PTSD: National Center for PTSD

Substance Use and PTSD

“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

Why do PTSD and substance use often occur together?

PTSD and substance use frequently happen together, or "co-occur". In the U.S., about 4 out of 10 adults who have PTSD also have problems with drug or alcohol use.

Research suggests that for most people who have both PTSD and problems with alcohol or drug use, PTSD develops first. Some people use drugs or alcohol to try to deal with PTSD symptoms. They might use drugs or alcohol to help them relax, feel more comfortable in social settings, or deal with thoughts and feelings they would rather avoid.

Using drugs or alcohol can also impair people's judgement, which can put them at risk for traumatic events like accidents or serious injuries. Experiencing these traumas can lead to PTSD.

How can co-occurring PTSD and substance use create problems?

Using drugs or alcohol can make PTSD symptoms worse. For example, although some people use alcohol to help them sleep, in reality, alcohol can make sleep less restful. Using drugs can increase irritable feelings and avoidance of emotions. Getting treatment for PTSD or using positive coping actions are better options than turning to alcohol or drugs.

When drug or alcohol use reaches the level of addiction, it is called substance use disorder (SUD). Substance use—especially when it rises to the level of addiction—can cause other problems, such as physical pain, medical problems, trouble in relationships, and difficulty keeping a job, staying in school, or meeting other responsibilities. People with both disorders (PTSD and SUD) also have a higher risk of depression, anxiety, and suicide. The toll of PTSD and substance use is heavy for individuals and society, but there are good treatments for both disorders.

What treatments are offered for PTSD and substance use problems?

It is important to know that treatment can help people with PTSD and substance use problems. Research shows that treating PTSD and substance use at the same time works to treat both conditions. This is called "concurrent treatment."

There are 2 ways to get concurrent treatment for alcohol or substance use and PTSD. Some people choose to do 2 different therapies—one for PTSD and one for substance use—at the same time, usually by different therapists. There is also therapy that combines—or integrates—treatment for both problems and is delivered by the same therapist in a single treatment.

PTSD treatments

For treatment of PTSD, trauma-focused psychotherapies are the most effective. This is true for people with and without substance use disorders. These treatments use different techniques to help people process their traumatic experiences. Those with the strongest evidence include Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), and Eye Movement Desensitization and Reprocessing (EMDR).

Substance use treatments

There are also effective treatments for substance use, including:

• Motivational enhancement therapy, which uses strategies to improve people's readiness to change their behavior and enter treatment.
• Cognitive-behavioral therapy, which seeks to help people recognize, avoid, and cope with the situations in which they're most likely to use drugs or alcohol.
• Contingency management, which involves using rewards or privileges for staying drug- or alcohol-free, going to counseling sessions, or taking treatment medications as prescribed.
• Relapse prevention, which helps with planning for and coping with things that might make a person want to return to using drugs and alcohol.

There are also medication options. Certain medications can reduce the pleasure of alcohol or drugs, reduce cravings, and also help withdrawal symptoms.

Integrated PTSD and SUD treatment

COPE (Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure) is a therapy that blends trauma-focused PTSD treatment with substance use treatment. Studies of COPE with Veterans and civilians have shown this integrated treatment improves PTSD symptoms.

Other support

You may have heard of 12-step or other mutual support and self-help programs, like Alcoholics Anonymous, Narcotics Anonymous, and Smart Recovery. They do not focus on treating PTSD, but many people who have both PTSD and problems with drugs and alcohol find them helpful. Combining mutual support and concurrent treatment is always an option.

What should I do if I think I have both PTSD and a substance use problem?

If you went through one or more traumatic events and have symptoms for a month or more, you may have PTSD. You can answer 5 questions—a PTSD self-screen—that can help you find out if your feelings and behaviors may be related to PTSD. There is also a brief alcohol and substance use problem questionnaire you can fill out if you are concerned about your substance use. Both these tools are confidential.

Each VA Medical Center has treatment resources, including a PTSD-SUD specialist who is trained to treat Veterans with PTSD and substance use problems. A PTSD-SUD specialist, your primary care provider, or a mental health provider can help you explore your treatment options.