PTSD and Substance Use

Welcome to Engage Wellness Acton’s page on dual diagnosis: post-traumatic stress disorder (PTSD) and substance use disorders.

The term dual diagnosis refers to the concept of living with a mental health and substance abuse disorder at the same time. Unfortunately, each condition often feeds into the other, and while they are unique disorders, treating them together encourages greater success.

To overcome a dual diagnosis of substance abuse and PTSD, individuals require professional, ongoing treatment and support. Although the initial step can be daunting, your ability to live a happy, healthy life is possible when you receive tailored and holistic treatment for PTSD.

This page explores everything you need to know to take that first step, focusing on the relationship between these disorders and the PTSD and addiction treatment options available to you.

Does PTSD Cause Substance Use – Or Vice Versa?

Post-traumatic stress disorder (PTSD) and substance use disorders frequently occur together, creating significant challenges for recovery. Studies indicate that those with PTSD are at a higher risk of developing problems with alcohol or drugs, often starting as an attempt to manage overwhelming symptoms.[1] The initial relief from substances can mask underlying trauma symptoms while gradually developing into dependency.

The biological mechanisms behind PTSD create vulnerabilities that increase substance use risk. Trauma alters brain chemistry, stress response systems, and neurotransmitter function.[2] These changes can make someone more susceptible to developing substance problems as they struggle with hypervigilance, flashbacks, and severe anxiety. Clinicians report that many patients describe using substances to numb these distressing symptoms or to achieve sleep without nightmares.

Substance use typically worsens PTSD symptoms and creates additional complications for treatment as well. Regular drug or alcohol use disrupts sleep patterns, increases depression and anxiety, and interferes with trauma processing. Psychiatrists, counselors, and mental health clinicians find that treating both conditions at once through specialized trauma therapy and addiction support leads to better outcomes. Recovery specialists emphasize that addressing the underlying trauma while building healthy coping skills provides the strongest foundation for long-term healing.

Fast Facts: The Link Between PTSD and Addiction

So, while one of these disorders does not “cause” the other, there is a close link between the two.

When examining veterans:[3]

• Over 20% of veterans with PTSD also have substance use disorder.
• Nearly one-third of veterans seeking treatment for substance use disorder also have PTSD.
• Those who have PTSD and a drinking problem tend to binge drink.

A similar connection was made concerning substance use, childhood traumatic experiences, and PTSD. A study on traumatic life experiences found that physical or sexual abuse and neglect, especially in childhood, are known to increase the risk of psychiatric disorders in adulthood, particularly PTSD — which is highly comorbid with substance use disorder.[4]

After examining 587 participants who experienced childhood trauma, it was found that:

• 39% showcased a lifetime dependence on alcohol
• 1% showcased a lifetime dependence on cocaine
• 8% showcased a lifetime dependence on marijuana
• 2% showcased a lifetime dependence on heroin/opiates

This study also reported that up to 59% of young people with PTSD subsequently develop substance abuse problems. However, this dynamic is incredibly complex, and individual variables must be considered, which is why holistic, personalized treatment is so important.

Signs and Symptoms of Co-Occurring Substance Abuse and PTSD

People living with co-occurring PTSD and substance use face unique challenges that can show themselves in distinct ways. The overlapping symptoms of both conditions often intensify each other, making recognition and diagnosis particularly important. Mental health specialists and addiction counselors look for specific patterns when evaluating someone who might be dealing with both conditions.[5]

• Avoiding people, places, or activities that were once enjoyed because they trigger traumatic memories or cravings. This isolation often leads to increased substance use in private settings.
• Using substances specifically to cope with flashbacks, nightmares, or intrusive thoughts about traumatic events. This pattern of self-medication becomes a primary method of emotional regulation.
• Experiencing intense mood swings that go beyond typical substance use effects, often triggered by trauma reminders and leading to increased substance use.
• Developing strict routines or rituals around both substance use and avoiding trauma triggers makes daily functioning increasingly difficult.
• Showing heightened paranoia or hypervigilance even when not under the influence, which may worsen during substance use or withdrawal.
• Struggling to maintain relationships due to both PTSD symptoms and substance use, often pushing away support systems that could aid in recovery.
• Demonstrating increased risk-taking behavior while under the influence, potentially leading to new traumatic experiences.
• Missing work or school regularly due to both PTSD symptoms and substance use creates a cycle of additional stress and anxiety.

