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Behavioral Addictions

PTSD and Addiction

In those who have an addiction, the most common precipitating thread is trauma. This can fall into any category, including physical, mental, emotional or sexual abuse, or being exposed to some sort of major trauma. The sad reality is that people experience things that others can’t even bear to hear about, much less imagine going through. The emotional, mental and even physical impact of these traumas cannot be understated – even among people who consider themselves to be “strong” and for whom difficulties can “roll off their backs”.

Human beings are incredibly resilient, it’s true, however, the human brain can only process so much horror before it must switch over to self-protect and self-preservation mode. In many cases, this is literally a life-saving coping mechanism. However, in doing so, a person often develops Post-Traumatic Stress Disorder (PTSD).

PTSD has gained notoriety of late, particularly within the context of the military and the horrors of war to which the members have been exposed. Certainly this represents a large segment of those suffering from legitimate PTSD. However, not everyone who endures some difficulty necessarily has the full-blown disorder.

Let’s break down the symptoms, as defined by the DSM-IV-TR, the mental health diagnostic manual:

Criterion A: Stressor

The person has been exposed to a traumatic event in which both of the following have been present:

  1. The person has experienced, witnessed or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.
  2. The person's response involved intense fear, helplessness or horror. Note: in children, it may be expressed instead by disorganized or agitated behavior.

Criterion B: Intrusive Recollection

The traumatic event is persistently re-experienced in at least one of the following ways:

  1.         Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
  2.         Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content.
  3.         Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: in children, trauma-specific re-enactment may occur.
  4.         Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
  5.         Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

Criterion C: Avoidant/Numbing

Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:

  1.     Efforts to avoid thoughts, feelings, or conversations associated with the trauma.
  2.     Efforts to avoid activities, places, or people that arouse recollections of the trauma.
  3.     Inability to recall an important aspect of the trauma.
  4.     Markedly diminished interest or participation in significant activities.
  5.     Feeling of detachment or estrangement from others.
  6.     Restricted range of affect (e.g., unable to have loving feelings).
  7.     Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span).

Criterion D: Hyper-Arousal

Persistent symptoms of increasing arousal (not present before the trauma), indicated by at least two of the following:

  1.     Difficulty falling or staying asleep.
  2.     Irritability or outbursts of anger.
  3.     Difficulty concentrating.
  4.     Hyper-vigilance.
  5.     Exaggerated startle response.

Criterion E: Duration

Duration of the disturbance (symptoms in B, C, and D) is more than one month.

Criterion F: Functional Significance

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

As you can see, PTSD comprises a very specific group of criteria. The key criteria category, as it pertains to addiction, is Criterion C: Avoidance/Numbing. In the face of unspeakable traumas, a person quite understandably would prefer to avoid any recollection or feeling attached to it, which makes abusing alcohol or drugs a very appealing option.

And, as with any situation in which a substance is used to numb out, as soon as the high wears off, the feeling and thoughts that originally drove the person to use resurface; the thoughts and feelings haven’t been properly dealt with, so they simply remain. It is easy to see the progression from drinking or using drugs to “get a break” from the overwhelming stress of the trauma’s impact to addiction. The person simply needs more to mask the PTSD symptoms as his or her tolerance to the substance increases.

At this point, when a substance addiction has formed, the person is now classified as “dually diagnosed”, that is, he or she has two clinical diagnoses at the same time: a mental health disorder and a substance abuse disorder. Obviously, this can complicate both the situation and the course of treatment.

However, since the root of the situation is the trauma, the logical course of treatment is to find a therapist or treatment program that specializes in trauma work. This course of action predicts the best outcome for the person suffering with PTSD and substance abuse issues. The clinician will help the person process the traumatic event in a gradual and safe manner, equipping him or her with healthy coping tools to replace the drugs or alcohol and to help the person get on the path to healing and recovery.

It is vital to find a properly trained person or program to assist you in this process. To speak to qualified and experienced people who can help you locate such a person, visit today.

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