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The relation between
substance use and trauma
Research demonstrates a strong
link between exposure to traumatic events and
substance use problems. Many people who have
experienced child abuse, criminal attack, disasters,
war, or other traumatic events turn to alcohol
or drugs to help them deal with emotional pain,
bad memories, poor sleep, guilt, shame, anxiety,
or terror. People with alcohol or drug use problems
are more likely to experience traumatic events
than those without these problems. Many people
find themselves in a vicious cycle in which
exposure to traumatic events produces increased
alcohol and drug use, which produces new traumatic
event experiences, which leads to even worse
substance use, and so forth. Just as traumatic
events and substance use often occur together,
so do trauma-related disorders and substance
use disorders. For example, trauma-related disorders,
such as post-traumatic stress disorder (PTSD)
and depression occur frequently among people
with substance use disorders and visa versa.
Not only do trauma-related and substance use
disorders wreak havoc on the person who has
them, they also often create major problems
for relationships with family members and friends.
A family doctor, clergy person,
local mental health association, state psychiatric,
psychological, or social work association, or
health insurer may be helpful in providing a
referral to an experienced counselor or therapist.
Traumatized people are more
likely than others of similar background to
abuse alcohol both before and after being diagnosed
with PTSD. For example:
• One-quarter
to three-quarters of people who have survived
abusive or violent traumatic experiences report
problematic alcohol use
• One-tenth
to one-third of people who survive accident-,
illness-, or disaster-related trauma report
problematic alcohol use, especially if troubled
by persistent health problems or pain
• Up to
80% of Vietnam veterans seeking PTSD treatment
have alcohol use disorders
• Veterans
over the age of 65 with PTSD are at increased
risk for attempted suicide if they experience
problematic alcohol use or depression
• Women
exposed to traumatic life events show an increased
risk for an alcohol use disorder
• Men
and women reporting sexual abuse have higher
rates of alcohol and drug use disorders than
other men and women.
• Compared
to adolescents who have not been sexually assaulted,
adolescent sexual assault victims are 4.5 times
more likely to experience alcohol abuse or dependence,
4 times more likely to experience marijuana
abuse or dependence, and 9 times more likely
to experience hard drug abuse or dependence.
• Adolescents
with PTSD are 4 times more likely than adolescents
without PTSD to experience alcohol abuse or
dependence, 6 times more likely to experience
marijuana abuse or dependence, and 9 times more
likely to experience hard drug abuse or dependence.
What are substance
use problems?
When people talk about substance
abuse, they usually mean the consumption of
alcohol or illegal drugs such as marijuana or
cocaine or the misuse of prescription drugs
(using them in a way that is not how they were
prescribed). Substance use disorders are generally
divided into two categories: substance dependence
and substance abuse. Substance dependence is
viewed as more serious than substance abuse
and occurs when people have several of the following
problems: (1) they have to take more of the
substance to get the same effect; (2) they suffer
withdrawal when they stop using after long periods
of heavy use; (3) they have difficulty controlling
the amount of the substance they use; (4) they
attempt to cut down or stop use unsuccessfully;
(5) they spend a great deal of time trying to
obtain the substance or getting over the effects
of use; (6) they give up important activities
or responsibilities because of substance use;
or (7) they continue to use substances in spite
of knowledge that it is harmful to do so.
Substance abuse occurs when
substance use results in (1) major problems
with family, friends, at school, or on the job;
(2) being high or intoxicated in situations
that are dangerous (e.g., while driving), (3)
problems with the police due to substance use,
or (4) continued use in spite of having problems
with family members about substance use.
The effects of substance
use on the symptoms of traumatic stress
Some of the problems people
experience after a traumatic incident are part
of the diagnoses of acute stress disorder (ASD)
and post-traumatic stress disorder (PTSD). ASD
describes experiences of dissociation (e.g.,
feelings of unreality or disconnection), intrusive
thoughts and images, efforts to avoid reminders
of the traumatic experiences, and anxiety that
may occur in the month following the event.
When these experiences last more than a month,
they are described by the diagnosis of PTSD.
The use of alcohol or drugs
can provide a temporary distraction and relief
for traumatized people who may be suffering
from very serious and even debilitating problems
across multiple areas of their lives (thoughts,
feelings, bodily experiences, relationship to
self and others, and behaviors). However, this
relief is only temporary, and the use of substances
to reduce symptoms ultimately can be harmful.
Substance abuse reduces a person's ability to
concentrate, to be productive in work and life
in general, to sleep restfully, and to cope
with traumatic memories and external stressors.
Substance abuse can increase emotional numbing,
social isolation, anger and irritability, depression,
and the feeling of needing to be on guard (hypervigilance).
Binge drinking or using drugs
by a traumatized person may be a well-intentioned
(but ultimately self-destructive) attempt to
"self-medicate" against memories or
reminders of horrific traumatic experiences.
It may also help with sleep problems such as
trouble falling or staying asleep, traumatic
nightmares, and constantly being "wound
up." Using substances as a way to self-medicate
may help with one problem but worsen another.
For example, substance abuse may temporarily
decrease the severity and the number of frightening
nightmares but may also increase irritability
and hypervigilance.
Additional mental or
physical health problems associated with traumatic
stress
When a person is experiencing
problems with both traumatic stress and alcohol
or drug abuse, he or she will often have other
psychological or physical problems. As many
as 50% of adults with both alcohol use disorders
and PTSD also have one or more other serious
psychological or physical problems. For example,
traumatized people who also abuse substances
are often troubled by anxiety disorders (such
as panic attacks, phobias, incapacitating worry
or compulsions), mood disorders (such as major
depression or dysthymia), disruptive behavior
disorders (such as attention deficit or antisocial
personality disorder), and multiple addictive
behaviors (alcohol abuse, use of illicit drugs
and abuse of prescribed medication).
Physical health problems are also very common
among traumatized people. They are at greater
risk for chronic physical illness (such as diabetes,
heart disease, or liver disease) and often suffer
from chronic physical pain, either due to physical
injury/illness or with no clear physical cause.
Treatment for people
with traumatic stress and substance use problems
Substance use problems must
be addressed in the treatment of traumatized
people. When substance abuse is or has been
a problem in addition to traumatization, it
is best to seek treatment from an experienced
and skilled practitioner who has special expertise
in both substance abuse treatment and the treatment
of traumatic stress.
The initial consultation with
a mental health professional should include
questions that sensitively and thoroughly identify
patterns of past and current substance use (alcohol,
illicit drugs, or prescribed medication). Treatment
planning should include a discussion between
the treater and the client about the possible
effects of substance abuse problems on trauma-related
problems, including sleep, anger, anxiety, depression,
and work or relationship difficulties. Treatment
can include education, psychotherapy, and support
groups that help the client address substance
abuse problems in a manner acceptable to the
client. Treatment for traumatization and substance
abuse problems should be designed as an overall
plan that addresses both sources of difficulty
and their interrelationships. Although there
may be separate meetings or clinicians devoted
primarily to traumatization or to substance
problems, all interventions should be carefully
coordinated and integrated.
© 2005 International Society
For Traumatic Stress Studies.
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