“You can’t patch a wounded soul with a Band-Aid.”
Michael Connelly, The Black Echo
Imagine you have a client 49-years-old named Sally. Sally was referred to you by her lawyer for a substance assessment. Sally, during the assessment, shares she was here do to a DUI with which she had recently been charged.
Sally had always regarded herself a social drinker and had started drinking around 15-16 and always with friends on weekends around school social events. She stated alcohol had made her carefree and helped her socialize and almost always had a great time.
As she grew more comfortable in the assessment, Sally states that she had a rocky relationship with both her divorced parents, siblings and other members of the family. She felt she needed to be in control and others in the family resented her.
In particular, her relationship with her father (whom she stated was emotionally and physically abusive) caused long voids of connection in their relationship that she still struggles to overcome.
Numerous issues related to trust from the past still sever her ties with her mother. Sally suggested that she had been involved in numerous needy relationships with men that have generated enabling behaviors that have not been healthy emotionally or physically for her.
After the assessment was completed, we discussed her tendency to be in codependent relationships out of the need to be needed.
Self-esteem has been an issue most of her life. She has a tendency to be over accepting, anxious, fearful, and a worrier who has difficulty to ask for help. She has a limited view of herself and issues with self-acceptance.
Over the past four years, have become insurmountable (health/emotional) that she has become reliant on alcohol to avoid and numb the pain in her life. Sally suggests that she had become increasingly isolating but recently for a job of which she was very proud. She believed she was putting her life together.
Sally shared numerous events in her life related to her relationship with her parents that have caused diagnosed PTSD symptoms along with adjustment disorders generating anxiety and depression. The effects have her relying on prescribed medications since age 9.
Sally stated she has seen therapists along with medications to overcome the after effects of PTSD with symptoms being depression which formulated into anxiety because of her suppressed her feelings.
Sally scored having severe depression and anxiety on Burns Depression Scale and Burns Anxiety Inventory. She denies any current or historical thoughts of suicide or homicide and does not appear to be a threat to herself or others.
Sally shared that she was a hard worker with high standards of morality and, at times, adventurous. She suggested she is very hard on herself with perfectionist tendencies and has very high expectations of herself and others.
A week after meeting with Sally and feeling we were making headway, she was arrested for her second DUI.
Effects of PTSD
Sally was acting out behaviors that were harming herself because of how she regarded herself from past relationships. For Sally, drinking had become the shield from which she lived her life– afraid of feeling so she numbed and avoided her inner turmoil.
Sally classifies as a candidate for dual diagnoses: PTSD and Alcoholic abuse.
Information on Affecting Relationships
An article from New York City Alliance against Sexual Assault called: “Factsheets: PTSD and Relationships” listed how past trauma may affect current relationships not only with others but with oneself:
- Trauma survivors with PTSD often experience problems in their intimate and family relationships or close friendships.
- PTSD involves symptoms that interfere with trust, emotional closeness, communication, responsible assertiveness and effective problem solving.
- Partners, friends or family members may feel hurt, alienated or discouraged because the survivor has not been able to overcome the effects of the trauma and they may become angry or distant toward the survivor.
- Feeling irritable and on guard is common.
- Survivors may experience a loss of interest in social or sexual activities. They may feel distant from others and they may be emotionally numb.
- They are easily startled, worried or anxious. Survivors may be unable to relax, socialize or be intimate without feeling tense or demanding. Significant others may feel pressured, tense and controlled as a result.
- Difficulty falling or staying asleep and severe nightmares may prevent both the survivor and partner from sleeping restfully, which may make sleeping together difficult.
- Trauma memories, trauma reminders or flashbacks and the avoidance of such memories or reminders can make living with a survivor feel like living in a war zone or like living with the constant threat of vague but terrible danger.
- Reliving trauma memories, avoiding trauma reminders and struggling with fear and anger greatly interfere with a survivor’s ability to concentrate, listen carefully, and make cooperative decisions. As a result, problems often go unresolved for a long time.
- Survivors of childhood sexual and physical abuse and survivors of rape, domestic violence, combat, terrorism, genocide, torture, kidnapping, and being a prisoner of war often report feeling a lasting sense of terror, horror, vulnerability and betrayal that interferes with relationships.
- Alcohol abuse and substance addiction, which can result from an attempt to cope with PTSD, can destroy intimacy and friendships
What Can be Done
The PTSD: National Center for PTSD in a recent article suggests the following most effective treatment patterns when clients like Sally who have both PTSD and a drinking problem:
- Alcohol can affect sleep, anger and irritability, anxiety, depression and work or relationship problems. Therapist and patient should discuss.
- Treatment should include education, therapy and support groups that help the patient with drinking problems in a way they can accept.
- Treatment for PTSD and alcohol use problems should be planned in a way that gets at both problems together. Patients may have to go to separate meetings on each issue or see providers who work mostly with PTSD or mostly with alcohol problems. In general, though, PTSD issues should be included in alcohol treatment and alcohol use issues should be included in PTSD treatment.
- Once the patient becomes sober (stop drinking entirely), he/she must learn to cope with PTSD symptoms in order to prevent relapse (return to drinking). Sometimes the PTSD symptoms seem to get worse after drinking ceases. More progress can be made with PTSD treatment once the drinking stops.
“Even in times of trauma, we try to maintain a sense of normality until we no longer can. That, my friends, is called surviving. Not healing. We never become whole again … we are survivors. If you are here today… you are a survivor. But those of us who have made it through hell and are still standing? We bare a different name: warriors.”