What’s the Link Between PTSD and Addiction?

Trauma, and more specifically, PTSD and addiction are linked in a number of ways. A PTSD diagnosis places a person at a high risk of developing a problematic relationship between drugs or alcohol. Read on for an in-depth look into the link between these two mental health conditions – backed by scientific research.

The link between mental illness and addiction goes both ways. About 50% of people with a severe mental illness are also affected by a substance problem. Moreover, roughly 37% of alcohol abusers and 53% of drug abusers have at least one other serious mental illness.

Although statistics for South Africa are not available, in the United States it is estimated that 69% of all the nation’s alcohol and 84% of all the cocaine used in that country is consumed by people who have been diagnosed with another mental illness at some point in their lifetime.

When another mental illness occurs alongside addiction it is termed dual diagnosis.

PTSD and addiction

What is PTSD?

Post-traumatic stress disorder (PTSD) is a mental illness triggered by a traumatic event or events. It can be caused by both directly experiencing a trauma or being a witness to one.

Common symptoms include:

  • Flashbacks: Reliving the traumatic event
  • Recurrent, unwanted and distressing memories of the trauma
  • Nightmares
  • Severe anxiety
  • Panic attacks
  • Uncontrollable thoughts about the traumatic event
  • Emotional or physical reactions to something that reminds the individual of the traumatic event
  • Avoiding thinking or talking about the trauma and avoiding activities or people that remind the individual of the event
  • Negative changes in thinking and mood such as hopelessness, feeling numb, feelings of guilt or shame, suicidal thoughts and difficulty experiencing positive emotions
  • Difficulty maintaining close relationships
  • Being easily startled
  • Constantly being on guard for danger
  • Trouble sleeping, concentrating or with memory
  • Irritability or angry outbursts
  • Self-destructive behaviour such as driving too fast or abusing drugs and alcohol

After a traumatic experience, most people struggle to cope temporarily. If an individual’s symptoms don’t resolve after several weeks, get worse, last for months or years and interfere with daily functioning, it is likely that they have PTSD.

Board Of Healthcare Funders in South Africa
Hospital Association Of South Africa
Department of Social Development in South Africa
Department of Health South Africa
National Hospital Network South Africa

Research has found that childhood trauma affects brain development and predisposes individuals to developing other psychiatric illnesses including addiction.

The link between trauma and substance abuse problems is strong and well-established. In fact, most people struggling with addiction have a history of trauma.

Surveys conducted in the United States have estimated that 70% of adolescents being treated for substance use disorders have a history of trauma.

In a 1997 study conducted on adolescents who were dependent on alcohol or drugs, 30% met the diagnostic criteria for PTSD at some point in their lifetime. More women (45%) than men (12%) were found to be suffering from PTSD.

However, other estimates suggest an even higher rate of co-occurrence of addiction and PTSD. For example, research has estimated that up to half of people seeking addiction treatment are currently suffering from PTSD.

According to a 2010 study, almost 60% of young people with PTSD go on to develop substance abuse problems.

It is thought that people turn to substances in an effort to delf-medicate symptoms of PTSD. Such individuals may need to use more and more of the substance to experience temporary relief: This cycle often leads to the development of an addiction. Although substance use helps people with PTSD in the short term, abusing substances usually ends up making PTSD symptoms worse in the long term.

Trauma in the South African context

South Africa has comparatively high rates of trauma and PTSD which is a significant driver of the country’s addiction epidemic.

A nationally representative survey found that 75% of South Africans had experienced a traumatic event and about half had experienced more than one trauma.

The country has high rates of criminal violence, domestic abuse and accidental injury.

These high rates mean that addressing trauma is very important when looking at addiction in the country. Substance abuse treatment in South Africa should be particularly sensitive with regards to identifying and treating clients with PTSD.

Treating PTSD and addiction

PTSD is common amongst people being treated for addiction and should, therefore, be high on the agenda of rehabilitation centres.

Individuals with co-occurring PTSD also tend to do worse in addiction treatment than those without the disorder. For example, people with PTSD receiving treatment for addiction have reported more intense drug cravings and tend to relapse more quickly than those without PTSD.

This is why it’s important for both the PTSD and the addiction to be treated simultaneously, with the help of experienced professionals including psychiatrists and psychologists.

An experienced psychiatrist should be able to properly diagnose PTSD, offering any suitable medicine-based treatments, while a psychologist will be able to help the client through a range of therapeutic approaches.

Therapies that have been successful in treating PTSD in addicts and alcoholics include cognitive behavioural therapy, prolonged exposure therapy and cognitive processing therapy.

A new and revolutionary therapy for treating trauma is called Brain Working Recursive Therapy (BWRT).

BWRT is an innovative type of psychotherapy that has been shown to reduce the symptoms of negative emotions. It is especially helpful for people who have experienced trauma or for people with anxiety, fears and phobias. BWRT shows results quickly, often after only a single session.

In January 2020 Changes became the first addiction treatment facility in South Africa to routinely provide BWRT to its clients, in response to the high rates of trauma and PTSD noticed amongst its patients.

