PTSD and Addiction: Why They Reinforce Each Other and What Actually Helps

Alex Penrod, MS, LPC, LCDC — Founder & EMDR Therapist | Neuro Nuance Therapy and EMDR, PLLC | Austin, TX

Post-traumatic stress disorder (PTSD) and addiction frequently occur together, not by coincidence, but because they affect the same underlying systems in the brain and nervous system. Many people living with both conditions find that treating one without addressing the other leads to partial relief at best and repeated setbacks at worst.

Understanding why PTSD and addiction reinforce each other is often the first step toward choosing an approach that actually supports recovery.

This page explains how trauma and substance use interact, why timing and readiness matter in treatment, and what current research shows about addressing both conditions together. It is written to help people make sense of their experience and understand how trauma-focused approaches, including therapies like EMDR, fit into a broader, carefully sequenced recovery process.

PTSD and Addiction: Quick Facts

  • Post-traumatic stress disorder and substance use disorders frequently occur together and interact through shared nervous system pathways.
  • Substance use in the context of trauma often begins as an attempt to regulate overwhelming emotional distress, not as a pursuit of addiction.
  • After sobriety, PTSD symptoms can intensify if trauma-related nervous system activation remains untreated.
  • When PTSD is present, treating substance use alone is associated with poorer long-term recovery outcomes.
  • Research shows some trauma-focused therapies can be safely integrated into recovery when readiness is established.
  • Effective care depends on timing, pacing, and nervous system stability, not a one-size-fits-all treatment sequence.

Why PTSD and Addiction So Often Occur Together

PTSD develops after exposure to a traumatic event or series of traumatic experiences that overwhelm the nervous system’s capacity to cope. Symptoms such as intrusive memories, hypervigilance, emotional numbing, sleep disturbance, and avoidance can make everyday life feel unsafe or unmanageable.

Substances are often introduced not as a pursuit of pleasure, but as an attempt to regulate these symptoms. Alcohol, opioids, stimulants, or other drugs may temporarily reduce anxiety, blunt emotional pain, improve sleep, or create distance from intrusive memories. Over time, this pattern can become self-reinforcing.

At the same time, substance use can increase the risk of trauma exposure. Impaired judgment, risky environments, accidents, violence, and assault are all more likely when substances are involved. In these cases, addiction may precede PTSD, creating a complex, bidirectional relationship.

When PTSD and addiction co-occur, each condition tends to intensify the other, creating a vicious cycle that is difficult to interrupt without addressing both sides of the problem.

Addiction as a Trauma Survival Strategy (Before It Becomes a Disorder)

Early substance use in the context of trauma is often better understood as a survival strategy rather than a moral failing or lack of willpower. For many people, substances function as a way to regulate overwhelming emotional states when other coping mechanisms are unavailable or ineffective.

This pattern is commonly referred to as self-medication—using substances to manage distress, fear, or emotional pain. When trauma is addressed early enough in the self-medication process, some people naturally moderate or stop their use. But over time, repeated use can lead to tolerance, withdrawal, and neuroadaptations that shift the behavior from coping into addiction.

When substance use is treated only as a behavioral problem without addressing the underlying trauma, relapse risk remains high. When trauma is treated with the expectation that a fully developed addiction will automatically resolve, relapse risk also runs high. 

The Shared Neurobiology That Keeps the Cycle Going

PTSD and addiction affect overlapping brain systems, particularly those involved in threat detection, emotional regulation, and decision-making.

The amygdala, which plays a central role in detecting danger, is often hyper-reactive in PTSD. Trauma cues, both internal and external, can trigger intense fear responses even when no present threat exists. Substances may temporarily dampen this response, reinforcing their use as a regulatory tool.

At the same time, repeated substance use alters the reward system and dysregulates stress circuits in the brain. Over time, the nervous system becomes conditioned to seek substances not only for pleasure, but to escape discomfort, anxiety, or withdrawal. This creates a “push–pull” dynamic: distress pushes use, and relief pulls it back again.

