Memorial Day is a good time to assess the condition of our returning military veterans, a group which is fraught with alarmingly high rates of PTSD, addiction and suicide. The rate of suicide among veterans is alarmingly higher than is found in the civilian population, and substance misuse is often involved in these tragedies. An underlying issue is PTSD, which is significantly higher among veterans than in the general population. Dr. Tom Horvath and Len Van Nostrand highlight the connection between PTSD and addiction and the critical role of treatment in healing our veterans….Dr. Richard Juman
As the month of May brings Armed Forces Day and Memorial Day, post-traumatic stress disorder, or PTSD, becomes a natural topic of discussion. Within this important conversation is the intricate relationship between PTSD and substance use.
Our greatest understandings of traumatic stress and post-traumatic stress often come from those who’ve experienced the horrors and devastation of war, which can last long after combat ends. For many veterans, the impacts of war remain as if it were yesterday. Heartbreakingly, their mind continues to be a battlefield of devastating, torturous memories and they are tasked with the challenge of coping with PTSD.
Casualties of War: The Somatic, Neurological and Psychological Systems
Traumatic stress impacts all of our systems, including the somatic, neurological and psychological systems. When we have painful thoughts and memories, we activate the various chemical and messenger systems of the body and experience distress, tension, anxiety and depression, resulting in ongoing deregulated emotions. Despite repeated efforts to avoid the painful memories and associated emotions, our minds and bodies remember. For reasons we may be only vaguely aware of, unresolved major trauma can result in seemingly unbearable emotions and physical sensations, negative and self-critical beliefs, interpersonal isolation and defensiveness, hypervigilance, and a deep sense of helplessness and hopelessness.
As if the assault on the somatic, neurological and psychological systems wasn’t enough, the deregulation of these systems can diminish the capacity for meaningful connection to others, eliminating a critical component of healthy coping. When left alone and consumed by traumatic stress, our coping can take many different forms, but engaging in addictive behavior is one of the most common.
Disturbing the Connection to Others
Trauma, especially war trauma, often has a substantial effect on our relationships. We are born with an innate need to attach to and connect with others. Our survival depends on the maintenance of these bonds. However, when our sense of connection and self-efficacy is ruptured, we no longer enjoy the ability to trust others or ourselves. The result is an inner world of numbness, terror and rage. With these bonds disturbed, our whole being is shocked and in an ongoing state of disequilibrium. Relationships lose their ability to provide us with a sense of safety and trust, and the need for relief from overwhelming negative emotions can become enormous.
Both situational (specific circumstances) and cumulative (ongoing and/or persistent) trauma can result in an inability to participate effectively in relationships. We can appear to be in a relationship, but the ability to connect and find meaningful attachment and security may not exist.
Everyone experiences some distress throughout the day, whether small, intense or catastrophic. When we confide in friends or family and trust others to listen to us, our distress is reduced. This form of emotional support keeps us regulated and able to handle a variety of stressors throughout the day (or week, month, year, or even lifetime). On a much larger scale, the same process can also be applied to the major distress caused by war. However, the traumatic experience of war can break down our trust in the emotional process, cause us to believe that we are no longer worthy of being listened to, or simply cause us to lose our ability to trust people. In such a state, we may search for another outlet for our emotional pain. Under such circumstances, drugs and alcohol (or even sex and gambling) have a powerful appeal. If the need for relief is strong, substances are typically very effective at providing that relief. Substance misuse becomes the solution to our universal need for connection. Perhaps alcohol, drugs, and destructive addictive behaviors can provide the most rapid and predictable relief from emotional pain.
Bonding With Substances and the Vicious Circle
Under these conditions, classic substance dependence can develop. Gradually, the substances replace our ability to cope with stress and tension. Rather than the development of resilience over time, we increasingly rely on the substance. Coping diminishes and substance use increases until the solution (substance use) has become the problem.
As inner capacities atrophy, and we abandon personal goals and relationships, our focus turns to more and more substance use. It becomes the primary, and ultimately, the only method to overcome numbness, terror, and rage. The new problems created by the “solution” add another layer of pain, isolation and immobility. We find ourselves in a vicious circle, which may not be escaped until a crisis occurs.
Treating Trauma and Substance Abuse
For someone with trauma, recovery is twofold: we not only need to start on a new path, but we must also work at overcoming the original issues. We must re-establish a basic trust in others and ourselves. Because trauma typically involves a substantial reduction in the capacity to experience, tolerate and articulate our inner experiences, significant psychotherapeutic work may be needed. No matter how painful, the journey to rediscovering your worth, restoring healthy relationships, and recovering from substance misuse and the effects of trauma is full of hope and certainly worth the effort.
The Practical Recovery and Full Spectrum Recovery teams express sincere appreciation for our veterans and service members. We recognize the immense internal battles that will be fought long after the external ones have ended. The trauma is real and the war wages on within many of them. Undeniably, we owe a deep gratitude for the expansive lives we are able to lead because of their sacrifices.
If you or someone you know suffers from trauma and substance abuse, please don’t be afraid to reach out – there is help.
Len Van Nostrand, a Licensed Marriage and Family Therapist, is the co-founder and owner of Full Spectrum Recovery and Counseling. He is trained in a variety of modalities, including TRE (Trauma/Tension Release Exercises), EMDR, hypnotherapy and Motivational Interviewing, and he has maintained a therapy and intervention practice for over fifteen years. He also facilitates weekly SMART recovery groups.
A. Tom Horvath, PhD, ABPP, is the founder and president of Practical Recovery in San Diego, CA, a self-empowering addiction treatment system including sober living, outpatient services and two residential treatment facilities for alcohol and drug abuse. He is also the president of SMART Recovery, an international nonprofit offering free, self-empowering, science-based, mutual-help groups for addiction recovery. A past president of the Society of Addiction Psychology, he is the author of Sex, Drugs, Gambling & Chocolate: A Workbook for Overcoming Addictions.