Prevalence of SUD and PTSD may increase depending on specific populations. For example, the prevalence of both PTSD and SUD is higher in combat veterans. Other populations that are disproportionately affected by both of these disorders include women ^[1], members of the black and hispanic populations, ^[2]and members of the LGBTQ community. ^[3] Alcohol use disorder (AUD) is the leading cause of SUD amongst veterans who have experienced trauma. While research indicates that alcohol is the most abused substance by those diagnosed with PTSD, additional substances with high abuse rates include other depressants such as cannabis and opiates, as well as the stimulant cocaine." ^[4]

The presence of both PTSD and SUD can hinder outcomes of those seeking treatment for either PTSD or SUD. A few different treatment options include trauma focused treatments such as psychotherapy, non trauma focused treatments, and pharmacological treatments like medications that can help reduce withdrawal symptoms or SSRI's. Those who experience both diagnoses may generally have poorer overall functioning and worse overall well-being than each diagnosis by itself. This can manifest as being hospitalized more frequently, experiencing increased levels of legal issues, have less social support, and have a harder time retaining employment. In treatment these individuals can have high dropout rates, respond poorly to the treatment of PTSD in general, have greater levels of addiction severity, and shorter periods of remission for substance use treatment.

Additionally, individuals who chronically use substances as a form of self-medication for PTSD symptoms strengthen an automatic mental link between PTSD symptoms and the substance use itself via conditioning. Therefore, conditioned link between PTSD and substance use may trigger craving for substances when it arises, potentially increasing psychological dependence and complicating treatment outcomes for both diagnoses. Stress is also a component of PTSD that may lead to drug use, due to the norepinephrine that is released from the stress response of the body. ^[5]

The goal of seeking safety's is to increase the safety of the individual's coping style by addressing thoughts, behaviors, and interpersonal interactions for the individual seeking treatment.Additional non-trauma focused treatments include but are not limited to CBT for PTSD (CBT-P) in existing addiction treatment programs, substance dependency posttraumatic stress disorder (SDPT), and transcend therapy. Other non-trauma focused treatments also include holistic alternatives such as yoga, meditation and acupuncture, which have shown to be effective in treating PTSD and SUD specifically in victims of sexual assault and veterans. ^[6]

Research integrating naltrexone with an exposure-based treatment for PTSD, such as prolonged exposure, has demonstrated modest support for this integrative framework on the reduction of drinking outcomes and amelioration of PTSD symptoms New research is currently evaluating the effects of classic psychedelics, including MDMA, psilocybin, LSD, and ayahuasca, on both PTSD and SUD. Current results have found that psychedelic therapy has had successful results in the treatment of both disorders, especially with MDMA and psilocybin. ^[7]

Summary of changes after peer reviews:

Sarah's review (username: Morrisse95) : I changed my first source that references the information about women being disproportionately affected by comorbid PTSD and SUD to a more recent source. The first source was a review paper that was published in 1997, so I changed it with a review paper that also had the same information that was published in a review paper in 2010. I am not completely sure what she meant in her comment about the lead of the article. Her comment was not extremely detailed as to what about the lead needed to be added or made more concise. I figured she might have meant that the lead did not mention a little bit of information about each of the sections, so I decided to add in a few sentences about the sections that were neglected like the different treatment options.

Adrian's review (username: FormallyTrainedHomunculus) : I took into consideration his feedback about my wording about the specific populations that are more vulnerable to developing both of these disorders, and changed the wording in my sentence. I also took out the "other than veterans" part since it did seem too repetitive. He mentioned that organization might be an aspect I want to edit, but did not exactly mention what was wrong about the organization, so I decided to keep it the way that is set up already. Lastly, I removed the part saying stress is a "big factor", and changed it to "Stress is also a component of PTSD that may lead to drug abuse."