What you need to know about the relationship between PTSD, trauma, and substance abuse

Posttraumatic stress disorder (PTSD) and addiction are two very different challenges that are sometimes experienced at the same time. People are often curious about the ways that these two struggles overlap.  There are actually several ways that PTSD and substance use go together.

Substances as a solution

People who have PTSD struggle with anxiety and fear, isolation, and sleep difficulties.  Substance use can, understandably, seem like a solution.

Using alcohol might help someone who feels on guard all the time to be able to relax.  Benzodiazepines or marijuana might be used to help individuals who suffer from trauma to fall asleep.  People with PTSD may use substances to avoid thoughts, feelings, or memories associated with the traumatic event.

Research suggests that the relief from substances is short-lived and does not permanently improve the experience of individuals with PTSD, even if it does provide some temporary aid.  In fact the reality is quite the opposite – avoiding symptoms actually helps to maintain the symptoms of PTSD in the long run. The more that trauma-related thoughts and feelings are avoided, the worse symptoms become.

PTSD often leads to negative views of other people or the world, and as a result people with PTSD sometimes feel quite disconnected from friends and family. Using alcohol or other substances may seem like a good way to temporarily suspend those negative beliefs and connect with others.  Again, although using substances may temporarily help someone feel the connection to others that they’re craving, this is not a permanent solution and there are often unintended side effects that wreak havoc in their lives.

Substance abuse sometimes causes trauma

Substance use can, unfortunately, lead to further trauma.

Substances themselves can have effects that can be traumatic, for example a terrifying acid trip or an accidental overdose.  In a similar way, when people are under the influence of substances, their inhibitions are lower and so they are more likely to get into situations where traumatic events occur.  It’s common for people who are under the influence of substances not to feel the full impact of the trauma until later.

It’s important to note that it is less common for substance abuse to lead to trauma; much more often individuals have traumatic experiences and then begin using substances as a way to cope.   They may then be more susceptible to those additional traumatic experiences for a number of reasons, including environmental factors and reduced inhibition when under the influence.

Treatment solutions for both PTSD and substance abuse

When considering the co-occurrence of PTSD and substance abuse, it makes a lot of sense that these disorders go together.  Substance use promises quick relief from pain, and the pain of trauma can sometimes seem intolerable.  However, using substances rarely provides any kind of long term relief and can have a number of negative consequences.

The good news is that a number of effective treatments for co-occurring PTSD and substance abuse have been developed and there are specialists who are trained to help.  Treatment with a qualified professional is a critical part of healing and creating the life that those who suffer from trauma and substance abuse desire and deserve.

If you or someone you love is currently struggling, contact our office today to schedule an initial assessment.

Vulnerability and Recovery

Because I work with people who struggle with addiction, I am particularly attuned to the ways that the public perceives people struggling with addiction and in recovery.  Too often, media portrayals of addiction dramatize or glamorize addiction in unrealistic ways.  These images contribute to a negative perception of addiction and recovery and lead to misunderstandings, fear, and stigma.

In my work, I’ve had the fortune to witness and be inspired by some of the many people who stop using alcohol or drugs each year. Based on this experience, I want to propose an alternative perspective on addiction — that most of us share a lot more experiences with folks struggling with addiction than we realize.

Think of a habit or behavior that you know is not so good for you or gets in the way of who you want to be.  This might take the form of a (more) socially approved of “addiction”.  Things like

  • chocolate,
  • shopping,
  • TV,
  • texting,
  • cell phone games

Have you ever tried to change that behavior?  Was it easy?

Have you noticed what happens when you start entertaining changing a habit?  If you are anything like me, your first thoughts might be something like “I could change if I wanted to,” and “it’s not a good time to change because…”  The truth is that changing is hard and would require being willing to experience a whole lot of difficult feelings and thoughts.

I experienced this recently when I quit eating sugar a few months ago.  For ten days I couldn’t concentrate, my emotions felt extreme and unpredictable, and my body ached in places that had not ever been injured.  I experienced triggers, urges, cravings – the whole nine yards.  I felt extremely sensitive, like a buffer between me and the difficult things that happen in my life had been removed. In the process of making this change, I encountered my own vulnerability.

In her now famous Ted Talk, Brene Brown talks about how she didn’t choose just one substance to retreat into to protect her from vulnerability, she used a failsafe combo: a couple of beers and a banana nut muffin.  Many of the behaviors that we do routinely may protect us from having to experience our own vulnerability.  But our vulnerability is a part of our humanity – and part of what connects us to each other. 

My admiration for folks in recovery comes from their willingness to experience their vulnerability in order to make a change.  Recovery usually involves giving up something that, at least at some level, feels like it keeps you safe and protected. Often it requires making changes to relationships, to daily routines, and to the things we use for comfort.  As if that weren’t vulnerable enough, it sometimes means making amends to people that you harmed in the past.  In my experience, recovery requires a courage of heart that is rarely required of most of us. 

