Trauma and PTSD With Substance Use: When Old Memories Lead to Dependence
Written by the medical team at Day One Rehabilitation Center, Nakhon Nayok, Thailand · Medically reviewed by Dr. Pichayut Kasemphakdeephong (Psychiatrist)
A violent or deeply distressing event can leave effects that last long after it’s over. Some people still have nightmares, involuntarily relive the event, startle easily, fear that something bad will happen again, avoid places or people that bring back the memory, or feel as though they must stay on guard all the time.
These symptoms can appear after facing a life-threatening event, severe injury, violence, sexual assault, an accident, a disaster, or a loss and certain other traumatic experiences. When the symptoms persist and affect daily life, they may be related to post-traumatic stress disorder, or PTSD.
The problem grows more complicated when the person finds that alcohol, sleeping pills, cannabis, or certain substances make them think less, fall asleep more easily, or temporarily stop feeling painful memories. What starts as using just to get through one night can gradually become using every time there’s a nightmare, stress, loneliness, or something that triggers the old memory.
Families should therefore look deeper than the question “why won’t they just stop using?” — for some people, the substance has become a way of coping with fear, memories, and feelings that have never been properly addressed. Appropriate treatment needs to address the psychological trauma, the PTSD symptoms, and the substance use problem together, not just one side of it.
What Are Psychological Trauma and PTSD, and What Are the Symptoms?
Going through a traumatic event doesn’t mean everyone will develop PTSD. Many people may feel afraid, have trouble sleeping, or think about the event a lot at first, and then gradually feel better.
PTSD is a condition in which symptoms following a traumatic event persist and clearly affect daily life. The symptoms can be grouped into several patterns to make them easier to understand.
Unwanted Memories of the Event Keep Coming Back
The person may keep seeing images or reliving the event, have nightmares, or have moments that feel as if the event is happening all over again, even though in reality they are somewhere safe.
The trigger can be a sound, a smell, a place, a news story, a certain person, an anniversary, or a situation that shares some detail with the original event.
Trying to Avoid Anything That Brings Back the Memory
Some people don’t want to talk about the event, avoid certain places, stop seeing certain people, or try not to think about what happened.
Using alcohol or other substances to numb themselves, fall asleep, or stop thinking can also become just another way of avoiding these feelings.
Changes in Thinking and Mood
Some people feel guilty, blame themselves, come to see the world as unsafe, feel distant from the people around them, no longer enjoy things they used to like, or feel that they are not the same person since the event happened.
These symptoms can occur alongside depression and anxiety, so they should be assessed together.
Body and Mind Stuck in a State of Excessive Alertness
This can show up as being easily startled, irritable, unable to sleep well, having trouble concentrating, being suspicious of one’s surroundings, or feeling like they constantly have to check that they’re safe.
Some people feel exhausted even without doing anything strenuous, because the brain and body seem to be constantly braced for danger.
If there is severe low mood, withdrawal to the point of being unable to function normally, or thoughts or behaviors of self-harm, an urgent evaluation by a specialist is needed.
Why Someone With Psychological Trauma or PTSD May Come to Depend on Substances
For someone with PTSD, using substances sometimes doesn’t start from wanting to have fun — it may start from wanting to stop a particular feeling.
Some people drink alcohol because it seems to help them fall asleep more easily and dream less. Some use cannabis because they want their thoughts to slow down. Some rely on sleeping pills or anti-anxiety medication because they fear the night, while others use stimulants to push through exhaustion or to try to stay awake because they’re afraid of nightmares.
This pattern can be described as self-medicating psychological distress. The person may genuinely feel that the substance helps at first, because the fear, the racing thoughts, or the memories temporarily ease.
But with repeated use, the brain can start to learn that whenever it feels unsafe, it needs to drink or use in order to get through that feeling. The person then becomes more likely to depend on the substance every time there’s stress, a nightmare, or something that triggers the old memory.
