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Dual Diagnosis: PTSD and Substance Use Disorder

PTSD and Substance Abuse Disorder SUD
The information in this blog was collected during a conversation with Sara Ridner, LCSW, Trauma Therapist at Cornerstone of Recovery, a Bradford Recovery Community.


About 6% of the US population will have Post Traumatic Stress Disorder (PTSD) at some point in their lives. People seeking treatment for PTSD are 14x more likely to also be diagnosed with Substance Use Disorder (SUD). This dual diagnosis presentation often results in additional complexity and challenges to treatment, requiring an integrated approach.

What is PTSD?

Once called “shell shock,” post-traumatic stress disorder (PTSD) was originally believed to only affect military veterans. Today, we know much more about this complex mental health condition, including how it relates to substance use and vice versa. 

PTSD is a severe anxiety disorder that occurs when someone witnesses or experiences a traumatic event or series of events. During a traumatic or dangerous situation, our body responds in various ways that we cannot control. This includes releasing chemicals to help us contend with what is happening at that moment. For most people, once the crisis has passed, their bodies will stabilize in a reasonable amount of time. However, for others, the biochemical changes persist and manifest in various psychological symptoms, including a compromised coping ability. This inability sometimes leads a person to drugs or alcohol to cope with their anxiety, stress, and other negative emotions.

What Causes PTSD?

The development of PTSD requires a triggering event that could be public and objectively fear-inducing (such as a car accident) or more personal such as responses to interpersonal violence or bullying. Anyone exposed to these situations is at risk of developing PTSD symptoms. Still, the risk is elevated, especially for those with insufficient or inconsistent protective factors in their life. 

Trauma can impact a feeling of safety in the world or in relationships. It can impact whether a person feels they can trust themself to be capable. It can impact whether people feel safe to trust or even ask for help. Trauma also can cause people to feel like they made mistakes that they should have been able to avoid or may really blame themselves or feel as if something about them is defective or broken. 

PTSD and Substance Use Disorder (SUD)

Those with PTSD frequently turn to drugs and alcohol to alleviate these symptoms. Unfortunately, those with PTSD have a significantly higher chance of developing substance use disorder. The assumption that alcohol calms your nerves, “takes the edge off things,” or allows you to sleep is incorrect and will do the opposite. 

It’s also common for those with PTSD to use other substances, like marijuana, to calm anxiety. Not being able to soothe yourself with other methods aside from using a substance is an indication that there can be a relationship between substance use and trauma. When we treat PTSD, as we are coping with and treating substance use issues, we help people understand how trauma caused the seeking of comfort and sometimes numbing through substance use. Whether it’s alcohol or some other drug, we treat all of it. We help people understand how the trauma has impacted them, how it’s contributed to their substance use issues, and what coping skills they can learn to address them.

How to Identify PTSD Symptoms


This is one of the most obvious symptoms. They don’t want to talk about painful things or past events or situations that happened. You may not notice it because they won’t always say, “I’m avoiding thinking about that.” But you may notice them avoiding situations like a family gathering, going to a certain store, or staying out of crowds. 

Losing Interest

You may notice people you care about losing interest in things they once enjoyed. They may feel distant and just not easily able to connect with you. 


You may notice some negativity or pessimism, feeling like life is not going well. They may say things like, “It’s not going well, and it’s never going to work,” or “I’m never going to find a partner who fits me or understands me, or my career will not be successful.” So, the negative thoughts and sometimes that can be subtle, but there may be some real overt things that happen. 

Lack of Sleep

You may notice people having trouble with sleep and concentration. There can be a lot of issues that can impact sleep, but with PTSD, not being able to turn the mind off is indicative of ruminating about things that happen, which contributes to anxiety and restlessness. The feeling of always being on guard or easily startled is also common.

Anger and Irritability

You also may notice things like irritability or anger, being short-tempered, or getting angry in a disproportionate way to a given certain situation. That may be an indication that someone is struggling with some traumatic-related incidents. 

PTSD Treatments

I think that if there is reasonable stability, trauma can be treated on an outpatient basis. Still, many patients’ journey starts at a residential treatment center. It can be helpful to begin recovery at a residential treatment setting where a person can step aside from the day-to-day stressors of life, and all the busyness of life and all the responsibilities of life where they can really focus and have a period where they can really reflect and look at themselves and hear stories of other people and how what they’ve been through and learning that they’re not alone.

We combine group and individual treatment here at Cornerstone, where patients benefit from the combination of both. We use these targeted therapies to address their trauma and help them increase serenity and feel safe. What happens with trauma is that it’s stuck in their memory, reminding them of the trauma. Even talking about it can create all kinds of overwhelming symptoms like a racing heart, feeling nauseated, or feeling their body tense up as if the trauma is happening all over again. When we help them walk through those memories, and they recognize they’re in a safe place with safe people, then their body begins to calm down. They can start recognizing, “Oh, talking about this helps me feel better.” They can see that they’re making progress, and they can also see other people making progress. 

Residential and Outpatient Treatment for PTSD and SUD

One benefit of residential treatment is that you can focus, reflect, and dig deep. You don’t have any other concerns besides your own recovery. 

Intensive Outpatient Treatment is beneficial because while you’re getting treatment, you’re living life, going home, doing kids, doing family, and maybe even working. Still, you’re dedicating yourself to treatment for a couple of hours daily. You’re using accountability to continue building your sobriety and learning to use the 12-Steps. 

Community recovery meetings are also an ongoing way to help continue learning how to stay sober and build healthier and more supportive relationships. Those healthy relationships also formed protective factors to help you stay sober and learn to walk through when trauma gets retriggered.

Get Help

Bradford Health has a proven track record of helping individuals with our dual diagnosis treatment. If you think you or someone you know has a problem, call us today: 888-SOBER-40.


National Institute of Mental Health 

Mayo Clinic

American Psychiatric Association

Substance Abuse and Mental Health Services Administration