Substance Abuse and Post Traumatic Stress Disorder (PTSD) Fact Sheet
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In an effort to assist prevention practitioners, ten CAPT Associates read and summarized twelve articles from current substance abuse and Post Traumatic Stress Disorder literature. The following summary provides highlights from the reviewed literature using six categories: general information, war veterans, gender differences, youth, comorbidity and treatment.
Click on the citations to view the article summary
General Information
War Veterans
Gender Differences
Youth
Comorbidity
Treatment
Post Traumatic Stress Disorder (PTSD) is a psychiatric disorder triggered by a severe
trauma or threat to physical integrity. It is characterized by persistent, intrusive flashbacks
to the trauma, numbing of responsiveness and persistent states of increased arousal
(Deykin and Buka 1997)
Studies have confirmed that comorbidity of PTSD with substance abuse is common and the symptoms of these patients tend to be more severe and less responsive to treatment.
(Jacobsen et. al 2001)
The relationship between PTSD and substance abuse is both common and complex. This appears to
be particularly prevalent among war veterans who have experienced exposure to heavy combat.
Research also suggests other possible variables including family history, individual responses to
stress, pre-exposure drinking behavior and post-exposure environment.
(Kofed et. al 1993)
Substance abuse is common among women Veterans Affairs patients and is associated with younger age and with screening positive for other psychiatric conditions. Providers are expected to follow up on positive screening tests, and these data indicate substantial provider burden.
(Davis et. al 2003)
Women are twice as likely as men to develop PTSD after exposure to trauma with the second most common disorder associated with PTSD being substance abuse.
(Cramer 2002)
Females have a higher risk of PTSD partly because they have a greater probability for rape, the highest-risk trauma. The impact of multiple traumas is more evident for males, since they are commonly exposed to lower-risk traumas.
(Deykin and Buka 1997)
Alcohol dependence was the most common substance use disorder present in women patients. This was followed by alcohol abuse, cocaine dependence and cannabis dependence, respectively. When working with female PTSD patients addressing appropriate alcohol use and confronting any illegal chemical use could aid in the prevention of a future substance use disorder.
(Zlotnick et. al 2003)
PTSD does not significantly increase men's likelihood of developing an alcohol abuse or dependence disorder, but it does increase women's risk. It is possible that when looking at alcohol prevention and treatment one size does not fit all, women may respond to different prevention and treatment methods.
(Breslau et. al 2003)
Adolescents experiencing a lot of stress, particularly those with PTSD or panic disorder, seem to be using alcohol for a calming effect.
(Kilpatrick et. al 2000)
Due to their lack of control over traumatic events children may experience very severe emotional distress that is related to the event. This finding indicates the extreme importance of providing early and intensive prevention services to young people who are victimized or otherwise affected by a traumatic event.
(Volpicelli et. al 1999)
Many studies of substance abuse and PTSD comorbidity have assumed that PTSD is the primary disorder and that the substances are used to self medicate symptoms. A number of studies have yielded conflicting data on this topic.
(Meisler 1996)
PTSD predicted the onset of nicotine dependence and other drug abuse or dependence, but trauma without PTSD did not. PTSD and trauma without PTSD did not predict the onset of alcohol abuse or dependence.
(Breslau et. al 2003)
Drug abuse or substance abuse disorders in people that have been diagnosed with PTSD might be the result of efforts on their part to self medicate, masking the symptoms of the PTSD.
(Chilcoat et. al 1998)
Family modeling was an interesting finding. Consistent with other studies, the risk of alcohol and hard drug abuse (but not marijuana) was doubled over and above the other risks in children with family members who abused alcohol. Conversely, family drug use increased the risk of marijuana and hard drug abuse but not alcohol abuse.
(Kilpatrick et. al 2000)
Patients who turn to chemicals to manage PTSD symptoms are less likely to develop other appropriate coping strategies and have a greater deal of difficulty resolving the PTSD episode.
(Zlotnick et. al 2003)
The comorbidity of PTSD and substance abuse clearly suggest that substance abuse prevention practitioners work closely with child abuse and domestic violence prevention workers.
(Brown and Wolfe 1994)
General literature explains that to be a success, treatment of concurrent PTSD and substance abuse requires prompt control of PTSD symptoms, combined with simultaneous substance abuse treatment.
(Kofed et. al 1993)
When a person experiences a trauma where they have little to no control over the outcome the symptoms of PTSD are usually more severe and pronounced. The research indicated that by helping patients with PTSD to gain some control over their feelings relating to the traumatic even might help them to also gain control over their response to reminders of the traumatic event and lessen the impact of the reminder.
(Volpicelli et. al 1999)
Neurobiologic research has indicated that elevated levels of corticotropin-releasing hormone (CRH) in the brain may be common to PTSD and substance withdrawal states. Research has also indicated that CRH antagonists reduce anxiety and the enhanced response to illicit substances that are induced by higher level of brain CRH. This could mean that CRH antagonist could have a role in treatment in patients with co-occurring PTSD and substance abuse disorders. However, there isn't a CRH antagonist that has been approved for use with humans.
(Jacobsen et. al 2001)
Clonidine, an a2-adrenonceptor agonist, has been used in treating both disorders, as has guanfacine, which is a selective a2-adrenonceptor agonist. These two agents appear to be effective in reducing noradenergic hyperactivity. Guanfacine may offer a more favorable side effect profile. The authors conclude that more research using patients with both disorders needs to be conducted.
(Jacobsen et. al 2001)
The therapeutic relationship is the single most powerful factor for success in treatment (of women with both PTSD and substance abuse), but is endangered by the therapist's own vulnerability to reaction formation, lack of feeling, or desire to leave the relationship. Process supervision is vital to maintain ongoing grounding and support.
(Cramer 2002)
The efficacy of any specific approach is not supported in the research but it is agreed that the treatment goals should involve the relief of PTSD symptoms and the reduction and eventual cessation of addictive behaviors. Controlling the PTSD symptoms is paramount for the success of both goals.
(Kofed et. al 1993)
