Fear is perfectly natural reaction to a traumatic event. The brain and body have defense mechanisms that work to keep us safe by engaging the “fight or flight” response, flooding the body with the hormone corticotropin-releasing factor (CRF), which engages the biological stress response, and endorphins that help to decrease sensations of pain that may be both physical and emotional.
After the trauma is over, endorphin levels drop and feelings of depression may follow in the hours or days that it takes for the natural balance to be restored in the brain. Following the involvement of a traumatic event causing physical harm, the exposure to the threat of bodily harm, or bearing witness to these circumstances, a disruption in the body’s stress response may occur.
What Is PTSD?
Post-traumatic stress disorder, or PTSD, causes people to continually feel fear, and the body may maintain the stress reaction long after the threat of danger has passed. PTSD may have first been brought to the public’s eye by returning war veterans, but PsychCentral reports that almost eight percent of the American adults have experienced PTSD in their lifetime, with women being twice as likely as men to suffer from the disorder. Symptoms of PTSD generally fall into three main categories: avoidance, hyperarousal and re-experiencing symptoms.
Someone with PTSD may have trouble sleeping, difficulties remembering the trauma, flashbacks, anxiety, anger, emotional numbness, guilt, depression, and feel tense and jumpy. The side effects of PTSD may lead someone to turn to drugs in order to cope with these difficult emotions and symptoms.
Substance Abuse as Self-Treatment
Illicit substances, such as alcohol and drugs, can raise endorphin and CRF levels in the brain and body, and they may temporarily mask PTSD symptoms. Chronic abuse of drugs can lead to the initiation of a substance abuse disorder, or addiction, as chemical pathways in the brain are altered. Some of the same chemicals produced by the brain that are found to be related to PTSD symptoms are also involved in addiction.
PTSD is considered a risk factor for substance abuse disorders, and the National Institute on Drug Abuse (NIDA) publishes that between 30 and 60 percent of those battling a substance abuse disorder also suffer from PTSD. The U.S. Department of Veterans Affairs reports that out of the veterans who seek out treatment for a substance abuse disorder, one in three is also diagnosed with PTSD.
When two disorders are diagnosed in the same person at the same time, they are considered co-occurring disorders, and integrated treatment plans that work to treat both disorders simultaneously may provide the highest success rates. Several treatment models and methods work to treat both PTSD and addiction, including medications, psychotherapy and high levels of support from loved ones.
Addiction is a disease manifested by compulsive drug-seeking behaviors and the inability to stop or abstain from drugs regardless of the desire to do so.
Since drugs make chemical changes in the brain, it is often not advised to stop taking or abusing them suddenly or “cold turkey.” This may be especially true for someone also suffering from a co-occurring mental health disorder, such as PTSD, as the brain will naturally attempt to right itself when drugs are removed, which can cause a rebound effect with intense and even dangerous withdrawal side effects.
Emotional symptoms, including depression, anxiety, and irritability, may accompany withdrawal from drugs as well as a return of heightened PTSD symptoms. Physical drug withdrawal side effects can include nausea, stomach cramps, vomiting, diarrhea, runny nose, watery eyes, muscle aches, insomnia, tremors, irregular heart rate, and blood pressure, fever, chills, and seizures.
Detoxification, or detox for short, is the safe removal of drug chemicals from the body. The process often utilizes accompanying medications and 24-hour medical monitoring in a specialized detox facility. The method and duration of detox will depend on the level of physical dependence to drugs as well as the management of any co-occurring mental health disorders. Someone with co-occurring PTSD and drug addiction may require additional medications or supervision during detox. The type of medications used will also depend on the class of drug the person may be addicted to as well. For instance, someone addicted to opioid narcotics may benefit from a partial opioid agonist such as buprenorphine during detox, while someone addicted to benzodiazepine tranquilizers may be best served with a longer-acting benzodiazepine medication.
