Key Takeaways
- Approximately 46 percent of individuals with PTSD also meet criteria for a substance use disorder, making this one of the most common co-occurring combinations.
- Trauma alters the brain's stress-response system, creating hyperarousal and emotional dysregulation that drive substance use as a coping mechanism.
- Substances may temporarily numb PTSD symptoms like flashbacks, nightmares, and hypervigilance, but they prevent the brain from processing and resolving traumatic memories.
- Evidence-based treatments including EMDR, CPT, and prolonged exposure therapy can effectively treat PTSD alongside addiction when delivered by trained clinicians.
- Trust SoCal provides trauma-informed dual diagnosis treatment in Southern California with clinicians trained in both trauma therapy and addiction counseling.
The Link Between PTSD and Addiction
Post-traumatic stress disorder and addiction are two of the most frequently co-occurring conditions in behavioral health. Research from the U.S. Department of Veterans Affairs indicates that nearly half of all individuals seeking treatment for substance use disorders also meet criteria for PTSD. This staggering overlap reflects the powerful role that trauma plays in driving substance use.
PTSD develops after exposure to a traumatic event such as combat, sexual assault, a serious accident, childhood abuse, or witnessing violence. The condition is characterized by four symptom clusters: intrusive re-experiencing of the trauma, avoidance of trauma-related stimuli, negative changes in cognition and mood, and hyperarousal. Each of these symptom clusters creates powerful motivations to seek chemical relief.
At Trust SoCal in Orange County, our clinical team recognizes that effective addiction treatment must address the traumatic experiences that often underlie substance use. Without resolving the trauma, the drive to self-medicate remains, and relapse becomes far more likely.
How Trauma Changes the Brain
Traumatic experiences produce lasting changes in brain structure and function that directly increase vulnerability to addiction. Understanding these neurobiological changes helps explain why willpower alone is rarely sufficient for recovery from co-occurring PTSD and substance use disorders.
The Hyperactive Amygdala
The amygdala, the brain's threat-detection center, becomes hyperactive following trauma. This heightened state of alertness means that the individual perceives danger in situations that are objectively safe, leading to chronic anxiety, exaggerated startle responses, and difficulty relaxing. Substances that suppress central nervous system activity, such as alcohol, opioids, and benzodiazepines, can temporarily quiet this overactive alarm system.
Over time, the brain adapts to the presence of these substances, requiring increasing amounts to achieve the same calming effect. Meanwhile, the amygdala remains hyperactive whenever the substance is not present, creating a pattern of escalating use that characterizes addiction.
Impaired Prefrontal Cortex Function
Trauma also compromises the prefrontal cortex, the brain region responsible for rational decision-making, impulse control, and emotional regulation. When the prefrontal cortex is functioning below capacity, individuals are more likely to act on impulse, less able to weigh long-term consequences, and less equipped to manage intense emotions without external help.
This impairment helps explain why individuals with PTSD may continue using substances despite clear negative consequences. The brain regions needed to make rational decisions about substance use are precisely the regions that trauma has compromised.
Dysregulated Stress Hormones
PTSD disrupts the hypothalamic-pituitary-adrenal axis, the body's central stress-response system. Cortisol and norepinephrine levels become chronically elevated or dysregulated, producing a persistent state of physiological stress. This chronic stress state depletes the brain's natural feel-good chemicals and creates an ongoing need for external sources of relief.
Substances temporarily normalize stress hormone levels, providing a fleeting sense of calm and equilibrium. This biochemical relief is so powerful that it can override conscious awareness of the harm substances are causing, driving continued use even when the individual desperately wants to stop.
Common Patterns of Substance Use in PTSD
Different substances tend to be associated with different PTSD symptom clusters, reflecting the specific types of relief that individuals are seeking. Understanding these patterns helps clinicians develop targeted treatment plans that address the underlying symptoms driving substance use.
Alcohol and opioids are most commonly used to manage hyperarousal symptoms such as insomnia, irritability, and exaggerated startle response. These central nervous system depressants produce sedation and emotional numbing that temporarily relieves the exhausting state of constant vigilance that characterizes PTSD.
Stimulants including cocaine and methamphetamine may be used to counteract the emotional numbing and withdrawal that constitute the avoidance and negative cognition symptom clusters. Cannabis is often used for its combined anxiolytic and sleep-promoting effects, though research on its long-term impact on PTSD outcomes remains mixed.