The prefrontal cortex, responsible for impulse control, emotional regulation, and long-term decision-making, is often compromised in both PTSD and addiction. When this system is weakened, it becomes harder to tolerate distress, resist urges, or evaluate consequences, further reinforcing both conditions.

Understanding this shared neurobiology helps explain why motivation alone is rarely sufficient to break the cycle.

Why Treating Only Addiction Often Falls Short When PTSD Is Present

Many people achieve periods of sobriety yet continue to struggle with intense anxiety, emotional instability, or intrusive trauma symptoms. In some cases, these symptoms actually intensify once substances are removed, because the nervous system is no longer being artificially regulated.

When PTSD remains untreated, sobriety can expose the full force of trauma-related distress. Emotional regulation becomes harder, sleep often worsens, and hypervigilance and irritability increase. As distress rises, relapse risk increases, not because of a lack of motivation, but because the nervous system is overwhelmed.

This does not mean trauma therapy should always be initiated immediately. It does, however, help explain why treating addiction alone often leads to poorer long-term outcomes when PTSD is present.

Understanding PTSD and Addiction as Co-Occurring Disorders

Common PTSD Symptoms and Treatment Considerations

Posttraumatic stress disorder is a mental health disorder that can involve a wide range of PTSD symptoms, including intrusive memories, avoidance symptoms, negative thought patterns, emotional numbing, sleep disturbance, and heightened anxiety. These symptoms of PTSD often intensify under stress and can increase the risk of substance use as a coping strategy.

When PTSD occurs alongside alcohol use disorder, drug addiction, or other substance use disorders, the conditions are commonly described as co-occurring disorders or PTSD and SUD. Research consistently shows that people with PTSD have a higher risk of developing substance-related problems and poorer treatment outcomes when trauma symptoms are not addressed as part of the overall treatment approach.

PTSD treatment options and addiction treatment approaches frequently overlap and may include evidence-based treatments such as cognitive-behavioral therapy, exposure therapy, cognitive processing therapy, group therapy, and trauma-focused coping skills. These approaches are often used as part of a comprehensive treatment plan that accounts for symptom severity, stability, social support, and individual risk factors, rather than applied in isolation.

Working with a mental health professional who understands co-occurring PTSD and substance use disorders helps ensure that care is coordinated, appropriately timed, and responsive to changes over the course of recovery.

What We Know About Treating PTSD and Addiction Together

For years, trauma therapy was routinely delayed or avoided in people with substance use disorders, but that assumption has changed.

Historically, the concern was that revisiting traumatic experiences would create too much emotional stress, increase relapse risk, or lead people to disengage from treatment. As a result, trauma work was often postponed indefinitely, even when PTSD symptoms were clearly driving substance use.

Over the last two decades, that assumption has been carefully tested. Research now shows that some trauma-focused therapies can be safely integrated into recovery for people with co-occurring PTSD and substance use, when timing and readiness are taken seriously. Across multiple studies, these approaches consistently reduce PTSD symptoms while having little to no negative impact on substance use outcomes. While improvements in addiction itself are less consistent and still being studied, the evidence has been strong enough to shift how the field approaches this issue.

What Current Research Supports

Several trauma-focused therapies have been studied specifically in people with PTSD and substance use disorders.

Prolonged Exposure (PE) has the strongest research base. When appropriately integrated into recovery, PE reliably reduces PTSD symptoms. While its direct effects on substance use are more limited, these findings played a major role in challenging the belief that trauma processing inevitably destabilizes recovery.

Cognitive Processing Therapy (CPT) and Eye Movement Desensitization and Reprocessing (EMDR) have shown similar patterns in early research: meaningful reductions in PTSD symptoms with minimal risk of worsening substance use. Although further research is still needed, current evidence supports their careful, readiness-based use.

Across these approaches, the consistent finding is not that trauma therapy “treats addiction,” but that addressing PTSD does not inherently make substance use recovery worse when therapy is paced appropriately.