How Is Addiction and Co-Occurring PTSD Diagnosed?

Diagnosing an addiction alongside PTSD can be challenging because these disorders often have overlapping symptoms. To receive a diagnosis, licensed professionals leverage comprehensive assessment tools, taking several variables into account, including:

• Family history
• Medical history
• Mental health history
• History of substance abuse

There is also the possibility of polysubstance use, which refers to using more than one substance, which is relatively common among individuals with a dual diagnosis. Research shows that a subset of people with severe polysubstance use experience PTSD and major depression symptoms.[6] The diagnostic process can be complex in these cases, and these individuals often require increased care.

PTSD and Addiction Treatment

Depending on the substances you use, PTSD and addiction treatment typically begins with a detoxification period. Mental health treatment, such as behavioral or combined therapy, will typically follow, and in some cases, medication-assisted treatment.

Each client is unique and will require a tailored treatment plan. However, here’s what you can typically expect from PTSD and addiction treatment.

Step One: Detoxification

When you enter a dual-diagnosis treatment plan, there will be an initial detox period. This process lasts days for some and weeks for others — although symptoms will gradually improve. Many will detox at home before entering an addiction and mental health treatment plan — but others may require medical support.

Withdrawal symptoms will vary depending on which substances you’re detoxing from, as some are more dangerous than others. For example, alcohol withdrawal can lead to seizures. The withdrawal symptoms from benzodiazepines and barbiturates can also be severe.

This step is something you can discuss with your healthcare provider, especially if you have pre-existing health concerns that withdrawal symptoms may complicate.

Step Two: Choose Your Program

When entering PTSD and mental health treatment for a dual diagnosis, you’ll have several options, depending on where you seek treatment.

In most cases, clients suffering from PTSD and addiction will enter an inpatient treatment program. This program offers 24-hour, on-site support and access to comprehensive treatment options, ranging from psychiatric services to experiential therapy.

Some clients will stay for 30 days, and others will remain for months. For this reason, you must seek a treatment facility that offers customized therapy and support.

Partial hospitalization programs (PHP) and outpatient programs are also available. These options are more flexible and are often offered to those with responsibilities outside of rehab or those seeking ongoing support after an inpatient program.

Additional Treatments For PTSD and Substance Abuse

Additional Treatments for PTSD and substance abuse include diverse therapeutic approaches that go beyond traditional methods. Specialized PTSD treatment programs for veterans are also available. Led by a fellow veteran, this program combines evidence-based therapies with peer support networks specifically designed for military trauma. EMDR therapy has shown particular promise in helping process traumatic memories while reducing substance use triggers.[7]

Dialectical Behavior Therapy (DBT) offers valuable skills for emotional regulation and distress tolerance, helping address both trauma responses and substance use challenges. Group therapy for PTSD provides essential peer support and shared learning experiences, while holistic treatment approaches incorporate mindfulness, meditation, art therapy, and physical wellness activities to support overall recovery.

Our treatment center integrates 12-step programs with trauma-informed care, creating a comprehensive support system that addresses both conditions. Throughout Massachusetts and other regions, specialized PTSD rehab facilities offer varying levels of care, from intensive outpatient programs to residential treatment options. These programs typically combine multiple therapeutic approaches to create individualized treatment plans that address each person’s specific trauma history and substance use patterns.

Discover Engage Wellness Acton’s Dual Diagnosis Program

The Engage Wellness Acton’s dual diagnosis program offers a professional, safe, and supportive environment for those living with PTSD and substance use disorder. Clients receive evidence-based treatment to help them overcome their addictions and address the trauma they have experienced. The result is a healthier, more fulfilling future.

If you’re ready to take the first step, we’re here to help. Contact us to begin your road to recovery today!

Frequently Asked Questions About Substance Abuse and PTSD Treatment in Massachusetts