Veterans are at particularly high risk for co-occurring PTSD and substance use disorders. The Veterans Administration reports that more than two in ten veterans with PTSD also have a substance use disorder, with alcohol being the most commonly misused substance.
Why Treating Trauma Is Essential for Addiction Recovery
Addiction treatment that ignores underlying trauma is incomplete at best and counterproductive at worst. When substances are removed without addressing the traumatic memories and physiological dysregulation that drive their use, the individual is left facing raw, unprocessed pain with no coping tools. The predictable result is relapse.
Research consistently demonstrates that integrated treatment addressing both PTSD and addiction produces superior outcomes compared to sequential treatment. A landmark study published in the Journal of the American Medical Association found that individuals receiving integrated trauma and addiction therapy showed greater reductions in both PTSD symptoms and substance use compared to those receiving addiction treatment alone.
At Trust SoCal, trauma processing is not an afterthought added to addiction treatment. It is a central component of our clinical program, woven into the treatment experience from the earliest stages of recovery when clinically appropriate.
Evidence-Based Therapies for PTSD and Addiction
Several therapeutic approaches have demonstrated effectiveness for co-occurring PTSD and substance use disorders. The selection of therapy depends on the nature of the trauma, the severity of symptoms, and the client's readiness for trauma processing.
Eye Movement Desensitization and Reprocessing
EMDR uses bilateral stimulation, typically guided eye movements, to help the brain reprocess traumatic memories so they become less emotionally charged. EMDR does not require the client to describe the trauma in detail, which makes it particularly appealing to individuals who find traditional talk therapy about trauma overwhelming.
Research supports EMDR's effectiveness for PTSD, and emerging evidence suggests it may also reduce cravings and substance use when applied in the context of dual diagnosis treatment. Trust SoCal clinicians are trained in EMDR and integrate it into individualized treatment plans as appropriate.
Cognitive Processing Therapy
Cognitive processing therapy helps individuals examine and challenge the distorted beliefs about themselves, others, and the world that develop after trauma. Common trauma-related beliefs like "I am damaged," "The world is completely dangerous," or "I should have prevented it" maintain PTSD symptoms and drive substance use.
By systematically evaluating and restructuring these beliefs, CPT reduces PTSD symptoms and helps clients develop a more balanced perspective that supports both emotional healing and sustained recovery from addiction.
Seeking Safety
Seeking Safety is a manualized therapy specifically designed for co-occurring PTSD and substance use disorders. It focuses on establishing physical, emotional, and behavioral safety as a foundation for recovery. Unlike exposure-based therapies, Seeking Safety does not require clients to process traumatic memories directly, making it suitable for early-stage treatment.
The program teaches coping skills organized around themes such as honesty, asking for help, setting boundaries, and self-care. These skills address both PTSD and addiction simultaneously and provide a practical toolkit that clients can use throughout their recovery journey.
The Importance of Timing in Trauma Treatment
One of the most common questions in dual diagnosis treatment is when to begin trauma processing. Historically, clinicians waited until clients had achieved sustained sobriety before addressing trauma, reasoning that the emotional intensity of trauma work could trigger relapse. Contemporary research, however, supports beginning trauma-focused therapy earlier in the treatment process.
The key is matching the type and intensity of intervention to the client's current stability. Stabilization and psychoeducation can begin immediately, coping skills development follows quickly, and direct trauma processing is introduced when the client has sufficient emotional regulation capacity and a supportive therapeutic relationship.
At Trust SoCal, our clinicians continuously assess each client's readiness for trauma work and adjust the treatment plan accordingly. This individualized pacing ensures that trauma is addressed thoroughly without overwhelming the client's coping resources.
If you have experienced trauma and are struggling with substance use, you do not need to wait until you are completely sober to begin addressing the trauma. Integrated programs can help you work on both issues safely from the start of treatment.
PTSD and Addiction Treatment at Trust SoCal
Trust SoCal offers specialized treatment for co-occurring PTSD and addiction from our facility in Fountain Valley, Orange County. Our clinical team includes therapists trained in EMDR, cognitive processing therapy, and other evidence-based trauma modalities, all working within an integrated dual diagnosis framework.
We understand that seeking treatment for trauma and addiction requires extraordinary courage. Our team is committed to providing a safe, nonjudgmental environment where healing from both conditions is possible. Contact our admissions team today to learn more about how we can help.
Rachel Handa, Clinical Director
Clinical Director & Therapist
