It is estimated that as many as one in five Iraq and Afghanistan veterans suffer from significant symptoms of posttraumatic stress. This is by no means a little known fact as the prevalence and impact of posttraumatic stress disorder (PTSD) on our veterans is discussed daily in television, online and in various print outlets.
However, what many people do not realize is the degree to which these veterans suffer with additional psychiatric issues. It is estimated that up to eight out of 10 people with PTSD have or will have another psychiatric condition at some point in their lives. And a smaller, but significant number of those individuals will experience even more psychological problems.
Co-morbid Disorders and PTSD
The type and severity of com-morbid conditions our veterans with PTSD battle varies. In addition to depression, social and generalized anxiety, and panic disorder, many combat alcohol and drug abuse.
Indeed, problem drinking and the use and abuse of prescription and illicit drugs are some of the more common co-occurring problems seen in troops suffering from posttraumatic stress. Typically referred to as Substance Use Disorders (SUDs), these abusive and compulsive behaviors can lead to physical, emotional, occupational and legal problems above and beyond those caused by PTSD alone.
Although the true prevalence rate is not known, it is believed that in the neighborhood of one in five veterans with PTSD may also meet the criteria for a SUD.
Sleep, PTSD, and Substance Use
The reasons behind the increased incidence of SUDs in troops suffering from PTSD are many. One of the more common ones is poor sleep. One specific type of sleep problem manifested in veterans is not being able to fall asleep. Referred to as initial insomnia, the inability to shut the mind down and relax is strongly connected to anxiety.
Specific to PTSD, for some veterans, the on-going rumination about the traumatic event and hyperarousal make getting to sleep near impossible some nights.
Another type of sleep disturbance is waking up too early and not being able to go back to sleep. Often labeled as terminal insomnia, this symptom is closely aligned with depression. It is understandable why this symptom would occur considering the high rate of depression in those with PTSD.
And lastly, sleep disruption because of nightmares fuels chronic sleep disruption. A hallmark symptom of PTSD, nightmares plague most all veterans suffering with the disorder to some extent. Not only do these individuals fear falling asleep because of the nightmares, they have a difficult going back to sleep when awakened by them.
Alcohol and drugs work in the short-term to curb some of the distress associated with these sleep problems. In fact, for many, they are effective at a superficial level. In other words, the person feels anxious or is consumed with negative thoughts and the alcohol or drug reduces the anxiety and dampens the thoughts.
This reduction reinforces the substance use. Unfortunately, over the long-term, alcohol and drug use wreak havoc on a person’s sleep cycle and leads to many other psychological and physical health problems.
Anger, Agitation and Avoidance
Anger and agitation are also responsible for increased substance abuse in veterans with PTSD. Both are common in PTSD and are often the most outwardly noticeable expression of the disorder. And the level of anger and agitation in veterans with PTSD goes well beyond the typical annoyance we all experience sitting in traffic or when he have to shell out money we don’t have on a new set of tires for the car. It can be extreme and manifest as aggression and rage.
Just like with sleep disturbance, 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.
And lastly, a defining characteristic of many PTSD sufferers is avoidance. Alcohol and drugs help individuals block out bad memories and uncomfortable feelings. Unfortunately, avoiding these memories and feelings 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.
Treatments are Available
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.
Many of these focus on maladaptive thoughts processes that maintain substance abuse patterns. They also provide relapse strategies for those who eventually stop using, but are faced with triggers that put them at risk of using again. Medications can also help, especially when other problems such as depression and insomnia occur. And couples and family counseling are available to help mend any damage drug and alcohol use have caused with loved ones.
*This article was adapted from a previous article written by Dr. Moore for his column “Kevlar for the Mind.”