PTSD: National Center for PTSD

PTSD and Substance Abuse in Veterans

“We have found that both posttraumatic stress disorder and substance use can be treated concurrently [meaning, at the same time].”

Dr. Ron Acierno

Clinical Psychologist

How Common Is Co-occurring PTSD and SUD in Veterans?

• More than 2 of 10 Veterans with PTSD also have SUD.
• Almost 1 out of every 3 Veterans seeking treatment for SUD also has PTSD.
• The number of Veterans who smoke (nicotine) is almost double for those with PTSD (about 6 of 10) versus those without a PTSD diagnosis (3 of 10).
• In the wars in Iraq and Afghanistan, about 1 in 10 returning Veterans seen in VA have a problem with alcohol or other drugs.
• War Veterans with PTSD and alcohol problems tend to binge drink. Binge drinking is when a person drinks a lot of alcohol (4-5 drinks or more) in a short period of time (1-2 hours).

How Can Co-occurring PTSD and SUD Create Problems?

Some people use drugs or alcohol to try to deal with PTSD symptoms. For example, people might use drugs to help them sleep, relax, or manage situations they would rather avoid. But, using drugs and/or alcohol can make PTSD symptoms worse. People with PTSD and SUD often have other problems as well: health problems (such as physical pain), relationship problems (with family and/or friends), and problems in daily life (like keeping a job or staying in school).

For example:

• PTSD may create sleep problems (trouble falling asleep or waking up during the night). People might "medicate" with alcohol or drugs because they think it helps with sleep, but drugs and alcohol change the quality of sleep and make people feel less refreshed.
• PTSD makes people feel "numb," like being cut off from others, angry and irritable, or depressed. PTSD also makes people feel like they are always "on guard." All of these feelings can get worse when using drugs and alcohol.
• Drug and alcohol use allows people to continue the cycle of "avoidance" found in PTSD. Avoiding bad memories and dreams or people and places can make PTSD last longer. People with PTSD cannot make as much progress in treatment if they continue to avoid problems.
• People may drink or use drugs because it distracts them from their problems for a short time. But drugs and alcohol make it harder to concentrate, be productive, and enjoy all parts of life.

VA made it easier to get help. It is important to know that treatment can help those with PTSD.

What Treatments Are Offered for Co-occurring PTSD and SUD?

Evidence shows that treating PTSD and substance use at the same time works to treat both conditions. Some people choose to do different therapies for PTSD and SUD at the same time.

• For treatment of PTSD, trauma-focused psychotherapies are the most effective. These treatments use different techniques to help people process their traumatic experience. Those with the strongest evidence include: Cognitive Processing Therapy (CPT) (en Español), Prolonged Exposure (PE) (en Español), and Eye Movement Desensitization and Reprocessing (EMDR) (en Español).
• The most effective treatments for SUD include relapse prevention, cognitive behavioral therapy, and contingency management. There are also medication options.
• COPE is a therapy that integrates trauma-focused PTSD treatment with SUD treatment.
• Treatment for specific symptoms like pain, anger, or sleep problems are options as well.

What Should I Do if I Think I Have Co-occurring PTSD and SUD?

The first step is to talk to a health professional and ask about treatment options. Each VA medical center has an SUD-PTSD Specialist who is trained to treat both conditions. There are treatment resources at every VA medical center.

You can use the VA Locator to find health services near you. On the locator, enter your location, choose "VA health" for Facility type and "Mental health care" for Service type. Call the mental health or main number for the facility closest to you and ask about an appointment for PTSD assessment or treatment and mention your interest in substance use programs.

If you went through a traumatic event and have symptoms for more than three months, you may have PTSD. If you have questions about your drinking or drug use, learn more about treatment options. Treatment can turn your life around. Talk to a VA or other health professional about care for co-occurring PTSD and SUD.

Download:
Understanding PTSD and Substance Use Disorder Flyer (PDF)