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Posted: July 3, 2009 12:30 a.m.

The link between PTSD The link between PTSD

Posttraumatic stress disorder and substance abuse are closely connected. Although the link frequently goes unrecognized, PTSD is one of the most common dual diagnoses for those with substance abuse problems. Research confirms that among women in treatment for substance abuse, 30 to 59 percent have co-occurring PTSD; among men in treatment for substance abuse, 11 to 38 percent have current PTSD. Women with PTSD and substance abuse typically experienced childhood physical and/or sexual abuse; men with both disorders typically experienced crime victimization or war trauma. Among those with both PTSD and substance abuse, four patterns are common.

1. PTSD may lead to substance abuse in an effort to self-medicate, to escape from feelings or memories. For instance, many start out using alcohol "to get to sleep at night."

2. Substance abuse may lead to PTSD. Using drugs or alcohol can increase the likelihood of exposure to dangerous, traumatic situations because it can interfere with insight and good judgment. For instance, low self-esteem combined with excess alcohol in a social situation can lead to going home with a stranger who assaults you.

3. PTSD and substance abuse often co-occur. It is common for those raised in a home where family members abused substances to have also witnessed or experienced abuse, either physical or emotional. Either experience plays a huge role in development on all levels and often leaves its victims unable to develop and sustain long-term relationships characterized by depth and healthy intimacy.

4. PTSD and substance abuse may result in a "downward spiral," which I sometimes refer to as "the long goodbye," or the "slow suicide," with an increased risk of re-victimization along the way. Research shows that victims of sexual abuse are at significant risk for re-traumatization, which increases the likelihood of more substance abuse in an effort of "cope," and so on and so on. Unfortunately, those with both PTSD and substance abuse problems tend to abuse the most dangerous substances: alcohol, cocaine, opiates and amphetamines.

Two main themes emerge in both disorders: secrecy and control. "Secrecy" typically reflects feelings of shame and the wish to keep traumatic experiences and the details of dysfunctional coping hidden. "Control’ refers to the fact that with trauma and substance abuse come feelings of being out of control. In sum, the relationship between the disorders is complex, e.g. using substances can either increase or decrease PTSD symptoms but abstinence from substances can also either increase or decrease PTSD symptoms. If you suspect either diagnosis in a loved one, seek immediate professional help. The road to recovery is far too treacherous and the risks far too great to journey alone in the dark when there are psychological, behavioral and medical interventions available with proven track records.

Peggy Nolen is a licensed professional counselor in Covington. Her areas of interest include anxiety, depression, recovery from traumatic experience and problems with drugs and alcohol. She can be reached at (770) 3134-5924

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