Over the long term, substance use can make sleep, mood, memory, relationships, and self-control worse. Once the substance’s effects wear off, the anxiety or low mood can come back, making the person want to use again to escape the same feelings.
So what a family sees as “using again” may have a trigger behind it — a nightmare, an argument with a partner, running into someone from the past, going back to a familiar place, or something that made the person feel as unsafe as they did before.
Identifying these triggers isn’t about making excuses for substance use — it helps treatment reach the root cause of why someone keeps going back to it.
How Can You Tell Whether It’s PTSD or a Symptom of Substance Use?
Many PTSD symptoms can overlap with the effects of substances — insomnia, restlessness, poor concentration, irritability, paranoia, abnormal dreams, or mood swings.
Stimulants such as yaba and crystal meth (ice) can cause insomnia, hyperarousal, restlessness, and paranoia, especially with continued use or prolonged sleep deprivation. In some cases, hallucinations or other psychotic symptoms can occur.
Cannabis may make some people feel relaxed, but in others it can increase anxiety, fear, or paranoia.
Alcohol and other central nervous system depressants may feel calming or sedating while they’re active, but once continued use leads to dependence, cutting down or stopping suddenly can cause anxiety, tremors, insomnia, and restlessness — and in severe cases, medical complications.
The treatment team therefore needs to look at when the traumatic event happened, when the symptoms began, whether they have ever occurred during periods without substance use, and how they change once the substance wears off or after withdrawal is over.
In some people, PTSD was already present and led to substance use. In others, symptoms from substance use simply resemble PTSD. And in others still, both PTSD and substance addiction genuinely co-occur. Untangling these relationships has a direct impact on the treatment plan.
How Is PTSD Treated When It Co-Occurs With Substance Addiction?
The goal isn’t simply to make the person stop thinking about the past — it’s to help them cope with memories and emotions safely, without needing to turn to substances to escape every time.
Establishing Safety and Stability First
Before going into the details of the traumatic event, the treatment team must first assess the person’s current safety — whether they are still in a situation involving violence or threats, whether they are experiencing withdrawal, whether there are any psychotic symptoms, and whether there are thoughts or behaviors of self-harm.
If the person is still intoxicated, experiencing severe withdrawal, or psychologically unstable, treatment will prioritize safety and stabilization first.
Treating psychological trauma doesn’t mean the person must be pushed to recount the entire event right away. They should feel safe and have a say in setting the pace of treatment.
Treating PTSD and Addiction as Connected Conditions
If someone uses substances every time a nightmare or intrusive memory occurs, treating the addiction without addressing PTSD may leave them facing the same feelings again with no other way to cope.
Conversely, if PTSD is treated while substance use continues, the effects of the substance, withdrawal, and disrupted sleep can all interfere with recovery.
Therapy should therefore help the person understand the connections between triggers, feelings, memories, cravings, and the behaviors that follow, while practicing ways to manage emotions and stress that don’t rely on substances.
Once the person is physically and psychologically ready, a specialist may use therapy aimed directly at treating the trauma, tailored to what’s appropriate for each individual.
Managing Sleep and Nightmares Without Relying on Substances
Sleep problems are one of the main reasons people with PTSD turn to alcohol, cannabis, or sleeping pills.
Treatment needs to ask clearly what exactly the person fears about sleep — is it that their body is too keyed up to fall asleep, or are they avoiding sleep because they’re afraid of nightmares?
Restoring sleep should be addressed together with treating PTSD and the addiction. It shouldn’t be solved by buying sleeping pills or anti-anxiety medication and using them without supervision, because some of these medications carry a risk of dependence if used inappropriately.
Using Medication When Clinically Indicated
PTSD can be treated with medication in some cases. A psychiatrist will decide based on the main symptoms, their severity, and any co-occurring depression, anxiety disorder, sleep problems, or other psychiatric conditions.
For those with a history of addiction, medication choices must also take into account the risk of dependence on the medication itself, so it’s important to tell the doctor honestly about any history of alcohol, sleeping pill, anti-anxiety medication, or other substance use.
