Posttraumatic Stress Disorder-simply referred to as PTSD-generally does not occur in isolation. Research has shown that up to 80 percent of people with the disorder have or will have another psychiatric condition at some point-many will have several.
Some of the more common co-occurring disorders, particularly in combat veterans, include depression, panic disorder, generalized anxiety disorder, and insomnia.
Heavy drinking and the use of prescription and illicit drugs are also very common co-occurring problems seen in troops suffering from PTSD. Often referred to as Substance Use Disorders (SUDs), these behavioral-based disorders lead to physical, emotional, occupational and legal problems above and beyond those caused by PTSD alone.
Some studies report that approximately one in five veterans with PTSD also has a SUD. However, it can be argued that the rate at which SUDs and PTSD occur together is much higher than reported. Alcohol and substance-related disorders are often overlooked by patients and clinicians leading to an under reporting of the condition(s).
Moreover, alcohol use, sometimes in excessive amounts, is implicitly supported in the military and has always been a part of this male dominated culture.
Sleep Problems and SUDs Use
The reasons behind the increased incidence of SUDs in troops suffering from PTSD are many. For example, sleep problems are common in those with the disorder. These problems can manifest in the forms of not being able to fall asleep, waking up too early and not being able to go back to sleep and sleep disruption because of nightmares.
Although they create more serious long term problems, alcohol and drugs work in the short term, which makes them highly reinforcing. Specifically, in the short-term, they interrupt sleep patterns leading to feeling unrested and unrefreshed the next morning.
They also reinforce maladaptive behavior in that the veteran relies on an external source to initiate sleep instead of allowing the body to generate rest naturally. In other words, it is extremely poor sleep hygiene.
Anger, Irritability, and Agitation and SUDs Use
Anger and agitation, being on guard and always feeling on edge are unpleasant feelings often associated with PTSD. The chemical properties of alcohol and many legal and illegal drugs are effective at reducing these symptoms.
However, similar to the improvement seen in sleep, these benefits are short lived and get worse with prolonged substance use. Once the alcohol is metabolized and leaves the body, the symptoms return. And as reported by many veterans, they are stronger when they do come back.
Substances are effective for these symptoms in the short-term, at least for alcohol, for the same reason powerful medications like benzodiazepines (lorazepam, clonazepam, alprazolam) work. They modulate the same brain receptors which are responsible for bringing about calmness, sedation, and euphoria. And just like these medications, if used for PTSD, the veteran is required to take them regularly and run the risk of increased tolerance and dependence.
Avoidance and SUDs Use
A defining characteristic of many PTSD sufferers is avoidance. A veteran may actively or unconsciously stay away from people with whom he deployed because these individuals remind him of the difficult experience.
This behavior can be problematic if these individuals are friends or members of the veteran’s unit. The veteran may avoid conversations about deployment entirely, which in essence, blocks out a significant period of her life.
Even the ability to go out to dinner or a movie may be difficult as the veteran feels uncomfortable in large crowds. Instead, he avoids these activities, which can reduce the veteran’s quality of life and negatively impact relationships.
Indeed, alcohol and drugs can help individuals block out these bad memories and uncomfortable feelings. Unfortunately, avoiding these memories, people, and places can cause PTSD to last longer. In fact, the most effective treatments for the disorder involve intentional and direct confrontation of those things which are most distressing. Alcohol and drugs prevent this from occurring.
The good news is that there are effective treatments when PTSD and substance use problems occur together. There are a range of talk therapies available that are provided in both individual and group settings. Medications can also help, especially when other problems such as depression and insomnia occur.
Couples and family counseling are available to help mend any damage drug and alcohol use have caused with loved ones. The most important thing to remember is that the veteran must acknowledge that alcohol and/or drugs are partly responsible for how they are feeling and behaving.
A previous version of this article was published in Dr. Moore’s column Kevlar for the Mind in Military Times.