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.

It’s Not Your Fault: How the Mind Copes with Abuse by Someone Close to you

If you have been hurt by someone close to you, it’s likely you are bothered by feelings of shame. Maybe you find that it is hard to stop beating yourself up over small mistakes you make. Maybe you can’t stop thinking about the way you look to other people. Maybe you feel bad about yourself and you are not even sure why. Just because you feel shame doesn’t necessarily mean that you have done anything wrong or that there is anything wrong with you.

Research on Betrayal Trauma has found that if you have been abused by someone you are close to or depend on, you may be affected in particular ways. One way you might be affected is that you may feel a lot of shame . When you feel shame, you may focus on beliefs that you are bad or flawed, rather than noticing that someone is hurting you. In addition to feeling shame, people who are hurt by someone close to them are also more likely to forget that the abuse happened or “dissociate” or feel spacey. Forgetting, spacing out, and feeling shame may all be different ways in which your mind tries to protect you from knowing about abuse, or at least knowing how bad it is or was.

Why would your mind keep you from knowing?

People who are in danger will sometimes try to get away from the thing that is causing them danger, or maybe try to fight it. However, if you really need the person who is hurting you, for example if they are helping to raise your children or they are paying your bills, you are in a bind. If you fight or flee, you might lose those resources. In addition, if the person is violent, then fighting or fleeing might result in more violence and harm. As a result, sometimes your mind can simply block you from even knowing about the abuse to protect you from further harm. Or you might know that something feels bad, but make sense of it by telling yourself there is something wrong with you instead of recognizing that it is the other person who is doing something harmful.

You may also feel shame because of ways the abuser acts toward you. Dr. Jennifer Freyd, an expert on betrayal trauma, came up with an acronym called DARVO, which stands for “”Deny, Attack, and Reverse Victim and Offender.” What that means is that the person who is hurting you may make you believe that you are the one doing the hurting and they are the one being hurt. They may ​deny that the abuse ever happened or even say something like​, “You are the one who is hurting me by saying that I hurt you.” This response makes things even more confusing and causes more shame and not knowing.

If you have experienced abuse and had periods of shame and not knowing, your mind may have been trying to protect you from further harm. At the same time, shame and not knowing may cause problems in other parts of your life and may keep you from finding resources that could help you be safer. With the support of resources like domestic violence centers, hotlines, safe friends and family, and/or a trusted therapist, you can learn to recognize when you are feeling shame even though you’ve done nothing wrong. You can notice, “Oh, this is shame I’m feeling. It’s telling me I’m no good but I don’t have to listen to it.” Then, with the help of your support system, you will have ​more​ power to decide what works for you.

I know it can be hard to reach out for help, but reaching out can be a very powerful step in the process of healing from trauma and shame. If you are in the Portland area and ready for some support, feel free to contact me at Portland Psychotherapy, or take a look at some of these resources:

Local Oregon resources for adult survivors of child abuse and for survivors of domestic violence:




National/International resources:

Psychotherapy Changes the Brain, Too: A Look at PTSD Treatment

It has become fashionable nowadays in psychotherapy circles to talk about neuroscience and interventions that target the brain. Some writers refer to this bias as “neurocentrism,” the notion that our behavior is best explained by locating it in the brain.

There’s a treatment for posttraumatic stress disorder (PTSD) called Eye Movement Desensitization and Reprocessing (EMDR) that anticipated this trend 20 years ago by using gimmicky neurological language as window dressing to sell the idea that it uniquely effects the brain. This marketing has been really effective, as EMDR has become a well-known “brand name” treatment even though there’s no evidence it’s more effective than other trauma-focused approaches. What people don’t often realize is that psychotherapy has always impacted the brain because making changes in how we think and behave affects the brain.

A new study about post-traumatic stress disorder (PTSD) shows how psychotherapy changes the brain. PTSD consists of a series of struggles (e.g., intrusive thoughts, irritability) that can develop after someone experiences one or more traumatic events. Many people recover after a trauma, but about 10% may develop problems that don’t go away without treatment. In this study, researchers looked at changes in the brain and gene expression before and after cognitive behavioral therapy for PTSD.

The Study

Researchers treated 39 people with PTSD with twelve 90-minute sessions of trauma-focused cognitive behavioral therapy (CBT). Brain scans and blood draws were taken before and after treatment. I found several results really interesting.

CBT Increases Hippocampus Volume

One finding is that there was an actual change in brain matter. The hippocampus is a part of the brain involved in memory. In this study, the size of the hippocampus increased by the end of treatment and these changes were related improvement in PTSD symptoms. The hippocampus can be directly impacted by high levels of long-term stress—such as PTSD—and has been shown to atrophy under these conditions. It appears that psychotherapy can help undo these changes.

The authors note that a prior study did not find any change in hippocampus volume following therapy for PTSD. They note that in the other study, the participants were more severe and had more chronic PTSD; consequently, they speculate that earlier intervention may be extremely important in bringing about improvements.

Changes in Gene Expression

The other biological marker of change the researchers looked at was the FKBP5 gene. Genes are outside my area of expertise, so I’ll try to summarize the results as accurately as I can. Apparently there’s evidence that FKBP5 is associated with anxiety and mood-related problems, and that it can be impacted by stressful external experiences. Reduced expressions of this gene have been linked to PTSD.

There’s also a relationship between FKBP5 and the hippocampus. Expression of FKBP5 can affect secretion of the stress hormone cortisol, which in turn can lead to atrophy in the hippocampus.

Using blood tests, the researchers found that increased expression the FKBP5 gene was also tied to improvement in PTSD.


To summarize, it appears that psychotherapy for PTSD can lead to actual changes in the brain—including increased volume of the hippocampus and changes in gene expression. It also suggests that early treatment for PTSD may be helpful undoing some of the damage.

The point I want to underscore is this: all effective treatments impact brain function.  Whether a treatment is a drug treatment, electroshock, or psychotherapy, they all affect the structure and function of people’s brains. Dressing up a psychotherapy in the language of neuroscience doesn’t make it any more effective or scientific. Any effective treatment changes the brain.

If you want to read the article yourself, click here for a pdf.

Recognizing Posttraumatic Stress Disorder Awareness Month

Unfortunately, mental struggles are often given scant attention in the media. Many people are surprised to learn that others struggle with the same difficulties. Although posttraumatic stress disorder (PTSD) has been getting more media attention lately because of the recent wars in Afghanistan and Iraq, I was pleased to learn that the secretary for Department of Health and Human Services (HHS) released a statement  recognizing Posttraumatic Stress Disorder Awareness Month. She writes:

During PTSD Awareness Month and on PTSD Awareness Day, June 27, 2012, we focus national attention on this debilitating condition and renew our commitment to support research, education, and treatment for those living with PTSD, as well as for their friends and families.

National recognition and focus on this often debilitating yet treatable problem is a wonderful step in helping people access needed services. I encourage you to read Ms. Sebelius’ statement yourself, and to pass it on to others.