PTSD and Substance Abuse: Why Trauma Survivors Turn to Substances (And How to Heal)

PTSD and substance abuse frequently occur together because trauma survivors often turn to alcohol or drugs to manage symptoms that feel unmanageable on their own. Flashbacks, hypervigilance, nightmares, and emotional numbness are exhausting to live with, and substances can temporarily silence all of it. 

What starts as a way to cope gradually becomes a dependency, and by the time most people seek help, they are managing two serious conditions instead of one. 

As someone who has worked with trauma survivors and individuals struggling with substance use in Sacramento for nearly two decades, I have seen this pattern play out in very real ways. People do not start drinking or using drugs because they want to create problems for themselves. They do it because something painful happened, and substances offered what felt like relief. 

Understanding why that happens, and what integrated treatment for both conditions actually looks like, is what this article covers. 

What Is PTSD and Who Does It Affect?

Post-traumatic stress disorder, or PTSD, is a mental health condition that develops after a person experiences or witnesses a traumatic event. This can include combat exposure, sexual assault, physical violence, childhood abuse, accidents, natural disasters, or the sudden loss of someone close. It is not limited to any one group, age, or background.

According to the U.S. Department of Veterans Affairs, approximately 6% of the U.S. population will experience PTSD at some point in their lives. Among combat veterans, that number is significantly higher. But PTSD is not only a veteran’s issue. It affects survivors of domestic violence, first responders, people who grew up in chaotic or abusive households, and anyone who has lived through something that their nervous system could not fully process.

Common symptoms of PTSD include flashbacks, nightmares, persistent anxiety, emotional numbness, hypervigilance, difficulty sleeping, and a tendency to avoid people, places, or situations that trigger memories of the trauma. When those symptoms go untreated, they do not just fade on their own. They look for an exit.

Why PTSD and Substance Abuse Occur Together 

The relationship between PTSD and substance abuse is not random. There is a very specific psychological and neurological reason why the two so often appear together, and it starts with what trauma does to the brain.

When someone experiences trauma, their brain’s stress response system becomes dysregulated. The amygdala, which processes fear and threat, becomes hyperactive. The prefrontal cortex, which handles rational thinking and emotional regulation, becomes less effective. The result is a nervous system that stays stuck in a heightened state of alertness, even when the actual danger is long gone.

Substances like alcohol, opioids, benzodiazepines, and cannabis have a direct effect on these same brain systems. Alcohol suppresses the central nervous system and can temporarily quiet the hyperarousal that PTSD produces. Opioids flood the brain’s reward pathways and create a sense of warmth and detachment from pain. Stimulants can create a sense of control or energy that feels impossible to access otherwise. In the short term, these effects feel like relief. The problem is that relief is temporary, and the brain adapts quickly.

Research published by the National Institute on Drug Abuse confirms that people with PTSD are two to four times more likely to develop a substance use disorder than those without PTSD. That overlap is not coincidence. It is biology.

Over time, the brain begins to depend on the substance to regulate what it can no longer regulate on its own. Tolerance builds, meaning more of the substance is needed to produce the same effect. Withdrawal symptoms emerge when the substance is not available, and those symptoms often look similar to PTSD symptoms themselves: anxiety, insomnia, irritability, and a sense of dread. The person uses more to manage the withdrawal. The cycle continues.

This is sometimes called a dual diagnosis, or co-occurring disorders, and it requires a treatment approach that addresses both conditions simultaneously rather than treating one and ignoring the other.

The Substances Trauma Survivors Most Commonly Use to Cope 

While any substance can become a coping mechanism, certain ones appear more frequently among trauma survivors based on the symptoms they are trying to manage.

Alcohol

Alcohol is the most widely used substance among people with PTSD. It is legal, socially acceptable, and immediately accessible. Many trauma survivors begin drinking heavily to fall asleep, to numb emotional pain, or to reduce social anxiety after trauma has made it difficult to feel safe around people.

The initial sedative effect feels like a solution. Over time, alcohol disrupts sleep quality, increases anxiety, and worsens depression, making the original symptoms significantly harder to manage without it.

Opioids and Prescription Painkillers

For survivors of physical trauma, whether from accidents, combat injuries, or violence, opioid prescriptions are sometimes part of the initial medical treatment. The emotional numbing that opioids produce can feel especially appealing to someone managing psychological pain alongside physical pain. 

This is part of why the overlap between opioid use disorder and PTSD is so significant, particularly among veterans and first responders.

Cannabis

Many trauma survivors report using cannabis to manage hypervigilance, nightmares, and anxiety. While some research suggests certain components of cannabis may have modest effects on PTSD symptoms, regular heavy use is associated with increased anxiety, emotional blunting, and in some cases, psychosis-like symptoms.

