Talking PTSD and addiction with the U of M
June is National Post-Traumatic Stress Disorder (PTSD) Awareness Month. It is estimated that one in 11 people will be diagnosed with PTSD in their lifetime, according to the American Psychiatric Association.
Mustafa al’Absi, Ph.D., with the University of Minnesota Medical School, Duluth campus, talks about PTSD and how addiction can co-occur.
Q: What is PTSD, and how does it develop?
al’Absi: PTSD, or post-traumatic stress disorder, is a psychological condition that is caused by experiencing or witnessing a life-threatening event or terrifying experience. PTSD symptoms may include having frequent nightmares, flashbacks of images related to the event, having intrusive or uncontrollable thoughts about the event, as well as experiencing significant anxiety. These symptoms can impact one’s normal life and can be a risk factor for other mental health and behavioral conditions.
Individuals who have experienced or witnessed life-threatening events including wars, physical or sexual assaults, accidents, disasters, abuse or other traumatic events are at risk for developing PTSD. We know that up to eight percent may experience PTSD at some point in their lives and women are more likely to develop PTSD than men. We know that certain history and early life experiences, such as adverse childhood experiences, having high levels of ongoing stress, as well as biological and genetic factors may increase our risk for developing PTSD. Of course, not everyone exposed to traumatic events develops PTSD—in fact, the vast majority don’t develop PTSD. That is why we always talk about how to help people endure and thrive even in the face of adversity. Factors such as having social and emotional support and learning skills for positive thinking about our abilities in facing threats can help us manage stress and recover from trauma.
Q: What is addiction?
al’Absi: Addiction is a condition where the brain goes through changes due to the effect of exposure to substances or behaviors. These brain changes lead to feeling pleasure (reward) or relief from withdrawal symptoms. With chronic use, the brain experiences a state of craving to the substance or behavior which leads to a compulsive behavior to obtain that “reward” or “relief” without concerns for consequences. Addiction interferes with normal functioning, and can escalate with time and the impact can worsen.
Q: Is there a connection between PTSD and addiction?
al’Absi: Yes, we know that PTSD causes changes in brain functions, and many times—as we have found in our laboratory—these changes are similar to those caused by addiction. This makes for an overlapping vulnerability where we see that adverse and stressful events, including exposure to traumatic situations, may increase risk for PTSD and for addictive behaviors. Research across different labs and with multiple populations has shown that PTSD increases vulnerability to engage in addictive behaviors and substance use. One striking piece of evidence suggests that more than two-thirds of survivors of personal trauma have alcohol-use disorders. One theory suggests that this happens because people with PTSD who experience negative feelings may resort to substance use (like using alcohol and other drugs) as a way to self-medicate and ease the sense of sadness, distress and anxiety they experience. With repeated and long-term use of these substances, this self-medication can lead to addiction.
Q: What support spaces are available for those seeking care?
al’Absi: We know that both addiction and PTSD are chronic and debilitating conditions. We also know that the two conditions frequently co-occur. Because of that, people with these co-occurring disorders need more careful attention to address the challenges they may face in their journey toward recovery. There are ways to provide support for these individuals, and resources and methods are being continuously refined to improve their effectiveness in treating these co-occurring challenges. Treatments that are being used, and are available locally and nationally, include integrative, psychosocial treatments that use multiple components, including therapy that focuses on exposure to the original causes of the trauma. Interventions using certain medications can also be incorporated in the treatment package.
Q: What are you doing to advance public knowledge about addiction and mental health disorders?
al’Absi: Our research over the last two decades has provided important and significant discoveries to the literature. The primary goal of our research program has been to elucidate biobehavioral mechanisms by which stress, trauma and early life adversity play a role in addiction, and to use this knowledge to develop and tailor interventions. The focus on the interaction between stress and addictive behaviors has led to important research discoveries related to mechanisms and predictors of relapse, which has stimulated subsequent efforts to develop treatment options for dealing with stress and addictive behaviors.
An important, replicated finding from our research is the abnormal stress response among smokers and stimulant users. This abnormal pattern of changes during stress is related to vulnerability to relapse (go back to smoking or other drug use). Recent findings from our research have also shown the role a brain system (the brain opioid system) can play in regulating changes in appetite during tobacco withdrawal. This is an important finding that could help us develop treatment to address cessation-related weight gain and removes another barrier for smoking cessation. We have published widely in these areas, with over 200 peer-reviewed publications and two edited volumes on stress, addiction and emotion regulation as well as guest-editing special issues in Psychosomatic Medicine and Biological Psychology on relevant themes.
Mustafa al’Absi, Ph.D, is a professor in the Medical School on the Duluth campus and directs the Duluth Global Health Research Institute. He is an expert on stress and addictive behaviors, stress psychobiology and appetite regulation and stress and risk for cardiovascular diseases. al’Absi has served in leadership positions within several scientific organizations including as a past president of the American Psychosomatic Society, president of the Africa and Middle East Congress on Addiction and several NIH panels and is associate editor for Psychophysiology. al’Absi is a fellow of the Association for Psychological Sciences, the Academy for Behavioral Medicine Research, the American Psychosomatic Society and the Society for Research on Nicotine and Tobacco.
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