PTSD & Trauma Treatment

PTSD and substance use disorders co-occur at extremely high rates. Studies show that 50-66% of individuals with PTSD develop a substance use disorder at some point in their lives—rates far higher than the general population. Conversely, among people seeking treatment for substance use disorders, 25-50% meet criteria for PTSD. This strong association reflects the common use of substances to self-medicate PTSD symptoms including intrusive memories, hyperarousal, nightmares, and emotional numbing. Trauma exposure itself increases substance use risk, while substance use increases exposure to traumatic events (violence, assault, accidents), creating a cyclical pattern. The high co-occurrence underscores the critical need for integrated treatment addressing both conditions simultaneously.

EMDR (Eye Movement Desensitization and Reprocessing) is an evidence-based psychotherapy for PTSD recognized by the American Psychological Association and WHO. During EMDR, clients recall traumatic memories while simultaneously focusing on bilateral stimulation (typically side-to-side eye movements, tapping, or sounds). This dual attention appears to facilitate processing of traumatic memories, reducing their emotional intensity and associated distress. The theory suggests EMDR helps the brain process stuck traumatic memories similar to how it processes normal memories during REM sleep. Research shows EMDR produces significant PTSD symptom reduction, often more rapidly than traditional talk therapy. For individuals with co-occurring addiction, EMDR helps resolve trauma fueling substance use while requiring fewer verbal descriptions of trauma, which some find less distressing than prolonged exposure therapy.

This is a common question, and the answer is: both simultaneously. Older treatment models suggested achieving stable sobriety before trauma work, but research now shows integrated concurrent treatment produces the best outcomes. Reasons for simultaneous treatment include: unresolved trauma drives continued substance use through self-medication, attempting addiction treatment while ignoring trauma leads to high relapse rates, modern trauma therapies (EMDR, CPT, PE) are safe and effective even during early recovery, and addressing both conditions together reduces overall treatment time and improves long-term success. Our trauma-informed integrated approach provides PTSD treatment while supporting sobriety, with safety planning, stabilization skills, and careful pacing to ensure clients can manage trauma processing without relapse. Research consistently shows this approach is both safe and more effective than sequential treatment.

Complex PTSD (C-PTSD) results from prolonged, repeated trauma, typically in situations where escape is difficult or impossible. Common causes include childhood abuse or neglect, domestic violence, human trafficking, prisoner of war experiences, and cult involvement. Unlike PTSD from single-incident trauma, C-PTSD involves additional symptoms including emotion regulation difficulties, negative self-concept and pervasive shame, relationship difficulties and problems with trust, dissociation and feeling detached from self, and loss of systems of meaning. People with C-PTSD have particularly high rates of substance use disorders as substances provide temporary relief from emotional pain and disconnection. Treatment for C-PTSD typically requires longer duration and emphasizes emotion regulation skills, relationship healing, and identity reconstruction alongside trauma processing. Our integrated program addresses both the complex trauma and addiction with specialized protocols for this challenging dual diagnosis.

This is a valid concern, but research shows that properly conducted trauma therapy in the context of integrated treatment does not increase substance use and actually reduces relapse risk by addressing the underlying driver of self-medication. Key protective factors include: gradual, paced trauma processing tailored to your tolerance, extensive emotion regulation and coping skills training before and during trauma work, ongoing substance use treatment and monitoring simultaneously with trauma therapy, safety planning for managing difficult emotions without substances, and therapist expertise in both trauma and addiction. Initially, processing trauma can bring up difficult emotions, but you learn healthier ways to manage these feelings. Studies comparing integrated trauma treatment to addiction treatment alone consistently show better substance use outcomes in the integrated approach. By resolving trauma, the drive to self-medicate decreases, supporting sustained recovery.

Two medications are FDA-approved specifically for PTSD: sertraline (Zoloft) and paroxetine (Paxil), both SSRIs. Other medications commonly used off-label for PTSD include other SSRIs (fluoxetine, citalopram) and SNRIs (venlafaxine), which reduce core PTSD symptoms; prazosin for PTSD-related nightmares and sleep disturbance (particularly effective for trauma nightmares); antipsychotics (quetiapine, risperidone) for severe hyperarousal or trauma-related psychotic symptoms; and mood stabilizers for emotional dysregulation in complex PTSD. Benzodiazepines are generally avoided as they can interfere with trauma processing, carry addiction risk, and may worsen PTSD long-term. For individuals with co-occurring substance use, medication selection considers addiction history, avoiding medications with abuse potential when possible. Medication is most effective when combined with trauma-focused psychotherapy (EMDR, CPT, or PE), not as standalone treatment.