How PTSD and Substance Use Disorders Are Connected
Post-Traumatic Stress Disorder (PTSD) and Substance Use Disorders (SUDs) are both complex, deeply personal mental health challenges that can have a significant impact on an individual’s well-being, relationships, and functioning. While each can exist independently, research and clinical experience consistently show a strong link between the two. For many people, trauma and substance use are intertwined in a cycle that can be difficult to break without compassionate, specialized care.
At Silver Lining Counseling, we frequently work with clients who are navigating both trauma and substance use. Understanding the relationship between PTSD and SUDs is essential to offering integrated, effective treatment that meets the needs of the whole person.
Understanding PTSD
PTSD is a mental health condition that can develop after someone experiences or witnesses a traumatic event. This may include events such as military combat, sexual or physical assault, childhood abuse, natural disasters, accidents, or sudden loss. Not everyone who experiences trauma develops PTSD, but for those who do, the impact can be lasting and disruptive.
Common symptoms of PTSD include:
Intrusive memories or flashbacks of the traumatic event
Avoidance of people, places, or situations that are reminders of the trauma
Negative changes in thoughts and mood, such as persistent guilt, shame, or emotional numbness
Heightened arousal, including being easily startled, difficulty sleeping, or irritability
These symptoms often interfere with daily life, relationships, and the ability to feel safe in one’s own body.
Understanding Substance Use Disorders (SUDs)
A Substance Use Disorder is a chronic condition characterized by the compulsive use of drugs or alcohol despite harmful consequences. SUDs can affect the brain's reward system, decision-making, and impulse control. While some people may begin using substances recreationally, over time this can evolve into a pattern that feels impossible to manage or stop.
Common substances involved include alcohol, prescription medications, marijuana, stimulants, opioids, and others. SUDs can vary in severity, but even mild cases can interfere with emotional, physical, and relational health.
The Connection Between PTSD and Substance Use
There is a significant overlap between PTSD and substance use disorders. According to research, individuals with PTSD are significantly more likely to develop a substance use disorder, and vice versa. In fact:
Around 46% of people with lifetime PTSD also meet criteria for a substance use disorder.
Veterans with PTSD are twice as likely to struggle with alcohol use and three times more likely to abuse drugs compared to those without PTSD.
People with SUDs are more likely to have a history of trauma or meet diagnostic criteria for PTSD.
Why is the connection so strong? The answer lies in the ways people cope with trauma and how substances interact with the nervous system.
Self-Medication: Using Substances to Cope
One of the primary reasons PTSD and SUDs often co-occur is the use of substances as a form of self-medication. Trauma survivors may turn to drugs or alcohol in an attempt to:
Numb emotional pain
Avoid traumatic memories or flashbacks
Soothe anxiety, panic, or hypervigilance
Sleep through nightmares or insomnia
Temporarily feel control or relief
While these coping mechanisms may provide short-term relief, they often come with long-term consequences. Over time, reliance on substances can exacerbate mental health symptoms, disrupt relationships, damage physical health, and lead to dependency or addiction.
The Cycle of Trauma and Substance Use Disorders
When trauma and addiction co-exist, they can create a reinforcing cycle. For example:
A person experiences trauma and develops PTSD symptoms.
To cope, they begin using substances.
Substance use provides temporary relief but worsens anxiety, depression, or sleep over time.
The negative consequences of substance use (e.g., relationship strain, job loss, legal trouble) increase stress and feelings of shame.
This stress further aggravates PTSD symptoms, leading to more substance use.
Breaking this cycle requires integrated treatment that addresses both trauma and addiction simultaneously.
Why Integrated Treatment Matters
Historically, mental health and substance use disorders were treated separately—often with the expectation that a person must become sober before addressing trauma. Today, research supports a different approach. Integrated treatment, where PTSD and substance use are addressed together, leads to better outcomes and lasting recovery.
At our practice, we offer trauma-informed, evidence-based care that respects the complexity of each person’s experience. Some of the key principles of integrated treatment include:
Safety First: Creating a secure, nonjudgmental therapeutic environment is essential, especially for those with trauma histories.
Understanding the Role of Substances: Therapists help clients explore how substances functioned in their lives and develop healthier coping strategies.
Addressing the Nervous System: Trauma and addiction both affect the nervous system. We incorporate somatic therapies and mindfulness-based approaches to help clients regulate their bodies and emotions.
EMDR and Other Trauma Therapies: Techniques like Eye Movement Desensitization and Reprocessing (EMDR), Cognitive Processing Therapy (CPT), or Trauma-Focused CBT can help process traumatic memories safely and effectively.
Relapse Prevention: Understanding trauma triggers is crucial in preventing relapse. We work with clients to build awareness and resilience.
Support Systems: Healing from both PTSD and SUDs often requires social support. Group therapy, 12-step or alternative recovery communities, and family involvement can be valuable.
What Healing Can Look Like
Recovery from PTSD and substance use doesn’t happen overnight. It takes time, trust, and a willingness to face the pain of the past with support. But healing is possible.
Many of our clients who have experienced trauma and addiction come to therapy feeling stuck, ashamed, or afraid. Over time, they begin to reconnect with themselves. They learn to manage their triggers, feel emotions without being overwhelmed, and make meaning out of their experiences. As substance use decreases or stops, they often rediscover their capacity for joy, connection, and inner peace.
When to Seek Help
If you or someone you love is struggling with both trauma and substance use, it’s important to know you’re not alone—and help is available. Consider reaching out if you notice:
You’re using drugs or alcohol to cope with painful memories or emotions
You’ve experienced trauma and feel stuck in fear, anger, or numbness
Your substance use is interfering with your health, work, or relationships
You want to heal but don’t know where to start
At Silver Lining Counseling we’re here to walk with you through the process. We offer compassionate, comprehensive care tailored to your needs, whether you’re new to therapy or returning after time away.
Final Thoughts
PTSD and substance use disorders often develop together, feeding off one another in a painful loop. But with the right support, that cycle can be broken. Integrated therapy that addresses both trauma and addiction can lead to meaningful, lasting change.
You deserve healing—not just from the trauma itself, but from the strategies that no longer serve you. If you’re ready to begin your journey, we’re here to help.