Double Whammy: Substance Abuse and PTSD

PTSD and Addiction

Double Whammy: Substance Abuse and PTSD

October 19, 2014
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The use of addicting and illegal drugs is an ongoing problem for many people suffering from PTSD. It’s estimated that about half of the men and a quarter of the women qualify for a Substance Abuse diagnosis. Among Vietnam veterans, it’s closer to 80%, probably because there were fewer treatment options forty years back. Unfortunately, people with both PTSD and Substance Abuse have a more difficult time with recovery, suffer more PTSD symptoms, and are at higher risk of suicide.

Alcohol and Benzodiazepines:

The most commonly used drug is alcohol, probably since it’s legal. When you can’t sleep, it’s easy to pour yourself a drink. At first it works. This encourages you to have one every night, or maybe two, or three.

What most people don’t realize is that alcohol, and also the benzodiazepines like Valium, Xanax, Klonopin, and Ativan, lull you with calmness while dragging you down into a very deep hole. Problems arise because these drugs work by releasing a chemical called GABA. GABA is the primary calming chemical in the brain, the off switch on our neural TV screen, so releasing GABA turns worries off and calms you down.

What’s wrong with that?

The problem comes with the word “release”. Our brains can make GABA, but not quickly. So if we release some GABA once a week—no problem. If we release it once a day—probably okay. But if we start releasing quantities of GABA several times a day for weeks or months, we get in serious trouble because we don’t have enough GABA left.

Since GABA is the off switch in the brain, not having enough means our brain gets very hyper. We start to shake, get irritable and angry, can’t sleep, and can progress to hallucinations— even seizures. Delirium Tremens, commonly called DTs, can be lethal, and benzodiazepine withdrawals are equally dangerous. Even if you keep on drinking or taking pills, they no longer work because there’s less GABA to release.

Bottom line: Go easy on the alcohol and benzos. They may help in an emergency, but they can make serious trouble if you use them all the time.


Marijuana is now legal in some states. It’s reported to reduce both anxiety and flashbacks, and there is actually a scientific basis for this claim. Recent research shows a reduction in natural cannabinoids in the brains of people with PTSD and an increase in cannabinoid receptors (your brain is listening hard for a weak signal).

Now there is further evidence that cannabis can help with PTSD. Recent research suggests that using MJ right after a trauma may actually prevent PTSD. It also can be useful during exposure therapy as it helps to disconnect your triggers from your memories. Hopefully MJ will soon become available for medical use in all fifty states, but be very sure your state has approved it before using. Being arrested and incarcerated is a very serious side effect that creates more problems in your life.

Side effects from MJ include reduced short-term memory and reduced focus and motivation. There may be new strains that have reduced these problems, but both standard marijuana and cannabinoids synthesized by pharmaceutical companies. (Yes, they would love to make money off of you) can produce these side effects.

Finally, if you’re under twenty-five your brain is still maturing and MJ poses a more serious risk. Cannabinoids have been proven to increase both depression and psychosis in young brains, and the problem continues long after you stop use.

Bottom line: Cannabinoids found in marijuana can be helpful in PTSD, but they can impair your memory and focus. If you use, please evaluate for side effects and keep yourself safe.


Opiates are popular with PTSD clients for two reasons. First, opiates have an alpha-blocking component which helps calm down hyper-arousal symptoms. Second, they block pain. Many survivors have physical injuries, and emotions associated with traumatic memories can also cause distress, so a drug that reduces that discomfort is tempting.

But if you take opiates for any length of time, you develop tolerance and they no longer work. That’s because the opiates replace your natural pain reducing chemicals—endorphins. The more opiates you use, the less natural pain chemicals you make.

Then you face a difficult decision. You can’t keep increasing your dose indefinitely. Using the same dose of opiate doesn’t work. And if you stop, you’re body reacts with serious discomfort and intestinal distress until it can remake it’s own endorphins. Luckily, opiate withdrawals aren’t lethal, but they’re painful.

Bottom line: Instead of narcotics, try alpha-blockers like Prazosin, or sedatives containing alpha blockers like Trazodone or Seroquel. Then work on letting go of your emotional pain using techniques in the blog: Treatment for Flashbacks, Nightmares, and Intrusive Memories. If you need them for pain, work with a professional to find appropriate alternatives to reduce the amount of opiates you need.

Cocaine, Crack, Methamphetamine:

These drugs work by releasing dopamine, a chemical that activates the pleasure center in our brain. That makes them the most addicting drugs around– and the most dangerous. They release so much dopamine so fast they can burn out your dopamine receptors. After that nothing can make you feel good for a long, long time.

Worse yet, these drugs can kill you with a heart attack or stroke. When a person under 30 shows up in the ER with symptoms of MI or stroke, the doctors always test them for cocaine and meth, and usually find it.

Bottom line: Just don’t. If antidepressants aren’t working for you, try X-sports. They’re safer than these drugs.


MDMA was used as an adjunct to therapy back in the 1970s and ’80s, and now there is renewed interest in the drug. Research shows that MDMA can raise serotonin and norepinephrine levels and improve functioning in the medial lateral prefrontal cortex, which in turn down-regulates the amygdala and controls negative emotions. It also increases prolactin, our “love” hormone.

That certainly suggests it should help PTSD. I just read a pilot study on 25 PTSD patients in exposure therapy.  They found that the group receiving MDMA did better than the control group following two or three therapy sessions, and the medicated group continued to improve through the next year. There were no serious side effects noted.

I expect MDMA to rejoin the list of medications that help people process traumatic memories.

Psilocybin, LSD, and other hallucinogens:

In spite of the fascinating stories I’ve heard, I’ve found no scientific research to show these actually help PTSD symptoms. If you disagree, keep me informed.

Bottom line:

If you’re addicted to a drug, don’t give up hope. Calming your arousal symptoms (see Treatment for Hyper-Arousal) can greatly reduce your need for drugs.

Research suggests that it’s best to find a counselor who can work with both your addiction and PTSD, but an integrated group where the professionals confer will also work. In most cases, your PTSD symptoms will drive the substance use, so you need to treat them simultaneously.


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