What Is Still Being Studied

There are important questions the field continues to explore, including:

  • when trauma therapy is most helpful during the recovery process,

  • which approaches work best at different stages of stability, and

  • whether sustained relief from PTSD symptoms helps protect against relapse over time.

For now, the most responsible conclusion is this: adding a trauma-focused therapy that is already known to help PTSD can meaningfully reduce trauma symptoms without undermining substance use recovery, when introduced thoughtfully and with adequate support.

This shift in understanding has moved clinical practice away from avoiding trauma work altogether and toward a more careful focus on timing, pacing, and readiness.

Where EMDR and Other Trauma-Focused Therapies Fit

Trauma-focused therapies such as Eye Movement Desensitization and Reprocessing (EMDR), Prolonged Exposure, Cognitive Processing Therapy, and approaches like Seeking Safety have all been studied in people with co-occurring PTSD and substance use.

EMDR is designed to target unprocessed traumatic memories that continue to trigger present-day distress. When readiness is present, trauma processing can reduce the intensity of triggers that often drive substance use and relapse. For some people, this reduction in trauma reactivity makes recovery feel more manageable over time.

EMDR is not a detoxification method and is not appropriate during acute withdrawal or instability. Used appropriately, it is part of a broader recovery strategy rather than a standalone solution.

Coordinating Care When PTSD and Substance Use Co-Occur

Recovery often requires coordination across multiple levels of care. Some people benefit from outpatient therapy alone, while others need additional supports such as intensive outpatient programs or other structured services.

Effective coordination involves clear communication between providers, attention to timing and sequencing, flexibility when symptoms fluctuate, and respect for the individual’s autonomy and goals.

Trauma-focused therapy does not replace substance use treatment when higher levels of care are needed, and substance use treatment does not replace trauma work when PTSD remains active. Before making any decision about stopping substance use abruptly, individuals should consult with a medical professional to ensure detoxification is safe and more likely to be successful. 

Resources

For resources on finding an SUD treatment provider in your area visit findtreatment.gov

Working With Someone Who Understands Both Trauma and Substance Use

Navigating PTSD and addiction together can be confusing and overwhelming. Working with a clinician who understands both trauma and substance use can help clarify what to focus on, when to proceed cautiously, and how to adjust when challenges arise.

As a therapist licensed in both trauma treatment and substance use counseling, and as someone in recovery myself, I approach this work with honesty, respect, and realism. Recovery is possible, but it often requires patience, coordination, and a willingness to address both nervous system patterns and behavioral habits over time.

Alex Penrod, MS, LPC, LCDC

Founder & EMDR Therapist

Neuro Nuance Therapy and EMDR, PLLC

Austin, TX

Common Questions About PTSD and Addiction

  • PTSD can significantly increase the risk of substance use by creating chronic distress that substances temporarily relieve.

  • Yes. Substance use can increase exposure to traumatic events that may lead to PTSD.

  • When trauma therapy is poorly timed or rushed, it can increase distress. When readiness and support are present, it can reduce long-term relapse risk.

  • In many cases, yes, when stability and coping capacity are present. It is not appropriate during acute withdrawal or instability.

  • Relapse does not mean therapy has failed. Treatment plans can be adjusted to restore stability before continuing trauma work.

If you’d like to explore whether trauma-focused therapy or EMDR may be appropriate for your situation, visit out EMDR service page where you’ll find a description of services and information on scheduling a free 15-minute consultation. Neuro Nuance Therapy and EMDR specializes in EMDR Therapy in Austin, TX with telehealth available throughout Texas. 

This page is for educational purposes only and is not a substitute for medical or psychiatric care. Medication decisions and detoxification should always be managed by licensed medical professionals.

References

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Mills, K. L., Teesson, M., Back, S. E., et al. (2012). Integrated exposure-based therapy for co-occurring posttraumatic stress disorder and substance dependence: A randomized controlled trial. JAMA, 308(7), 690–699. https://doi.org/10.1001/jama.2012.9071

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