Quick Summary
If you started drinking or using to quiet something that happened to you, and the two problems now feel knotted together, you’re noticing something real. For many people, substances begin as a way to turn down trauma symptoms that won’t turn off on their own. Treating only the drinking or the drug use can leave the underlying trauma untouched, which is a big reason relapse often happens. Trauma-informed care works on both at the same time, at a pace that can keep you safe when the numbing stops and old feelings surface. That pacing, and the clinical setting around it, is a big part of what makes healing possible.
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Substances are often used to cope with trauma symptoms, not just for pleasure or habit.
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PTSD and substance use frequently co-occur and can feed each other over time.
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Treating them separately or in sequence tends to leave the root cause active.
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Trauma-informed treatment addresses both conditions together, with safety and steady pacing.
How PTSD and Addiction Are Connected
The first drink after a bad night quieted the replay of the scene in your head. It slowed your heart rate. It let you sleep without jolting awake at 3 a.m. So you did it again. But at some point, it stopped being a choice and started being the only thing that seemed to help.
For a lot of people, alcohol or other substances start out as a way to manage what trauma left behind: the racing thoughts, the dread, the body that will not settle. The relief can be real in the short term, which is exactly why it becomes a pattern so commonly. The National Center for PTSD notes that post-traumatic stress disorder and substance use disorders co-occur at high rates, and that many people describe using substances to cope with symptoms.
The relationship between the two is symbiotic. Trauma symptoms can push someone toward substances, and heavy substance use can worsen sleep, mood, and reactivity, which for many people makes the trauma symptoms louder. This is the reason why working on one of the issues alone doesn’t truly fix the issue, because they feed off of each other, rather than one issue simply causing the other to happen. That is why dual diagnosis treatment exists in the first place, to address both at the same time.
Recognizing the Signs of Post-Traumatic Stress Disorder (PTSD) Alongside Substance Use
Because of how long you’ve been living with it, some of the things you experience because of PTSD may have started to feel like just another part of your personality. The way you sit facing the door in every restaurant, or a certain smell or the sound of a car backfiring takes your mind to somewhere else for a few seconds. Or maybe it’s the way you’ve quietly stopped going to places that used to be normal, because it is easier than the wave that hits when you get there.
PTSD tends to show up in a handful of ways that are worth looking at yourself honestly:
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Scanning rooms and reading exits without deciding to, always half braced for something.
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Sudden vivid returns to the event, in daylight or in dreams that leave you soaked and shaking.
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Steering around people, places, or conversations that might bring it back.
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Feeling flat or far away, as if you’re watching your own life through glass.
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Sleep that never fully lands, or that you have to shut down with a few drinks to reach at all.
When substance use gets brought into the mix, these things get harder to see clearly, as it can mask the trauma symptoms and mimic them at the same time. A nightly six-pack can look like the reason you’re exhausted and irritable, but those same feelings might be the symptoms of PTSD that you’re trying to dampen. Withdrawal can look like hypervigilance, hangovers avoidance, and that morning shakiness could be the alcohol leaving your body or the memories flooding back. When both conditions are present, it can be genuinely difficult to tell where one ends and the other begins, and that’s part of why so many people go years without connecting the two.
Why Treating PTSD and Addiction Separately Often Fails
There’s a common pattern people with PTSD go through when they only get treatment for substance use. They get sober, sometimes through a detox program and a stretch of hard, difficult weeks. Everyone congratulates you. And then, a month or two in, something you didn’t expect happens. You start to feel worse. The nightmares come back sharper. The panic that the drinking used to flatten is suddenly right there, undulled, every evening.
That’s what happens when the thing you were using to numb the trauma is gone, but the trauma is still there. It’s not that you failed to get sober, but that the real driver behind the use never got addressed. So that pull your body feels to use again is often a very logical response to symptoms that never got care.
Sequential treatment, where you’re told to get clean first and deal with the trauma later, tends to stumble over exactly experience, because when it’s time to address it, the trauma returns right when you’re the least protected. A review of treatment options for co-occurring PTSD and substance use disorder found that addressing both conditions together can produce greater improvement in PTSD symptoms than no treatment or treatment focused on only one condition. When the two problems are tangled together so strongly, the treatment usually needs to untangle both at the same time.
What Trauma-Informed Treatment for PTSD and Addiction Looks Like
Before anyone asks you to talk about the worst day of your life, the ground under you has to feel solid. Trauma-informed work starts with safety and trust, because pushing into painful memory before you’ve got steady enough footing can do more harm than good. You have to pace yourself, and work though your history at your own speed in a judgment-free zone where nothing you say lands as shame.
From that steadier place, actual treatment can begin. There are a few evidence-based approaches that you’ll probably encounter.
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EMDR therapy, which can help the brain reprocess a stuck traumatic memory so it stops firing with the same intensity.
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Cognitive behavioral therapy, which works on the thought patterns and avoidance behaviors that keep both the trauma and the substance use running.
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Group therapy that treats the drinking or drug use and the trauma as parts of one picture.
The American Psychological Association’s clinical practice guideline on PTSD recommends trauma-focused psychotherapies such as these as effective treatments for adults. What matters just as much is that all of it happens inside one continuum of care, so the same team is watching both the recovery and the returning symptoms, and can adjust when things surface. At Able To Change Recovery, that continuum runs from supportive housing through PHP and IOP, so you can be assisted every step of the way.
The clinical environment and pacing aren’t optional, because when the numbing stops, the symptoms can rear their heads. When that happens while you’re inside a program, with people who understand what is happening, it tends to be far safer than going it alone in your kitchen at midnight.
“When someone has been using a substance to address their trauma, treating the substance use on its own often just removes the thing that was holding the symptoms down,” says Chris Cramer, MSW, LAADC, Program Director at Able To Change Recovery. “In our experience, when we work on the trauma and substance use at the same time, with the same team watching both, people tend to stay steadier through the parts that used to send them back out. That’s really why we do it together and not one after the other.”
What to Expect When You Reach Out to Able To Change Recovery
You don’t need to have it all figured out before you make contact, or need to know whether the symptoms you’re experiencing is from the PTSD or from the drinking. That is precisely what a confidential assessment is for.
During the first call, you describe what has been happening in your own words, at your own pace, to someone who is there to listen. Together you start to map what you are dealing with and what level of care may fit. If a medical detox is needed first, that gets arranged upstream, and you step into residential or day treatment once that handoff is complete. Insurance is often less of a wall than people fear, and A2C being in-network with multiple carriers means the coverage question can get answered early instead of becoming one more reason to wait. Everyone deserves the chance to heal, and reaching out can take real nerve, even if your voice shakes while you do it.
For anyone across San Juan Capistrano and the wider Orange County area carrying both the aftermath and the coping that grew around it, you don’t have to keep managing this on your own. When you’re ready, reach out to our admissions team and we will work alongside you through the whole process.
Sources
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National Center for PTSD. “Substance Use and PTSD.”
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Banerjee S, Spry C. “Concurrent Treatment for Substance Use Disorder and Trauma-Related Comorbidities: A Review of Clinical Effectiveness and Guidelines.”
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American Psychological Association. “Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder.”