There is a strong correlation between trauma, PTSD, and substance use disorders. Research has shown that 8.3 percent of people who have experienced trauma go on to develop post-traumatic stress disorder (PTSD) at some point during their lifetime. Meanwhile, a NIDA study found that those who suffer traumatic experiences, such as violence, abuse, neglect, or family or social conflict, are more at risk of developing a substance use disorder (SUD).
The development of PTSD and SUD
Violence-related trauma is one of the single biggest causes of PTSD. A 2017 study shows that traumas involving interpersonal violence have the highest risk of PTSD development. These include intimate partner violence (IPV) and sexual assault. Women exposed to intimate partner violence or other forms of interpersonal violence are also at an increased risk of developing substance use disorders.
Children are also especially vulnerable. The same study showed that associations of trauma exposure with subsequent PTSD are significantly increased when experienced during childhood and adolescence. Individuals who experienced childhood physical or sexual abuse are 74 percent and 73 percent more likely, respectively, to develop substance use disorders throughout their lives.
The risk of addiction is also heightened for military personnel who have been deployed multiple times, exposed to combat, or sustained combat-related injuries. Additionally, many studies have revealed that drug and alcohol use, as well as smoking, increase in the wake of terrorist acts.
One study found that veterans with lifetime PTSD were twice as likely to meet the criteria for an alcohol use disorder, three times as likely for a substance use disorder, and more than three times as likely for a nicotine use disorder, compared to those without PTSD.
People can also be traumatized by witnessing events or by discriminatory behavior. According to a 2024 study, between 30 and 40 percent of people who witness a natural disaster, including floods, tsunamis, tornadoes and earthquakes, go on to develop PTSD.
According to the NIDA study above, the experience of discrimination can also lead to chronic stress and racialized trauma, which increases the risk of substance use and misuse. Research suggests that individuals facing discrimination have an elevated risk of substance misuse.
The relationship between PTSD and substance use disorder
Recent analysis found that suffering from PTSD increases your risk of developing an SUD by up to 14 times. This is significantly increased for young people, with evidence demonstrating that up to 59 percent of adolescents who suffer trauma that leads to PTSD go on to develop an SUD.
There are a variety of ways that PTSD can lead to SUDs:
Self-medication
According to research, around 20 percent of PTSD sufferers use substances such as alcohol and drugs to self-medicate, with men more likely than women to engage in this behavior. It becomes a tool to cope with distressing symptoms such as irritability, difficulty concentrating, nightmares, flashbacks, and insomnia. Over time, this reliance on self-medication can develop into an SUD.
Altered brain function
Experiencing a traumatic incident can also cause changes to a person’s brain function, making it more likely that casual substance use will lead to an SUD. This is especially the case for childhood trauma, when the brain is not yet fully developed.
Reduced impulse control
Traumatic experiences can affect the part of the brain known as the nucleus accumbens, which is associated with reward and motivation. Those suffering from PTSD often experience increased cravings and an inability to control their response to impulse triggers.
Impulsive behaviors, often driven by urgency and sensation seeking, can be mitigated by addressing PTSD symptoms. This treatment approach may be particularly effective for patients exhibiting high levels of impulsivity.
Reverse causative link
While we typically think of PTSD as a risk factor for the development of an SUD, the causative link can also work in reverse. Alcohol and drug misuse can heighten vulnerability to traumatic events (e.g., risky behaviors or environments) and impair coping mechanisms after trauma, increasing the likelihood of PTSD development.
The importance of treating PTSD and substance use disorder together
Historical approaches to treatment, such as requiring individuals to become sober before they were permitted to access PTSD treatment, were ineffective and failed to get to the root of this combined problem. Untreated PTSD in patients with SUD is associated with more frequent relapses.
Shared decision-making and measurement-based care are critical components of successful treatment for individuals with PTSD who are also suffering from SUDs. This collaborative approach ensures that treatment is tailored to the unique needs of each individual, using self-reported outcome data and ongoing assessment to track progress and inform treatment decisions.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR therapy uses bilateral stimulation, usually eye movements, while the patient briefly focuses on the traumatic memory. EMDR has been shown to significantly reduce PTSD symptoms, including flashbacks, hyperarousal, and emotional distress. Studies report high success rates, with some showing that 77%–90% of single-trauma victims no longer met PTSD criteria after just a few sessions
Somatic Experiencing
Somatic Experiencing (SE) is a type of alternative therapy whose main goal is to change how the body responds to trauma-related stress. Studies report significant symptom reduction, with improvement rates ranging from 44.1% to 90% in PTSD symptoms after SE interventions. SE has been effective in addressing autonomic nervous system dysregulation, improving resilience, and reducing psychological symptoms like anxiety and somatization.
Traditional healing
The health practices, approaches, knowledge, and beliefs of Native American / First Nations peoples emphasize cultural identity and community integration, which are protective factors against PTSD. Ceremonial protocols (e.g., sweat lodges, smudging) and storytelling help restore self-community relationships and human-ecological balance, which are critical for mental health recovery in Indigenous frameworks.
Integrated Therapies
CBT (cognitive behavioral therapy) and the use of Prolonged Exposure therapies have been successfully used for the treatment of PTSD and SUDs. PE therapy has shown effectiveness, but studies have been limited. As well, Seeking Safety (SS) is a non-exposure-based treatment for individuals experiencing both PTSD and substance use disorder.
Pharmacological treatments
Certain medications have FDA approval, such as selective serotonin reuptake inhibitors for PTSD. Prazosin has a role in stopping the consolidation of fear memories and reducing the primitive response to fear, and has emerged as the main agent for treating PTSD-related nightmares.
Create a trauma-informed care facility
The intricate relationship between PTSD and substance use disorder highlights the importance of addressing both simultaneously, recognizing their interconnectedness and the need for integrated interventions that meet the unique needs of a diverse population. With an understanding and sensitivity towards the impact of trauma, we can better support individuals in their healing journey and facilitate their access to comprehensive and coordinated care.
