If your loved one is trying to change their relationship to substances while at the same time managing symptoms of Post-Traumatic Stress Disorder (PTSD) it can be difficult to understand what is happening for them and how to be helpful. Substance misuse and trauma have a very unique and interconnected relationship. Studies have found that anywhere from 30-60% of substance abusing clients seeking treatment also suffer from a co-occurring diagnosis of Post-Traumatic Stress Disorder (PTSD).
While most people in their lives experience some degree of trauma, not everyone goes on to develop PTSD. Many people naturally recover from a traumatic experience, while others continue to have trouble related to trauma, and continue to experience symptoms of avoidance and anxiety.
Avoidance of trauma reminders (either through behaviors like avoiding triggers, or by using substances) has a powerful short term, and immediate pay off. Having a drink or using a drug can instantly reduce anxiety and other symptoms, however there are likely many long term consequences and many symptoms of trauma (e.g., relationship issues, insomnia, depression) remain. PTSD does not resolve through avoidance, and using substances can actually exacerbate symptoms. So your loved can end up with 2 painful problems, PTSD and a substance use problem.
If your loved one is living with PTSD, their world can become a very constricted and small place. Isolation, poor overall functioning at work and in relationships, and other problems like depression and anxiety, can be the outcome of untreated PTSD symptoms. Second, using substances to manage trauma-related symptoms can add a host of other problems that can ultimately result in physical and emotional dependence on substances.
Why Talk About Trauma?
Many family members understandably just want their loved one to stop using substances and don’t recognize that unresolved PTSD symptoms can be driving substance use choices, often leading to relapse. By recognizing this relationship, you can develop more compassion for the issues your loved one faces and why they are using substances. You can also be better equipped to identify resources that may help them address the relationship between trauma and substance use choices. There are a variety of evidence-based treatments such as Prolonged Exposure (PE), Eye-Movement Desensitization (EMDR), and Skills Training in Affect and Interpersonal Regulation (STAIR) to treat traumatic disorders. Additionally, meditation, yoga and other body-based modalities have been found to reduce symptoms.
PTSD does not fade with time and can have a terrible impact on your loved one’s ability to cope with and enjoy life. PTSD is, however, highly treatable. There are skills your loved one can learn to manage anxiety. Life does not have to be fear-based, small, or constricted! By educating yourself about trauma’s impact and ways to address you can help your loved one thrive.
Helping Someone with Trauma
As you try to help, there are a few things to keep in mind. While you may be frustrated, angry or scared due to your loved ones substance use choices, it likely that your loved one has been doing the best they can considering their current circumstances. Trauma can cause shame and deep reluctance to talk about either the traumatic event(s) and symptoms they are experiencing. Often, those with PTSD feel that what happened is their fault and may even feel guilty for letting it happen. As you try to engage with them, be mindful of creating a non-judgemental, curious, compassionate approach to asking questions about their experience or symptoms and try to manage your own intense emotions. It can also be helpful to try and be a consistent cheerleader for your loved one. PTSD is maintained by avoidance as a coping strategy because facing memories, trauma triggers or symptoms can be very scary. You can encourage them to face these things by being supportive and neutral as they begin treatments that may initially stir up anxiety.
It’s important to remember that PTSD is out of your loved one’s control and they will need to set the pace as they engage in treatment and try to face their fears and other feelings. It can help a lot to have a family member who is open to hearing about their experiences but also respectful of boundaries and willing to simply let silence be present if that is what they need. While some of the things you hear may be deeply disturbing it is important to not express intense horror or anger, as it may cause your loved one from opening up in the future because they want to protect you from these feelings.
You may also want to consider getting support for yourself and practice compassion and self-care for yourself as you try to help. Remember, behavior change in general often takes a long time and is a process of a step forward and back (sometimes two). If your loved one is also suffering from PTSD this process may move along at a slower pace and will have it’s own setbacks and triumphs. You will be better equipped to help and tolerate the process if you are taking good care of yourself!