Now I am aware that experiments in vulnerability, like choosing to give up sugar, TV, or your cell phone, or making other changes that disrupt our sense of safety, do not capture the experience of overcoming addiction. My intent is not to make light of the experience of addiction or recovery.  It is to suggest that making changes is hard for all of us and that we have more in common with those who struggle with addiction than we may realize.  In fact, I often think that stigma and judgements about others, including people who struggle with addiction, may be a way to distance ourselves from vulnerability. Unfortunately, this also restricts our connection to our humanity.

The truth is all of us humans experience very unpleasant sensations and feelings when we change our behavior — there is no permanent way to keep us safe from that.  We all have vulnerabilities we might prefer to avoid.  By noticing the ways in which we defend our vulnerability, we increase our empathy and humanity, and may even find a little of the courage of recovery in our own lives.

A Call for More Services for Families with Loved Ones with Serious Mental Illness

With all the talk about healthcare reform and budget cuts to healthcare programs, my colleague, Jerome Yoman, PhD, and I were inspired to write an editorial about the need for more family services for The Oregonian, our local newspaper. We just found out that the editorial was published in the April 10, 2012 edition!

You can read the editorial by clicking on the linked title below:

Plans for Treating Mental Illness Should Encourage Family Involvement

-By Christeine Terry, Ph.D.

What Questions to Ask When Looking into Addiction Treatment

In late February the National Institute on Drug Abuse (NIDA), a government agency dedicated to studying addiction, published a free resource on what to ask when looking into addiction treatment programs. This short booklet, which can be viewed online or downloaded for free, lists 5 questions to ask any addiction treatment provider you are considering seeing and offers the reasons why it is important to ask these particular 5 questions. As part of the description of their reasoning the booklet’s authors provide useful information about the types of available addiction treatments, as well as the important elements of effective addiction treatments. In looking over the booklet I began to think about additional questions that might be helpful to ask when pursuing addiction treatment. In no particular order, here are the:

Additional questions you may want to consider. 

  • What is the treatment philosophy or model? Many programs include or heavily emphasize the 12 steps (AA, NA) approach. Although the 12 step model can be very helpful to people in recovery, it may not be the best fit for some. If you are not a fan of the 12 steps, be sure to ask if there are alternative programs available (e.g., SMART Recovery).

  • What resources are available after treatment ends? Check to see if the treatment program offers monthly groups or other services once the intensive phase (i.e., the phase where you participate in treatment frequently) is over. As stated in the booklet, treatment needs to be long enough to work; research suggests that a minimum of 3 months of treatment is needed for many people to stop or decrease drug/alcohol use. This does not mean that you need 3 months of inpatient treatment (i.e., you live at a facility where you receive treatment), but it does mean that you may need to stay in some type of treatment, whether it’s weekly group meetings, one-on-one meetings with a therapist, etc., for at least 3 months. When looking into treatment programs, be sure to ask what treatment is available after the intensive phase is complete to make sure you have the resources you need to be successful.
  • What about family or couples therapy? The booklet briefly mentions that family therapy may be needed as part of treatment, but if you are looking for or think you may need family or couples therapy be sure to ask about them directly. You may be wondering why you would need family or couples therapy. When a person is addicted to drugs or alcohol it not only affects the person, but the person’s relationships with his/her family or partner. Many family members and partners have learned how to relate to their loved one when he/she was addicted; it can be quite difficult to learn how to relate to a loved one when he/she is sober. Some family members feel at a loss as to how to best support their loved one’s sobriety, or worse, they may unknowingly interact with their loved ones in ways that are detrimental to their loved one’s recovery. This does not mean that family members cause loved ones to use! The choice to use still resides with the person who uses, but family members can be positive or negative influences in a person’s path to recovery (one type of therapy that works with family members and partners to be allies in their loved one’s recovery is called Community Reinforcement and Family Training (CRAFT). CRAFT is a highly effective treatment for family members and for people with addictions). Family and couples therapy can help family members and partners heal from their loved one’s use and to learn new, supportive ways of interacting with their loved ones while they are recovering.
  • Depending on your needs, you may need to ask about:
    • Whether the program will meet requirements for assessment and/or treatment that is court-ordered (e.g., DUII).
    • Assistance with job placement, housing, or other needs.
    • Spiritual services. Does the treatment program offer the opportunity to continue with your spiritual practices?
    • Insurance and payment options.

Of course, the above is not a complete list of questions to consider, but hopefully it helps you start thinking about what your own unique needs may be and what questions you want answered before committing to treatment.

Finding the right treatment can be difficult, but knowing your needs and the types of questions to ask, can put you on the path to finding the treatment program that will work best for you.