Post-Traumatic Stress Disorder

Acute Stress Disorder and Addiction

Table of Contents

• Signs of Acute Stress Disorder
• Stress and the Addiction Cycle
• Signs of Addiction
• Dual Diagnosis and Treatment

Exposure to an extremely traumatic event like witnessing a death or accident, or being the victim of violence, can lead to acute stress disorder (ASD). Feelings including hopelessness, horror, and fear may appear within the month of witnessing or being involved in the event. Traumatic events come in many forms, such as a school shooting or massive traffic accident. ASD can be a precursor to post-traumatic stress disorder (PTSD) as well.

Depression, severe anxiety, suicidal behavior, panic attacks, and substance abuse are common in those that suffer from acute stress disorder. Those exposed to the bombing of the Federal Building in Oklahoma City in 1995 had a 50 percent increase in alcohol and tobacco use in the wake of the tragedy. Similarly, 28.8 percent of New Yorkers after the terror attacks of 9/11 reported an increased usage of marijuana, alcohol and tobacco. Substance abuse has long been an answer to stress and is often viewed as a way to cope, although it can actually work to make symptoms worse.

Signs of Acute Stress Disorder

When put in what an individual perceives as a life-threatening or particularly dangerous situation, the body automatically reacts in a “fight-or-flight” mode. Heart rate accelerates, blood pressure increases, sweat surges as does breathing and metabolism, and muscles tense to be ready for action or to run away. This is deemed acute stress. As aforementioned, acute stress disorder is brought on by a severe emotional trauma stemming from a traumatic event.

As aforementioned, acute stress disorder is brought on by a severe emotional trauma stemming from a traumatic event.

These events can include:

• Natural disaster
• Accident
• Incident of violence
• Witnessing a death
• War or combat
• Near death experience
• Terror attack
• Abduction
• Rape

Trauma has two parts, physical and emotional. Physical trauma is bodily injury, and emotional or psychiatric trauma involves an emotional response to an event in which memories are stored deep in the brain.

In order to be diagnosed with acute stress disorder, a person must have the following symptoms:

• Anxiety or increased arousal
• Avoidance
• Reliving the trauma
• Dissociation

Sufferers of acute stress disorder may also experience an inability to sleep, poor concentration, flashbacks, dissociative amnesia, derealization, emotional numbness, an unawareness of their surroundings, “out-of-body” feelings, nightmares and depersonalization. They tend to avoid anything to do with the event, including sights, sounds, smells and other associations, and they can’t help reliving it over and over again, sometimes without warning.

These symptoms must be severe enough to impair an individual’s normal ability to function in a social, occupational, or otherwise normal capacity. Individuals are more likely to develop ASD if the trauma included violence, and the closer they were to the trauma, the greater their risk. For example, gunshot victims are more likely to exhibit symptoms than those across the room from the violence. Victims of childhood abuse, other intense prior trauma, or other mental health disorders may be at a higher risk of developing ASD. The symptoms for ASD start within a month of the traumatic event and last anywhere from three days to four weeks. Anything beyond that is considered PTSD.

The New York Times reports that 25 percent of American adults have experienced intense anxiety at some point in their lifetime. Anxiety disorders affect more than 20 million Americans, making them the leading cause of psychiatric conditions in the country. Studies reported by the U.S. Department of Veterans Affairs state that victims of assault and robbery developed acute stress disorder 25 percent of the time while 13 to 21 percent of motor vehicle accident survivors did, and an alarming 94 percent of rape victims presented with ASD symptoms. While acute stress disorder is less widely known that its counterpart, post-traumatic stress disorder, both are likely to increase an individual’s tendency toward substance abuse and sometimes even addiction.

Stress and the Addiction Cycle

Everyone deals with some amounts of stress in their daily lives. Stress refers to the emotional strain brought on by demanding or challenging circumstances. It is perfectly normal for the body to release small amounts of stress hormones daily; however, a major stress event leads to the flooding of these hormones throughout the body. Someone suffering from ASD will have heightened levels of these stress hormones in their systems. Sometimes this acute or intense stress is too much for one person to bear, leading them to seek out other ways to handle or dull their senses.