It can also interfere with processing trauma in therapy, which is an important consideration when someone is trying to heal.

Stimulants

Some people with PTSD, particularly those who experience emotional numbness or dissociation, turn to stimulants like cocaine or methamphetamine to feel something or to regain a sense of control and energy. This is less common than alcohol or opioid use, but it is a pattern I have seen, especially among individuals whose trauma involved situations where they felt completely powerless.

PTSD and Substance Abuse in Veterans: Why This Population Is at Higher Risk

Veterans are one of the groups most significantly affected by the intersection of PTSD and substance abuse. Military service exposes people to repeated trauma over extended periods, often without adequate time or resources to process it. By the time many veterans return to civilian life, they are carrying layers of unresolved trauma that civilian support systems are often not equipped to address.

According to the U.S. Department of Veterans Affairs, more than one in five veterans with PTSD also have a substance use disorder, and about one third of veterans seeking treatment for substance use also meet the criteria for PTSD. Treating one without the other consistently produces weaker outcomes.

Many veterans do not identify their drinking or drug use as trauma-related. They see it as a way to unwind or sleep, and by the time the substance use becomes undeniable, the PTSD driving it has often gone unaddressed for years.

I cover this in more detail in this article on why veterans are at higher risk for substance misuse.

First responders, including police officers, paramedics, and firefighters, face a similar pattern. Repeated exposure to traumatic events on the job, combined with a workplace culture that discourages showing vulnerability, creates conditions where self-medicating becomes normalized long before anyone seeks help.

Signs Someone May Be Dealing With Both PTSD and Substance Use

When PTSD and substance abuse occur together, the signs can be easy to miss or misattribute to stress, personality, or simply going through a rough patch. Understanding what to look for is often the first step toward getting the right kind of help.

Some of the most common behavioral signs include:

• Using alcohol or drugs specifically to fall asleep or to get through situations that trigger anxiety or fear
• Avoiding people, places, or conversations that bring up memories of a traumatic event
• Feeling unable to get through the day or night without a substance, even when genuinely wanting to stop
• Noticeable mood swings or emotional shutdown after exposure to a trauma reminder
• Difficulty functioning at work or in relationships that cannot be explained by outside circumstances alone

Physical signs often appear alongside these behavioral patterns as well. Disrupted sleep, chronic fatigue, and a heightened startle response are all common. Many people also experience withdrawal symptoms when substances are not available, including irritability, sweating, and intense anxiety, which can look almost identical to a PTSD response and make it difficult to know which condition is driving the symptoms.

What makes this combination particularly hard to recognize is that each condition can mask the other. The substance use looks like the main problem from the outside, while the trauma driving it stays hidden underneath.

It is also worth noting that depression frequently develops alongside both PTSD and substance use, further complicating the picture. I cover that overlap in this article on depression and addiction. 

How Trauma Affects Families and Relationships

PTSD and substance abuse rarely affect only the individual. The people closest to a trauma survivor often carry their own weight of confusion, fear, and grief. Partners may not understand why the person they love has become emotionally unavailable, quick to anger, or dependent on alcohol. Children in the household pick up on the tension and anxiety, even when adults believe they are hiding it. Family members often alternate between trying to help and pulling away out of exhaustion or hurt.

When substance use is part of the picture, family dynamics become even more strained. Loved ones may feel like they are walking on eggshells, unsure of which version of the person they will encounter on any given day. If your family is experiencing this, family counseling can provide a structured space to rebuild communication and begin to address what everyone in the household is carrying.

Spouses and partners of trauma survivors who struggle with substance use often develop their own anxiety, depression, or patterns of codependency. Recognizing that the entire family system is affected is an important part of moving toward meaningful recovery.

The Role of Professional Counseling in Treating PTSD and Substance Abuse Together

When PTSD and substance abuse are both present, treating them together is what actually works. Addressing only one while ignoring the other leaves a gap that the untreated condition will eventually fill.

Someone who gets sober without working through the trauma may find that PTSD symptoms become louder once substances are no longer buffering them. Someone processing trauma while still using substances will often find it interferes with what they are working through in sessions. Either way, one condition keeps pulling the other back.

Integrated treatment means working with both at the same time, with a counselor who understands how they interact and adjusts the approach based on where each person is in their recovery.

Some of the evidence-based approaches used in treating co-occurring PTSD and substance use include:

Cognitive Behavioral Therapy (CBT)

CBT helps individuals identify the thought patterns and beliefs that maintain both PTSD symptoms and substance use behaviors. It teaches practical tools for managing triggers, restructuring distorted thinking, and developing healthier responses to stress and trauma reminders.

