PTSD and substance use

Understand the relationship between PTSD and substance use. Learn about the common causes of PTSD and the risks associated with self-medication.

Ophelia team
PTSD and pills
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Arthur Robin Williams, MD

Post-traumatic stress disorder, or PTSD, is a mental health disorder that affects millions of people in the United States alone. It’s common for people experiencing PTSD to self-medicate with drugs or alcohol to alleviate their symptoms. Physicians may also prescribe opioids for patients with PTSD to address trauma-related pain that may manifest as headaches or back pain, etc. 

Over time, continued use of these substances puts those with PTSD at risk of addiction. Medical professionals and researchers are exploring the relationship between PTSD and substance use — specifically opioid use — in more depth. Addressing both these disorders requires careful, comprehensive treatment. 

Common causes of PTSD

Any intensely stressful, frightening event or experience can cause post-traumatic stress disorder. Among those who experience severe trauma, around one in three people will subsequently develop PTSD. The good news is that the majority of the time people live through a terrifying experience, it does not lead to PTSD. Yet for some individuals, certain experiences can lead to long-term impairment.

PTSD was initially associated with veterans, and between 10 and 20% of veterans deal with PTSD stemming from their service. There are many other common causes of PTSD beyond war and combat exposure, however. 

Some other causes of PTSD are now appreciated to include:

  • Sexual violence
  • Abuse, especially in childhood
  • Severe accidents like a car or plane crash
  • Physical assaults
  • Serious health problems

Self-medicating with PTSD

The symptoms of PTSD — which include intrusive memories, nightmares and night sweats, hypervigilance (constantly being on the lookout for threats), hopelessness, shame, and angry outbursts — are deeply distressing. To alleviate these symptoms, people with PTSD may choose to self-medicate with alcohol or drugs. Around 20% of those with PTSD self-medicated with substances to relieve their symptoms, though this behavior was much more common in men than women. 

Research into self-medication for PTSD symptoms has historically focused on alcohol and recreational drugs. Only recently have researchers begun focusing on opioids as a substance that people with PTSD use to self-medicate. They’ve found that a recent PTSD diagnosis is associated with significantly higher opioid use and frequency of use in both men and women.  

The danger of self-medicating with opioids or other substances is that the individual may develop a physical dependency or even outright addiction leading to more harm and chaos in life. Without intending to, people who self-medicate may become physically and psychologically dependent on the substance over time. 

Who is at the highest risk?

People who suffer from anxiety or depression (or suffered from these conditions in the past) may be more likely to develop PTSD after experiencing an extreme event. Lack of support from family and friends may also raise a person’s risk of developing PTSD. It’s possible genetics play a role in whether someone develops PTSD as well. If a close relative experienced mental health issues, an individual may be at greater risk of developing the condition. 

As for self-medication, people who cannot afford or otherwise access mental health treatment are more likely to use drugs and alcohol to self-medicate. There’s also a heavy stigma around seeking treatment which may cause PTSD patients to self-medicate rather than reach out to professional healthcare providers. 

PTSD and substance use comorbidity

This tendency to self-medicate leaves people with PTSD at a much greater risk of substance use disorders like opioid use disorder (OUD). Substance abuse and trauma are frequently linked even outside of PTSD, but people who are seeking PTSD treatment are up to 14 times more likely to receive a substance use disorder (SUD) diagnosis. Comorbidity of SUDs and PTSD can complicate treatment, often geared toward one disorder at a time. Treating just one of the disorders may not be enough to create positive outcomes—healthcare professionals must develop treatment plans to address both disorders. 

It’s important to note that when these two disorders are present, they become intertwined in complex ways. The symptoms a patient experiences from PTSD may affect their symptoms of OUD and vice-versa. Researchers developed the mutual maintenance model, which suggests that the symptoms of PTSD and chronic pain exacerbate each other. As the patient experiences worsening symptoms of PTSD and chronic pain, they may choose opioids for quick relief. Unfortunately, self-medicating with opioids dramatically increases the risk of developing OUD. 

For those with PTSD and OUD, medication-assisted treatment (MAT) alone may not address the underlying mental health concerns that lead to substance abuse. Buprenorphine, an FDA-approved drug for opioid dependence, does not explicitly treat PTSD symptoms. Preliminary studies suggest that MAT may reduce PTSD symptoms for those with OUD, but more research is required. 

Overcoming substance abuse disorders with PTSD

If you or a loved one is dealing with PTSD and addiction, Ophelia is here to help. Our team will work with you to develop a personalized treatment plan that addresses all your concerns. You can connect with a dedicated care team from the comfort of your home through our  convenient telehealth approach. We send prescriptions for Suboxone or other approved MAT drugs straight to your pharmacy if you’re eligible. So get started today in a few easy steps.


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