In this blog we have described the complicated link between trauma, PTSD and addiction. We’ve also outlined the need to treat PTSD and addiction simultaneously with a brief description of the best therapies that should be used for this purpose.

Are you looking for addiction treatment experienced in addressing dual-diagnosis clients as well as people with PTSD though multiple techniques including BWRT? Contact us today.

Gareth Carter is a Director, Internationally Qualified Counsellor at Changes Rehab in JHB

Gareth CarterRead Bio

Director, Internationally Qualified Counsellor

Helping you find strength within.

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Clients Questions

How does untreated trauma make alcohol or drugs feel like the only option on Johannesburg streets?

Trauma rewires the brain: hypervigilance, intrusive memories and numbing create unbearable states that people learn to short-circuit with substances. Alcohol and sedatives blunt arousal; stimulants can silence intrusive thoughts by forcing focus elsewhere. In Johannesburg — with high rates of violent crime, daily stressors and limited safe public spaces — that short-term relief is reinforced constantly, which strengthens addiction pathways. Clinically this looks like negative reinforcement: using to avoid pain rather than to seek pleasure. The practical takeaway: if someone is self-medicating trauma, you are not dealing with willpower failure — you’re dealing with overlapping biological and environmental drivers that require coordinated trauma-informed addiction treatment, not just abstinence slogans.

My partner uses drink to cope with a rape years ago. How do I step in without triggering them or making dependence worse?

Start with safety and boundaries, not ultimatums. If there’s active drinking that threatens physical safety, medical detox is priority — alcohol and benzodiazepine withdrawal can be life‑threatening and needs clinical oversight. Otherwise, open a low-pressure conversation focused on concrete problems (missed work, childcare, sleep) and link those to options: outpatient dual-diagnosis programs, trauma-focused therapy, or a medical review for safer symptom control. Avoid shame or simplistic “just stop” messages; that increases avoidance and secrecy. If you’re in a community where stigma or family reputation matters, involve a trusted clinician or social worker who understands your context and can help with a private, legally sensible plan for children or work obligations.

Will PTSD medications worsen an existing substance problem?

Some medications commonly used for PTSD carry real risk in people who are dependent. Benzodiazepines ease anxiety and nightmares but are highly addictive and often make substance dependence worse — they should be avoided or tightly controlled if there’s current misuse. SSRIs are generally safer and can reduce core PTSD symptoms, but they work best alongside addiction treatment and therapy; they are not a stand-alone fix. For nightmares, prazosin can help and has less abuse potential. Also recognise interaction risks: mixing alcohol with sedatives, antipsychotics or opioids increases overdose risk. The clinical approach is integrated: stabilise substance use (medical detox or opioid substitution where available), then treat PTSD with evidence-based therapies and carefully chosen medications under supervision.

What exactly should I ask a Johannesburg treatment centre to make sure they can handle both PTSD and substance dependence?

Ask if they provide integrated dual-diagnosis care — not separate silos of “addiction” and “mental health.” Specifically: do they run trauma-focused therapies (EMDR, prolonged exposure or cognitive processing therapy) delivered by trained clinicians; do they have on-site medical detox and protocols for withdrawal complications; what is their policy on prescribing benzodiazepines; can they coordinate with public health services for HIV/TB comorbidity; do they offer family or caregiver sessions; and what aftercare or community follow-up is available locally? Also check staff credentials and whether they practice trauma-informed care to avoid re-traumatisation. If a facility can’t answer these or pushes quick fixes, keep looking — integrated, evidence-based options reduce relapse and harm.

We can’t access formal rehab right now. What immediate harm-reduction steps lower the risk while trying to get help?

First rule: don’t stop heavy alcohol or benzodiazepine use cold turkey without medical supervision — seizures and delirium are real risks. If detox isn’t possible immediately, reduce quantity gradually and arrange urgent medical review. Other practical harm-reduction: avoid using alone, don’t mix depressants with opioids or alcohol, store or lock medications away from children, and have an emergency plan (who will take the person to hospital if they overdose or become acutely suicidal). If injecting, use sterile equipment where available and get tested for HIV/TB; local NGOs and some clinics provide needle exchanges and testing. Finally, make contact with a local mental health NGO or SADAG-style helpline to get referrals and crisis support — incremental safety steps buy time until you can access integrated care.

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Content on this website is for general information only and is not a substitute for professional medical advice, diagnosis, or treatment. Always speak to a qualified health professional about any medical concerns.
Changes Addiction Rehab PTY LTD (‎2013/152102/07) is licensed by the South African Department of Social Development (Practice No. 0470000537861) and the Department of Health, and is a registered detox facility and practice with the Board of Healthcare Funders. Our treatment programme is led by counsellors registered with the HPCSA, working alongside a multidisciplinary team of medical professionals under a unified practice. We are proud, standing members of the International Certification & Reciprocity Consortium (IC&RC), the Occupational Therapy Association of South Africa, the South African Council for Social Service Professions, the South African Medical Association, the South African Nursing Council and the South African Society of Psychiatrists. Changes Addiction Rehab has been in continuous professional operation since 2007, when it was founded by Sheryl Rahme, who has worked in the addiction treatment field since 1984. Our core clinical team brings over 100 years of combined professional addiction recovery experience.