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The Connections Between Trauma and SUD

It’s well understood that there is a connection between psychological trauma and substance use disorder (SUD). Decades of research and hundreds of studies have confirmed links between trauma and patterns of habitual drug and alcohol use.

Below are some of the things we know and don’t know about SUD and trauma, particularly with regards to post-traumatic stress (PTS) and post-traumatic stress disorder (PTSD). If you think you have a dual diagnosis of SUD and PTS/PTSD, please contact a qualified psychiatrist. You can contact Boston Drug Treatment Centers to find dual diagnosis treatment programs all over New England.

The prevalence of PTSD and SUD comorbidity

SUD and PTSD reporting can be difficult because of the shame that’s often connected with being a drug user or being a victim or perpetrator of acts that are not approved of by society at large.

As such, most studies have differing figures on how often both illnesses co-occur. According to the National Institutes of Health, about 46.4 percent of all Americans with PTSD also have a drug or alcohol use disorder. However, other studies show figures much lower or higher than this.

While some kind of link was suspected from the very beginning, the aftermath of the Vietnam War proved to be a turning point in our collective knowledge of the subject. This specific conflict, more than others before it, has been ingrained in the American consciousness as the time when the connections between substance misuse and PTSD were proven and became known to the wider public.

A series of surveys in the 1980s on Vietnam War veterans by The National Vietnam Veterans Readjustment Study found that in the ones surveyed, over 80% met the criteria for SUD or PTSD. Of the ones with PTSD, a whopping 74% also had an SUD. Perhaps a third to half of all combat veterans from that conflict are conjectured to have developed PTSD as a result.

This seems to correlate with what we know about people who experience traumas in other circumstances. While the numbers vary depending on the study cited, SUD and PTSD occurrence tends to be higher among people who have experienced serious health problems, accidents, natural disasters, sexual abuse, and other similar traumatic events.

Why are they connected?

While we can be sure that trauma and SUD are connected in some way, the reason or reasons for this are still disputed. There are several hypotheses on the subject, but so far, four have become popular in the United States:

1.) Susceptibility hypothesisThe premise behind this hypothesis is that some individuals who use drugs or alcohol are more susceptible to developing PTS/PTSD after experiencing trauma compared to those who do not regularly misuse these substances. In recent years, this hypothesis has become less popular as fewer studies now support it.2.) High-risk hypothesis

This hypothesis is similar to the susceptibility hypothesis, as it identifies substance misuse as a cause of trauma, albeit through the deviant lifestyles people with SUD tend to have. As with the susceptibility hypothesis, it has become less popular among mental health experts with time.

3.) Self-medication hypothesis

The oldest and perhaps the most popular and scientifically-supported hypothesis, the self-medication hypothesis suggests that PTSD can be caused by SUD. The idea is that traumatized individuals use drugs and alcohol to cope with their traumas. Interestingly, this idea is ancient and predates the idea of trauma and SUD as we know them today.

4.) Shared vulnerability hypothesis

This hypothesis suggests that PTSD and SUD share the same environmental and genetic risks, which is why these two conditions co-occur so frequently. This is the most recent hypothesis to have gained popularity, due partly to genetics being more widely explored in the past decades.

What are the implications for SUD treatment and rehab?

Depending on the views of the rehab and treatment specialists, the approaches they take may influence how they approach different SUD cases. Some implications include the following:

1.) Which condition to treat firstIf the treatment specialists strongly subscribe to the susceptibility and high-risk hypothesis, they may put more emphasis on treating the SUD first, as these hypotheses state that trauma is caused by SUD. If they subscribe to the self-medication hypothesis, they may treat the trauma as the root cause and focus more on the treatment of PTS/PTSD. If they more strongly believe in the shared vulnerability hypothesis, they may attempt a more holistic approach or treat whichever is more serious.

2.) Which modalities and approaches should be taken

While it’s common to use a wide range of modalities and approaches in complex dual diagnosis cases, the views taken by the clinicians can favor a certain set of approaches more, depending on which hypothesis they believe.

3.) The agency of the individual

Older hypotheses on SUD and PTSD often subscribe much more agency to individuals. This can influence just how much responsibility treatment specialists think patients should have in their own recovery.


There is still plenty we don’t know about the connection between trauma and SUD. What we do know is that addressing trauma tends to have beneficial results for co-occurring SUD and that leaving traumas unaddressed often leads to increased relapse rates for recovering individuals. It’s clear that, if mental traumas are identified, they should be treated with the same or greater priority than a co-occurring substance use disorder.

If you want to find substance rehab programs that offer treatments covering traumas and dual diagnosis cases, please reach out to our team at Boston Drug Treatment Centers.

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