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Untangling the Knot of Comorbid PTSD and Addiction

Because it’s not uncommon for two conditions to show up at the same time, medicine has a word for the phenomenon – comorbidity. In the case of post-traumatic stress disorder (PTSD), many people with the condition are often struggling with some form of addiction at the same time. A person who is willing to seek help for PTSD can be gently helped to also address their addiction issue, but treating the PTSD should take precedence. This treatment approach is referred to as the trauma-informed method. As many as 59 percent of those treated for addiction are also struggling with some level of PTSD. That is not to say that most people who experience trauma will develop PTSD and a comorbid addiction. Actually, only one-third of those who experience a significant life trauma go on to battle PTSD. But when a person does have PTSD, there is a high probability they will also struggle with addiction. Of men with PTSD, 52 percent also struggle with alcohol abuse and 35 percent will have a problem with substance abuse. The fact that two health issues frequently co-exist suggests some common source. Addiction is like a river with several tributaries, with family history a large factor. If someone in their immediate family has substance abuse problems, chances are greater that the person will also have this issue because addiction appears to run in families. Heredity is a causal factor, but family environment also increases the risk of addiction, since most of us tend to repeat behaviors that were modeled for us. Whatever the shared source, PTSD and addiction often go hand-in-hand. The negative emotions and anxieties associated with PTSD can feel overwhelming, and if a person finds that a substance allows them to escape from that stress, functioning as coping mechanisms, and then it’s simply a matter of time for that to become a compulsion. Trauma-informed treatment addresses the PTSD first, with the patient then taught coping strategies for the addiction. In other words, the clinician does not demand that the patient surrender their coping mechanism in order to be treated for PTSD. Oftentimes, as the anxiety disorder resolves, the dependency on maladaptive coping mechanisms does as well. Clinicians who follow this method do require that patients participate in regular counseling and that they do so sober. In this way, there is an opportunity to address addiction as a component of the unraveling knot of PTSD. In short, it’s best to focus on one thread when untangling a knot.

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