experiences a unique treatment plan made up of services that will directly address individual issues.
In addition to unique and personalized treatment that begins with a thorough diagnostic and evaluation process, comprehensive drug or alcohol abuse disorder treatment should also provide:
- Medical detox: The cessation of use of many drugs and high amounts of alcohol can result in withdrawal symptoms in the first days and weeks of recovery. Medical detox is necessary to ensure safety during this time and to help the client to swiftly move from active drug use to stability in sobriety.
- Pharmacotherapies: Some medications are recommended in certain situations, depending upon the drug of choice, underlying medical conditions, and co-occurring mental health disorders, like PTSD. Identifying the best possible medications and adjusting the doses can take time, and this should be a priority.
- Behavioral therapies: Learning how to avoid relapse is a big part of the focus during rehab, as is processing through the issues, perspectives, and experiences that may be contributing to the drive to continually drink or use drugs despite the negative consequences. This can be accomplished through a range of different therapies chosen based on the needs of the individual person.
- Aftercare services: Long-term support is recommended in recovery from any chronic illness, and addiction and substance abuse disorders are chronic in nature. Ongoing connection to a recovery community as well as the therapist that proved most effective during rehab can help to ensure the client has the support necessary to remain sober for the long-term.
What Are the Success Rates of Treatment for PTSD and/or Substance Abuse?
There is quite a bit of research into post-traumatic stress disorder and substance abuse treatment, together and separately, as well as a range of research-based treatment methods that are both therapeutic and pharmacological in nature. Specific to first responders, there is a large body of research dedicated to understanding the following related to PTSD in this population:
- Risk factors for the development of PTSD
- How symptoms first begin and unfold
- The course of the disorder as it progresses and potential outcomes in terms of function
- Co-occurrence of other disorders in addition to PTSD
There are, however, no in-depth and comprehensive studies specifically on the treatment of first responders for PTSD, according to a report published in the July 2012 issue of the journal Clinical Psychology Review.
Though there is no cure for post-traumatic stress disorder or for substance abuse and addiction, there are numerous research-based treatment options that have proven effective in managing each issue. With the right support, a strong start in professional treatment, and ongoing support in the community and from the psychological and medical communities, clients can learn how to avoid relapse and enjoy long-term recovery.
Will Seeking Treatment Negatively Impact the Careers of First Responders or Enlisted Military Members?
There is some concern among first responders and enlisted military members that to admit to experiencing symptoms of PTSD would be to also admit to being unfit for duty. The fear is that this would potentially bring negative repercussions in terms of advancement and duty schedules. Though a great deal of effort has been put forth into educating the public about what first responders and military face in the line of duty, and some progress has been made, a report published in the International Journal of Emergency Medical Health supports the notion that in some cases, first responders and military who seek support and assistance for PTSD may have to deal with stigma and prejudice as well as discrimination due to the ignorance of others.
Great efforts are being made in not only making sure that first responders and military who suffer from PTSD symptoms understand the nature of what they are experiencing and why, and have access to treatment, but also that others fully understand the nature of the disorder and that treatment can help people living with the disorder to manage their symptoms and be fully functional at work. Increased education efforts in the community and in the workplace, and increased access to treatment, can serve to decrease stigma and encourage those who would benefit from treatment to get the help they need.
Health Is a Priority
Regardless of concerns about seeking treatment, one thing is undeniable: Avoiding treatment when it is necessary will only mean continuing to struggle with post-traumatic stress disorder and addiction.