Turning to opiate drugs such as heroin or morphine in response to acute stress disorder can actually build up a vicious cycle between addiction and stress, according to an NIHPA manuscript. Opiates work to inhibit the neurotransmitters that cause stress symptoms in the brain, helping the user to dull these feelings, which makes them feel good. After the drug wears off, withdrawal symptoms include a sort of “hair-trigger” for stress, making them more susceptible to higher levels of stress. This in turn can cause someone who is already suffering from high levels of stress due to ASD to want to take the drug again. The more this cycle is repeated, the easier the stress hormones are triggered when the drug is not in the system – hence, the feeling of needing to repeat the drug use to keep those symptoms at bay.

Cocaine works in a different way than opiate drugs by actually increasing the stress hormones at the same time as enhancing the pleasure receptors in the brain. Users feel this as part of the high and won’t perceive the stress for what it is until withdrawal starts. Then they too feel the heightened sense and quicker stress levels. These changes in the stress pathways in the brain can actually lead a casual user toward addiction as they are more susceptible to a loss of control, increased cravings, and compulsion.

During a traumatic event, the brain produces endorphins that work to help numb the pain of what is happening. After the trauma is over, individuals can experience endorphin withdrawal that can last for hours or even days. Alcohol can compensate for these lower endorphin levels and people often turn to alcohol to relieve anxiety, irritability and depression. The NIAAA published that this can also lead to the cycle of binge drinking, withdrawal, and then a need to drink again to recreate the feelings brought on by the rise in the endorphin level alcohol creates. In a sense, alcohol numbs the pain created by acute stress disorder. Continued episodes of binge drinking may also lead to alcohol dependence and addiction.

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Signs of Addiction

Dependence on a medication, alcohol or an illegal drug is considered addiction. Addicts are unable to control their drug or alcohol use and continue to abuse these substances even when negative side effects occur. Casual drug or alcohol use can lead to addiction when the user can no longer control the intense cravings for the substance. Mental and physical health both suffer, as do relationships and occupations.

Symptoms of addiction include:

• A feeling of needing the substance
• Changes in personality or mood swings
• Spending excess money on the substance
• Physical health problems
• Trouble at work or school
• Neglecting personal appearance
• Loss of interest in previously enjoyed activities
• Accidents or criminal behavior
• An inability to cope without the substance
• Not being able to stop using

Dual Diagnosis and Treatment

The National Institute on Drug Abuse reports that people diagnosed with anxiety or mood disorders are twice as likely to also suffer from drug abuse or dependence. Acute stress disorder and drug or alcohol addiction need to be treated simultaneously in order for treatment to be most effective. When a person suffers from a mental health disorder as well as an addiction, it is called a Dual Diagnosis. Both issues need to be treated, and each in its own way. On their own, each disorder’s symptoms can be more severe and persistent, making them more resistant to treatment and relapse more prevalent.

For example, sufferers from acute stress disorder are often treated with Cognitive Behavioral Therapy as well as medication, while those suffering from addiction may need detoxification and help identifying emotional and social triggers for their addiction. Concurrent treatment can include behavioral therapy as well as medication in some cases.ASD should be treated as early as possible to avoid it developing into PTSD. Psychology Today reports that around 80 percent of people who suffer from ASD will develop PTSD without proper treatment. Exposure therapy – therapy in which the patient is systematically exposed to the stressor – has had some success in treating patients with co-occurring ASD and cocaine addiction. That being said, attempting to shock or force a person with ASD or PTSD and addiction to confront their fear without the proper training and the right setting can be hazardous. Never attempt this without the help and supervision of a trained professional. Individual and group therapy coupled with family support can really make a difference in recovery as well.

Michael's House offers individualized treatments for both stress disorders and addictions. Continued research and work to understand both disorders is something Michael's House strives toward. The first step toward recovery is understanding, which comes with further education. Our admissions coordinators are standing by to help identify the best type of treatment plan to help you or your loved one. Call 760-548-4032 today so the healing process can begin.