Medications should not be bought and taken without guidance, borrowed from someone else, or adjusted to suppress memories, anxiety, or induce sleep without a proper evaluation.
How Should Families Talk About This When Trauma Is Tied to Substance Use?
Families may want to know “what happened” and believe that if the person just tells them everything, it will help them get better. But questioning or pressuring someone to describe an event they aren’t ready to talk about can make them feel even less safe.
What helps is acknowledging that the symptoms are genuinely affecting the person’s life, without judging how they should feel.
Phrases to avoid include “It happened so long ago,” “Why can’t you just move on,” “Other people have been through worse and they’re fine,” or “Just don’t think about it” — because PTSD isn’t caused by someone choosing to dwell on the event.
If substance use is also involved, the past shouldn’t be used as a reason to accept ongoing use — but at the same time, families shouldn’t overlook the fact that the substance may be serving a real function for the person.
Families might say something like, “Lately I’ve noticed that every time you can’t sleep or have a nightmare, you go back to drinking or using. I’m worried it’s making you depend on it more, and I want to help find a safer way through this.”
If the person doesn’t accept that they have a substance use problem, there’s no need to start by forcing them to accept the word “addicted.” It can start instead from problems they themselves recognize — insomnia, nightmares, irritability, worsening relationships, or feeling that they need the substance to feel calm.
When PTSD Co-Occurs With Substance Use, Where Should You Start Seeking Help?
If the main problem is symptoms from psychological trauma or PTSD, and alcohol, cannabis, or other substances are only used occasionally without a clear pattern of addiction — or if the person isn’t ready for treatment yet and the family wants guidance first — a good place to start is a consultation at Piti Clinic, our outpatient mental-health clinic in Bangkok (Pradiphat Road, Saphan Khwai), to assess symptoms, safety, sleep, and the relationship between the trauma and the substance use, and to help the family plan how to talk with the person and encourage them into appropriate treatment.
But if substance use is repeated and uncontrolled — needed regularly to fall asleep, stop nightmares, reduce fear, or feel numb; increasing in amount; stopped and then restarted multiple times; accompanied by withdrawal symptoms; or affecting work, finances, and relationships — then treating the addiction seriously needs to become the priority.
For someone with both PTSD and addiction, their usual environment may be full of triggers — people, places, relationships, and easy access to the substance. Residential treatment can create a period free of substances and triggers, allowing systematic recovery from both problems at once.
Treating PTSD and Addiction at Day One Rehabilitation Center
For those with addiction alongside PTSD or psychological trauma, Day One Rehabilitation Center focuses on treating both the substance use and the underlying mental health condition together, because stopping the substance alone may not be enough if the person still has no other way to cope every time a memory or nightmare returns.
Residential treatment reduces access to the substance and to triggers in the early period, while monitoring symptoms after stopping use — sleep, anxiety, mood, cravings, and any co-occurring psychiatric symptoms.
A psychiatrist can assess which symptoms relate to PTSD, which may come from the substance or from withdrawal, and whether depression, anxiety, or other mental health conditions are present, as well as considering medication where clinically indicated.
Individual therapy helps the person gradually understand the connections between past experiences, present emotions, and substance use, without being forced to disclose details of the event before they’re ready.
At the same time, addiction treatment helps identify triggers connected to the trauma — conflict, feeling abandoned, certain sounds or places, nightmares, or moments of feeling unsafe — while building ways of coping that don’t require going back to the substance.
Before returning to everyday life, relapse prevention should prepare a plan for real-world situations — what to do if a nightmare returns, who to reach out to if they encounter a person or place that triggers a memory, and what other ways of coping are available if the urge to use arises to stop a feeling.
The goal of recovery, then, isn’t to force someone to forget the past, but to help ensure that past events no longer have to control the present, and that the person doesn’t need to rely on substances every time a difficult memory or feeling resurfaces.
