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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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