Post Traumatic Stress Disorder and Addiction
By Britt Gottlich, Psy.D.
I often meet with people who say they are unsure of whether they have experienced trauma or not. So what is trauma? Most people define trauma based on how trauma is portrayed in the media. But in reality it is a very subjective experience. Something that may be traumatic for one person may not be traumatic for another. The American Psychological Association defines trauma as “an emotional response to a terrible event like an accident, rape or natural disaster.”
The way I like to understand trauma is based on an individual’s interpretation of the event. As children we live under the assumption that ‘good things happen to good people and bad things happen to bad people.’ When we experience a trauma, often our interpretation of this rule becomes clouded and confused. For example, it could change to, ‘if good things happen to good people, and this happened to me, then I must be bad.’ Therefore, a person’s reaction to a traumatic experience often affects the way they see themselves, other people, and the world around them.
We can’t change or erase a traumatic experience, unfortunately. But what we can do is change the way we interpret it and ultimately the way we understand the world around us as a result of that event. This is where Cognitive Processing Therapy (CPT) can be a useful treatment modality. It helps us identify the cognitive distortions that are derived from our traumas, and using evidence and facts, combat those thoughts with rational ones.
CPT has been a very effective treatment modality which is often used in treating Veterans with Post Traumatic Stress Disorder or PTSD. CPT is a 12 session behavioral psychotherapy. It has been found to be highly effective in treatment for PTSD. A study conducted in 2017 that studied the effectiveness of CPT on Veterans found that Veterans who completed the 12 session treatment had a significant difference in their symptoms and had a decline in Post Traumatic Stress Disorder Checklist scores than Veterans who did not complete or comply with treatment. Other treatments that are used for PTSD are Eye Movement Desensitization & Reprocessing (EMDR) and Prolonged Exposure (PE). In my experience and training with all the above modalities, I have seen the most improvement and success with CPT.
While there are treatments such as CPT that are very effective in treating trauma, one of the most important pieces in this type of therapy is rapport. It is important in all therapy to have a positive relationship with your therapist where you feel comfortable and not judged. But especially when disclosing a trauma, and going deep into the event, feelings, and cognitions related to it, it is important that you feel trusting of the person providing that treatment.
From my experience working at a VA and currently here at Fifth Avenue Psychiatry, I see that there is a high comorbidity for substance abuse and PTSD, especially when PTSD goes undiagnosed or untreated. VA statistics note that more than 2 out of 10 Veterans with PTSD also have a substance use disorder, and 1 out of 3 Veterans seeking treatment for substance use disorders also meet criteria for PTSD. The American Addictions Center reported that 55-60% of individuals who suffer from PTSD have comorbid addiction or alcoholism. They also note that “people who suffer PTSD are between two and four times more likely to also battle addiction than their peers who do not also struggle with PTSD.”
Again, traumas are not something that can be erased, but they can be something you can learn to live with. You can begin to see the world, people, and yourself in healthier ways again. You may never fully believe that ‘good things happen to good people,’ but eventually you may believe that ‘bad things sometimes happen to good people.’