PTSD Flight to Freedom

Breaking the Cycle: Treating PTSD and Substance Use Disorder Together

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MotionMechanic
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Introduction

Post-Traumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) frequently co-occur, with nearly 50% of individuals with PTSD developing substance abuse issues at some point in their lives (Roberts et al., 2015). Many trauma survivors turn to alcohol or drugs as a coping mechanism to numb distressing memories, manage anxiety, or escape emotional pain. However, substance use can worsen PTSD symptoms over time, leading to a cycle of addiction and trauma-related distress.

Traditional addiction recovery programs often do not address underlying trauma, while many PTSD treatments fail to consider how substance use complicates healing. Integrated treatment models that address both PTSD and addiction simultaneously have been found to be the most effective (Hien et al., 2010).

This blog post explores why PTSD and substance use are so closely linked, how addiction worsens trauma symptoms, and the best evidence-based approaches for treating both conditions together.

The Link Between PTSD and Substance Abuse

Trauma survivors who develop substance use disorders are often self-medicating PTSD symptoms rather than using substances recreationally (Jacobsen et al., 2001).

Common PTSD symptoms that lead to substance use:

  • Intrusive memories and flashbacks → Alcohol or sedatives to “turn off” memories.
  • Hyperarousal and anxiety → Marijuana or benzodiazepines to calm nerves.
  • Emotional numbness and depression → Stimulants or alcohol to “feel something.”
  • Sleep disturbances and nightmares → Sleeping pills or heavy drinking before bed.

While these coping strategies provide short-term relief, they ultimately reinforce PTSD symptoms and create dependence on substances to function (Khoury et al., 2010).

How Substance Use Worsens PTSD Symptoms

While many trauma survivors turn to substances for relief, long-term substance use can actually make PTSD symptoms worse (Chilcoat & Menard, 2003).

1. Increased Emotional Dysregulation

  • Drugs and alcohol interfere with the brain’s ability to regulate emotions, making trauma responses more intense when sober.

2. Impaired Trauma Processing

  • Many PTSD treatments, such as Cognitive Processing Therapy (CPT) and EMDR, require emotional presence. Substance use disrupts memory processing and can delay healing.

3. Increased Risk-Taking and Re-Traumatization

  • Individuals with PTSD and SUD are more likely to engage in dangerous behaviors (e.g., high-risk sexual activity, unsafe environments), increasing the risk of further trauma.

4. Withdrawal Symptoms Mimic PTSD

  • Symptoms like panic, insomnia, and irritability in withdrawal mirror PTSD symptoms, making it difficult to distinguish between the two conditions.

Without proper treatment, PTSD and addiction reinforce each other in a destructive cycle, making long-term recovery more difficult (Ouimette et al., 2000).

The Best Approaches for Treating PTSD and Substance Use Together

Because PTSD and SUD are so closely linked, the most effective treatments integrate both conditions instead of treating them separately (Hien et al., 2010).

1. Trauma-Informed Addiction Treatment (Seeking Safety Model)

One of the most well-researched models for treating co-occurring PTSD and addiction is Seeking Safety, a therapy developed by Lisa Najavits (2002).

Key elements of Seeking Safety:

  • Focuses on present-day coping skills rather than revisiting traumatic memories too soon.
  • Teaches survivors how to self-soothe without using substances.
  • Uses cognitive behavioral strategies to challenge negative thought patterns.
  • Incorporates mindfulness and grounding techniques to manage PTSD symptoms safely.

Why it works:

  • Helps survivors feel safe and stable before diving into deep trauma work.
  • Reduces risk of relapse by replacing substances with healthy coping mechanisms.

2. EMDR for PTSD and Substance Cravings

Eye Movement Desensitization and Reprocessing (EMDR) is a leading therapy for PTSD. It has also been successfully used to treat substance cravings and addiction triggers (Hase et al., 2008).

How EMDR helps with PTSD and addiction:

  • Reprocesses traumatic memories so they no longer trigger avoidance behaviors.
  • Targets addiction cravings by identifying trauma-related urges to use substances.
  • Interrupts the connection between substance use and trauma relief.

Example:
A veteran who drinks to avoid combat nightmares may undergo EMDR to process the original trauma, making the need for alcohol less compelling over time.

3. Mindfulness-Based Relapse Prevention (MBRP)

Mindfulness-Based Relapse Prevention (MBRP) is an evidence-based therapy that helps trauma survivors break the cycle of automatic substance use (Bowen et al., 2014).

Key components of MBRP:

  • Mindfulness practices to create space between urges and actions.
  • Self-compassion techniques to reduce shame and self-judgment.
  • Breathwork and grounding to regulate emotional distress without substances.

Why it works:

  • Disrupts the automatic urge to self-medicate PTSD symptoms.
  • Helps individuals tolerate emotional discomfort without reacting impulsively.

Example:
A domestic violence survivor who drinks when triggered by loud voices might use breathing techniques to ground themselves instead of reaching for alcohol.

Key Takeaways

  • PTSD and substance use disorders frequently co-occur, with many trauma survivors using drugs or alcohol to self-medicate.
  • Substance use worsens PTSD symptoms, leading to emotional dysregulation, impaired trauma processing, and a higher risk of re-traumatization.
  • Integrated treatment models like Seeking Safety, EMDR, and Mindfulness-Based Relapse Prevention offer effective ways to treat both conditions simultaneously.
  • Healing from trauma does not require substances—recovery is possible with the right coping strategies and professional support.

Conclusion

PTSD and addiction reinforce each other in harmful ways, but breaking free from the cycle is possible. By using evidence-based approaches that treat both conditions together, survivors can develop healthier coping mechanisms and regain control over their lives.

If you or someone you know struggles with PTSD and substance use, seeking professional help through trauma-informed addiction treatment can be a life-changing step toward recovery.

References

  • Bowen, S., Chawla, N., & Marlatt, G. A. (2014). Mindfulness-Based Relapse Prevention for Addictive Behaviors: A Clinician’s Guide. Guilford Press.
  • Chilcoat, H. D., & Menard, C. (2003). Epidemiological investigations: Comorbidity of PTSD and substance use disorder. The Psychiatric Clinics of North America, 26(1), 91-103.
  • Hien, D. A., Cohen, L. R., Miele, G. M., Litt, L. C., & Capstick, C. (2004). Promising treatments for women with comorbid PTSD and substance use disorders. American Journal of Psychiatry, 161(8), 1426-1432.
  • Hase, M., Schallmayer, S., & Sack, M. (2008). EMDR reprocessing of the addiction memory: Pretreatment, posttreatment, and 1-month follow-up. Journal of EMDR Practice and Research, 2(3), 170-179.
  • Najavits, L. M. (2002). Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. Guilford Press.
  • Roberts, N. P., Roberts, P. A., Jones, N., & Bisson, J. I. (2015). Psychological therapies for post-traumatic stress disorder and comorbid substance use disorder. Cochrane Database of Systematic Reviews, 2015(4).

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