Comprehensive Treatment for PTSD and Co-Occurring Substance Abuse

The symptoms of post-traumatic stress disorder can be categorized into 4 symptom clusters. Each cluster reflects an area where the disorder has impacted the person.

Cluster I — Re-Experience Symptoms

These include:

• Unwanted memories of the traumatic incident
• Flashbacks— as if the traumatic incident were occurring again
• Nightmares or distressing dreams associated with the traumatic incident
• Panic attacks, anxiety, or other intense emotional reactions which occur while experiencing reminders of the traumatic incident

Cluster II — Avoidant Symptoms

These include:

• A tendency to avoid thinking or remembering the traumatic incident
• Avoiding people, places, events, activities, or stimuli that bring back memories of the traumatic incident
• Emotional numbing and detachment from others

Cluster III — Negative Cognition and Mood Symptoms

These include:

• Persistent negative views of yourself or the world around you
• Distorted feelings of blame toward self or others
• Persistent negative emotions — fear, horror, anger, guilt, shame
• Loss of interest in hobbies or other pastimes once enjoyed
• Feeling isolated or disconnected from family, friends, and others
• Inability to feel happiness or positive emotions

Cluster VI — Hyperarousal symptoms

• Hypervigilance — being constantly on alert for danger
• Exaggerated startle response
• Sleep disturbances and insomnia
• Irritability and angry outbursts
• Difficulty concentrating

The relationship between PTSD and substance use disorders is one of the most extensively researched co-occurring presentations in addiction medicine.[4] Trauma and addiction are deeply intertwined, and understanding that relationship is the key to effective treatment.

Self-medication is the most commonly identified path toward addiction for individuals with PTSD. People with PTSD often consume alcohol, opioids, marijuana, and a variety of other substances to control their hyperarousal, inhibit flashback episodes, soothe emotional pain, and fall asleep. Studies published in JAMA on PTSD and substance use disorders conducted by VA research departments have repeatedly shown that people diagnosed with both PTSD and a substance use disorder will experience more severe symptoms, higher relapse rates, and worse treatment outcomes when only one condition is treated.[5]

Substance use also worsens PTSD symptoms over time. Alcohol alters REM sleep — the stage of sleep most associated with emotional regulation and trauma recovery — creating a chronically disordered nervous system.[6] Stimulants increase hyperarousal and paranoia.[7] Withdrawal symptoms from any substance can produce intense anxiety, nightmares, and emotional flooding that can trigger re-experiencing symptoms.[8] The cycle is self-reinforcing: PTSD leads to substance use, and substances worsen PTSD symptoms.

Concurrent treatment that addresses both PTSD and addiction in the same program is the evidence-based standard. Randomized controlled trials and systematic reviews consistently show that integrated treatment produces significantly better outcomes than sequential treatment for co-occurring PTSD and SUD.[9]

If you have experienced trauma and have been using substances to alleviate the symptoms, you would benefit from comprehensive co-occurring disorder treatment.

Signs that both PTSD and addiction warrant concurrent treatment include:

• Using alcohol or drugs to prevent experiencing flashbacks, nightmares, or hyperarousal
• Continued worsening of PTSD symptoms while withdrawing from a substance or immediately during early sobriety
• Avoiding trauma treatment out of fear that sobriety alone won’t make it manageable
• History of multiple attempts at addiction treatment where the underlying trauma was not addressed
• Ongoing feelings of emotional numbness, detachment, or feeling unsafe without substances

You don’t need a formal PTSD diagnosis to reach out for help. Our clinical team will assess your situation at intake and determine the right level of care for your needs.

At Agape Detox Center, PTSD is treated as a core clinical focus within our integrated dual diagnosis program. All treatment at Agape is provided through a trauma-informed framework because our team understands how trauma can affect behavior, regulate the nervous system, and impact recovery.

• Trauma-Informed Assessment: Every client entering Agape undergoes a comprehensive mental health and psychological evaluation at intake, including trauma screenings. These evaluations identify co-occurring PTSD, evaluate the extent and degree of trauma and the client’s symptoms, and inform the development of an individualized treatment plan.
• Evidence-Based Trauma Therapies: The PTSD treatments used at Agape incorporate the most rigorously supported trauma-focused therapies available, including Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Eye Movement Desensitization and Reprocessing (EMDR) – an effective and well-researched treatment for PTSD.[10]
• Medication Management: Some clients benefit from medication as part of their PTSD treatment. Each client is evaluated on an individual basis by our psychiatry team and receives medication for PTSD symptoms such as sleep disturbance, hyperarousal, and depression if clinically necessary. Our psychiatry team works very closely with our addiction treatment team so that all medication decisions promote the client’s overall recovery plan.
• Holistic Treatment for PTSD: Healing from trauma requires more than just talking about it. At Agape Detox Center, our comprehensive holistic treatment approaches — including mindfulness practices, stress management, physical wellness programs, and nutritional education — are combined with our PTSD treatment protocols to provide support for regulating the entire person’s nervous system and healing.