According to the National Institute of Mental Health (NIMH), there are two FDA-approved medications for the treatment of adult PTSD in America: Zoloft (sertraline) and Paxil (paroxetine), which are both antidepressant medications. Since sadness, depression, and feelings of numbness are symptoms of PTSD, antidepressants are often useful during treatment. Addiction and drug withdrawal symptoms also often include depression, making antidepressant medications a top choice during detox and substance abuse recovery as well.
Benzodiazepine medications may be prescribed as short-term sleep aids or anti-anxiety medications for those suffering from PTSD. However, due to their highly addictive nature, these drugs must be monitored closely if used at all in someone also battling drug addiction. Medications are generally used during PTSD, detox, and addiction treatment as part of a larger and more comprehensive treatment program that will also include mental health treatment and therapies.
Psychotherapy, or talk therapy, can treat both addiction and PTSD by helping to manage symptoms and working through potential pitfalls either in a group or individual setting. Behavioral therapies may be an integral part of addiction and PTSD treatment, and they can be performed on an outpatient basis or as part of a more comprehensive residential program. The following are behavioral therapies and psychological methods commonly used to treat co-occurring PTSD and substance abuse disorders:
- Cognitive Behavioral Therapy (CBT)
- Exposure therapy
- Seeking Safety
- Cognitive processing or restructuring therapy
- Stress inoculation training
CBT is a method that aids in the identification of stressors, or triggers, and modifying negative emotional responses to them. A study published in Addictive Behaviors found that CBT was able to significantly decrease PTSD diagnoses by as much as 80 percent in patients three months post-treatment.
CBT focuses on the interaction between emotions and behaviors. New coping skills and ways for managing stress are taught, generally in group CBT sessions. Individual therapy sessions may focus on personal traumas and how to work through the difficult emotions that may accompany them. Homework may be assigned between sessions. Stress inoculation training is a part of CBT therapy that works to reduce anxiety by teaching patients to react and manage these intense feelings in a healthier manner.
Exposure therapy is a treatment often employed for the treatment of PTSD as a method of handling the avoidance symptoms. Therapists will use tools such as writing exercises or visualization in order to help patients face their fears head-on in a safe environment and learn methods to control them.
Cognitive processing and cognitive restructuring therapies address the sometimes “false” memories that may accompany PTSD, helping patients to make sense of difficult emotions as well as manage the feelings of guilt and shame that may go along with both PTSD and addiction. Experiencing trauma can change the way the brain processes things and in turn may change the way a person views the world. Cognitive processing therapy is a method for learning how to better understand and come to terms with these changes.
Seeking Safety is an integrated treatment program designed specifically to treat substance abuse and PTSD with the ultimate goal of achieving and maintaining safety in relationships, through cognitive behavior patterns and emotional responses. This is an evidence-based treatment model, meaning that empirical research as well as the experience of the medical and mental health professional team are utilized in designing treatment methods. Integrated treatment models for co-occurring disorders ensure that all medical personnel involved in treatment are working together to attain the same end result.
Stress management is an important aspect in the treatment of both PTSD and drug addiction. Learning how to properly handle difficult situations and emotions can go a long way toward avoiding a relapse, or return to drug abuse.
Another piece of the puzzle is ongoing support from family and friends. Couples and families may attend therapy sessions together in order to learn how to improve their relationships and better understand how addiction and PTSD affect them. Educational opportunities ensure that all parties fully understand what to expect with both disorders and what to watch and prepare for during recovery. Peer support, or 12-Step programs, can also be helpful in maintaining sobriety and managing addiction during recovery.
Aftercare treatment generally includes relapse prevention programs for long-term recovery and success. Aspects typically addressed during relapse prevention are proper nutrition, good sleep habits, and healthy levels of exercise. Taking care of the body can help heal the mind and spirit.
Michael’s House offers a full continuum of care to help you or your loved one recover from drug addiction and co-occurring PTSD. Admissions coordinators are standing by to assist you. Call 760.548.4032 today to learn more.