What came first: the chicken or the egg? In substance use treatment, we often come across a very similar question – what came first: trauma or substance misuse? Individuals who have experienced both typically find themselves trying to answer that question. Sometimes the answer is clear, other times it is not.

Research shows that between 30-60% of people in substance use treatment have both a substance use diagnosis and Post Traumatic Stress Disorder (PTSD).  Rates of people experiencing lifetime trauma without an official PTSD diagnosis are much higher.  Post Traumatic Stress Disorder is an emotional set of problems that occurs after a person experiences a traumatic event.  What makes PTSD different than a normal human reaction is that the symptoms persist for months and even years — nightmares, flashbacks, avoidance, easily startled, and problems in major areas of life are all symptoms of PTSD. To the public, PTSD is a familiar term when discussing combat veterans; however, PTSD doesn’t stop there. Any experience that a person perceives to be traumatic can lead to emotional disturbance and dysfunction.

People who have experienced trauma are likely to seek substances as a way of self-medicating and emotionally numbing themselves.  Individuals with PTSD are known to use “hard” drugs, like opioids.  The catch in this attempt to avoid the negative feelings associated with trauma is that individuals who become dependent on substances actually find themselves in situations that increase the chances of experiencing even more trauma.  This vicious cycle can repeat itself, making it harder for a person to seek help or treatment.

Seeking help for people with PTSD and substance use is an incredibly difficult task.  Once the numbing power of the substance has been removed through abstinence, the symptoms of PTSD often increase.  Many individuals find it difficult working through the traumatic pain they have experienced.  The past clinical approach was to address each need separately.  However, current studies indicate that the best practice is to treat both problems simultaneously.  As the problems are so intertwined, they cannot be isolated from each other in treatment. 

Creating physical and emotional safety is a primary need during this time.  Several approaches can be used, including:  Cognitive Behavioral Therapy, Eye Movement Desensitization and Reprocessing (EMDR), and Cognitive Processing Therapy.  The treatment each person receives should always be based upon a thorough evaluation of the individual needs identified. Here at SMA Healthcare, we have therapists trained in Cognitive Behavioral therapy, Cognitive Processing Therapy, and EMDR.  Our staff can assist individuals struggling with substance misuse and PTSD in restoring their sense of self and meaning through individual, group, and family therapy.