Frequently Asked Questions About PTSD and Substance Use
Does everyone who experiences a traumatic event develop PTSD?
No. Everyone can experience stress after a traumatic event, but that doesn’t mean everyone will develop PTSD. Diagnosis depends on the pattern of symptoms, how long they last, and their impact on daily life.
Is PTSD just overthinking or refusing to let go of the past?
No. PTSD isn’t caused by someone choosing to dwell on an event. The memories, nightmares, and physical responses can occur without the person wanting them to.
Can PTSD cause insomnia?
Yes. People with PTSD may be highly alert, find it hard to fall asleep, wake up startled, or have nightmares. Some begin to fear sleep itself and turn to alcohol or other substances to help them sleep, which can develop into a substance use problem.
Is it okay to drink alcohol to help sleep after a nightmare?
Alcohol shouldn’t be used as a way to treat PTSD or sleep problems. Even though it may make someone drowsy at first, it can disrupt sleep quality, and using it repeatedly to control symptoms can lead to dependence.
Can cannabis help treat PTSD?
Cannabis shouldn’t be used to self-treat PTSD. Its effects vary from person to person, and in some people it can increase anxiety, fear, or paranoia. If someone is using cannabis to cope with nightmares or memories, both their PTSD and their pattern of substance use should be evaluated.
Does someone have to tell the therapist every painful detail of the event from the very first session?
No. Treatment should take into account the person’s safety and readiness. Building trust and coping skills for handling emotions is an important part of the process, and no one should be forced to disclose details they aren’t ready to share.
Can PTSD be treated?
Yes. Treatment can help reduce the severity of intrusive memories, avoidance, excessive alertness, sleep problems, and their impact on daily life. Psychological therapy is a key part of treatment, and some people may also receive medication as clinically indicated.
If PTSD keeps leading to relapse, what should be treated first?
In many cases, both PTSD and the substance use problem should be treated together. Safety comes first — if there is intoxication, severe withdrawal, psychotic symptoms, or thoughts or behaviors of self-harm, these need to be managed first, before planning trauma treatment at the right pace.
If a family member won’t talk about what happened, should they be pressured to tell the story?
No, they shouldn’t be pressured. Giving space and a sense of safety is usually more helpful than pressing for details. Families can instead encourage the person to get an evaluation based on symptoms that are disrupting their life — nightmares, insomnia, anxiety, or substance use — without needing to know every detail of the event first.
Do PTSD and substance use always require going to a treatment center?
Not for everyone. If the main problem is PTSD and substance use is only occasional, without a clear pattern of addiction, a mental health evaluation can be a starting point. But if there is repeated, uncontrolled use — relying on the substance to sleep, reduce fear, or escape memories; stopping and relapsing; or experiencing withdrawal symptoms — residential addiction treatment at Day One Rehabilitation Center should be seriously considered.
Recovery Isn’t About Forgetting the Past — It’s About Returning to Life Without Depending on Substances
Psychological trauma can affect a person’s sense of safety, relationships, sleep, and how they see themselves or the outside world. Some people use substances not because they want fun, but because they want to stop the memories, reduce fear, or feel nothing at all for a while.
Once the substance becomes the main way of coping, the two problems can reinforce each other — PTSD symptoms drive substance use, while the effects of the substance, withdrawal, and the life problems it causes can make mood, sleep, and feelings of unsafety even worse.
Treatment should therefore help the person find safer ways of coping with memories and emotions, while seriously addressing the substance use problem. Families don’t need to know every detail of the event before they can start helping. Listening without pressure, noticing the connection between symptoms and substance use, and helping the person get an appropriate evaluation can all be a starting point for recovery.
The past may be part of a person’s life, but it doesn’t have to be the reason they depend on substances forever. Treatment that addresses both the psychological trauma and the addiction can help a person gradually feel safe again, gain other options for coping with distress, and return to living life without needing to escape their feelings through substances.