Motivational Interviewing

This approach is particularly useful in the early stages of treatment when ambivalence about change is high. It helps people explore their own reasons for wanting to change and strengthen their internal motivation without feeling pressured or judged.

Trauma-Focused Approaches

Methods that directly address the traumatic memory, such as trauma-focused CBT or other structured trauma processing approaches, can reduce the emotional charge of traumatic memories over time. This is important because as long as those memories retain the power to overwhelm the nervous system, the pull toward substances as a coping tool remains strong.

Talk Therapy and Individual Counseling

Consistent one-on-one sessions provide a stable, confidential space where a person can begin to tell their story, identify patterns, and build the coping skills needed to manage both PTSD symptoms and substance use urges. If you want to understand more about how this process works, I wrote about the specific benefits of talk therapy for addiction recovery in more detail elsewhere on this site.

If you are weighing whether individual or family therapy is the right starting point, I broke down the differences in detail in this article on individual therapy vs family therapy for addiction. 

What Healing From PTSD and Substance Abuse Actually Looks Like

People often ask me what recovery looks like when both PTSD and substance abuse are involved, and I think it is important to be realistic rather than overly optimistic. Healing is not linear. There will be progress and there will be setbacks. There will be moments when the old patterns feel irresistible and moments when something shifts in a way that feels genuinely new.

What I can say, based on the work I have done with individuals over the years, is that sustainable recovery from co-occurring PTSD and substance abuse usually involves several things working together. It involves building a relationship with a counselor you trust enough to be honest with. It involves developing a toolkit of coping strategies that actually work for your nervous system, not just the ones that look good on paper. And it involves being willing to revisit what happened, not to relive it endlessly, but to reduce its power over your present-day choices. 

If you have already experienced a relapse, that does not mean you are back at the beginning. It means there is more information available about what still needs attention.

Family involvement, when the relationships are safe and supportive, can be a significant factor in how well someone recovers. Isolation tends to feed both PTSD and addiction. Connection, even when it is uncomfortable at first, tends to work against them.

PTSD and Substance Abuse Support in Sacramento, CA 

Sacramento and the surrounding areas are home to people dealing with all kinds of experiences that quietly push someone toward substance use. For some it is past trauma. For others it is ongoing stress, relationship strain, or situations that have built up over time with no real outlet.

While the region does have a significant veteran and first responder population, most of the people I work with are everyday people who have started leaning on alcohol or drugs to get through what life has thrown at them. The reasons vary, but the pattern tends to be the same. Substance use becomes the way to manage what feels unmanageable.

At Life Steps Consulting, I provide substance abuse counseling that looks at the full picture, including what is underneath the use and what it is going to take to address it properly. I work with clients across Sacramento and nearby areas including Elk Grove, Roseville, Folsom, West Sacramento, Wilton, and San Jose. 

For those outside the Sacramento area, virtual counseling is available to clients throughout California, so getting proper support is possible regardless of where you are located.

How to Help Someone Dealing with Both PTSD and Substance Abuse 

Watching a family member or partner struggle with what looks like addiction, without fully understanding that trauma may be driving it, can lead to responses that feel logical from the outside but make things worse.

Ultimatums, shame-based conversations, and withdrawal of support tend to push trauma survivors further into isolation, which typically increases both PTSD symptoms and substance use.

If someone in your life is dealing with both, the most helpful thing you can do is connect them with professional support rather than trying to manage it alone. Individual counseling for the person who is struggling, combined with couples counseling or family counseling for those around them, creates a much more stable environment for recovery than any one person trying to hold everything together.

For families unsure whether an intervention is the right next step, I have written about when it is time to stage a family intervention and what that process actually looks like. For those dealing with someone who is refusing help altogether, this article on how to help someone who refuses addiction treatment covers what actually works in that situation.

 

Final Words

PTSD and substance abuse are rarely simple problems with simple solutions. They develop together over time, they reinforce each other, and they require an approach that takes both seriously at once. Understanding that connection, whether you are the one living it or someone trying to help, is where meaningful change usually begins. 

Recovery from PTSD and substance abuse is possible. It takes time, honest work, and the right support. But people do it, and the version of your life on the other side of this is worth moving toward.

If you are ready to talk, reach out to schedule a free consultation with me at Life Steps Consulting. Whether you are taking the first step or trying again after a setback, this is a space where your whole story is welcome.

Sources:

1. U.S. Department of Veterans Affairs, National Center for PTSD – https://www.ptsd.va.gov
2. National Institute on Drug Abuse –  https://nida.nih.gov
3. Substance Abuse and Mental Health Services Administration – https://www.samhsa.gov