Studies show correlation between PTSD and substance abuse
By Taylor Sexton • Special to SMN | Emma Jordan lives in Hatteras, North Carolina, where she spends her days working hard, soaking in the sun’s rays, and struggling with PTSD and substance abuse.
“My whole deal was to bottle it up, leave it somewhere buried deep down inside,” Jordan said. “Somewhere you can’t think about it.”
Jordan has suffered from environmental trauma, including what she describes as the absence and neglect of her biological father and the sudden passing of her father figure. Struggling with an eating disorder since she was 12, she feels her entire life’s been spent feeling gaslighted about her emotions and traumas.
“Everybody within the picture has tried to tell me that it’s not as bad as I think it is, and then everybody from the outside of the picture has been like ‘Holy shit, that’s a horrible painting,” Jordan said.
Three months after she turned 17, Jordan alleges, she was molested by her cousin’s 29-year-old roommate. She said her brother and cousin were also in the house, unaware.
“This was the first year I actually told my brother about it, and he was horrified,” said Jordan. “For the past four years, I’ve had a really hard time just being around my brother and being around my cousin and being around everybody that was at the house, because those are the people that are supposed to protect you. But when they’ve made you feel uncomfortable addressing those types of situations in the first place, you freeze up.”
Jordan said that same night, she had gone to see her favorite band, and although she said it was the best concert of her life, she hasn’t been able to listen to them since.
Not long after the assault, Jordan found herself in a three-month-long relationship with someone who she says spent a month-and-a-half of it raping her.
“Because of him, I can’t go to the bathroom in public settings,” she said. “I can’t go to parties. I can’t comfortably fall asleep in someone’s house if there’s unknown people, like if there’s people I don’t know.”
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Due to these traumas, Jordan said she’s found herself struggling to allow people to be anywhere near her physically.
According to the Rape, Abuse & Incest National Network, there are an average of 321,500 rapes and sexual assaults commited in the U.S. each year. To put it in perspective, every 92 seconds, an American is sexually assaulted.
One out of every six women have been a victim of an attempted or completed rape in her lifetime, and one out of every 33 men is a victim of an attempted or completed rape in his lifetime.
As of 2016, the rate of sexual assaults in the U.S. has fallen 63 percent since 1993, going from approximately 625,000 sexual assaults per year to 321,500, according to RAINN.
There are approximately 8 million Americans living with Post Traumatic Stress Disorder, according to the Anxiety and Depression Association of America. Of those 8 million, 50 to 66 percent of those who struggle with PTSD are simultaneously struggling with addiction.
“Imagine running as fast as you can, as hard as you can up a hill, and suddenly you get a chance to stop and breathe,” said Bob Cummings, who works with those who struggle with addiction and trauma as the recruitment, training and prevention manager at Red Oak Recovery, a rehab center in Asheville. “That’s the feeling that a trauma-based person gets when they use. Then, when the drug wears off, they’re back to the high anxiety, the fear, the hate.”
Trauma has been around as long as mankind has, but it was not until the last 40 years that trauma began to be understood, said psychiatrist Derek Rutter, program director at Red Oak.
“I think the big shift is that as you start to unpack what we know trauma is now, it’s best conceptualized as an injury to the nervous system,” Rutter said. “This is really significant because it’s often in the past been thought of like a mental or a psychiatric issue or conceptualized as a shortcoming in someone’s character or their personality.”
Rutter explained trauma as a physiological issue, rather than a psychological issue. The understanding of trauma being a physiological issue has led to the contemporary understanding of what trauma is and the stigmas originally surrounding it.
When someone breaks a bone or endures any other type of physical injury, they receive sympathy and understanding. When someone suffers from trauma, they are often met with judgment or questioned about their moral integrity. In reality, when someone suffers from trauma, they are also suffering from physiological effects and should be met with the same compassion, according to Rutter.
“Our response to threat, whatever that might be, is something that happens on an autonomic level,” he said. “Which is to say that below the level of our conscious awareness before we are making decisions or choosing, we’re actually using something called neuroception and neuroception is the way in which we are scanning the environment on a deeply instinctual level and understanding whether it’s safe or dangerous.”
Rutter described autonomic responses as our fight-or-flight response. When our autonomic response activates, that’s when we feel we are in a dangerous situation, and the only way we can feel safe again is by allowing ourselves to go through an entire mobilization cycle.
“What happens with trauma is that that cycle essentially gets interrupted somewhere in the process, and what that means is that on the level of our nervous system, it’s like our being does not know that that threat has now ended, so our nervous system and our whole autonomic response then kind of persistently stays in that place of activation or collapse depending on where in the process it got interrupted,” he said. “Then this manifests the many symptoms of PTSD.”
When it comes to PTSD, there are two categories in regard to trauma, said Rutter. The first, called “big T” trauma, happens when there is one, singular event that was traumatic, such as a life-threatening incident or personal assault.
The second, called “small t” trauma, happens when there is a cumulative experience of events, such as living in an abusive household or being exposed to regular dangers or hardships over a period of time.
“What you’re looking for is something that will help you feel OK. And when you encounter substances which are very powerful, potent molecules, chemicals that will elicit really strong dopaminergic responses, which is this process of releasing dopamine and endorphins into our system, that’s common to all substances of abuse,” he said.
When suffering from trauma, the part of the brain that registers whether things are good or bad is constantly telling sufferers they are feeling bad. When finding something that can counteract this constant feeling of bad, such as drugs or alcohol, those who suffer from these negative feelings will find themselves abusing substances to normalize, said Rutter.
“You can imagine then, if your regular experience following trauma or living with trauma is feeling anxious, feeling not well, feeling not right, feeling like you’re broken or somehow your life has lost its quality of goodness or stability or being OK and then you encounter something that pretty reliably and predictably counteracts that, it’s not even a question,” he said. “On a physiological level that quickly becomes something that’s registering as survival, like, ‘I need this in order to feel OK.’”
Cummings described PTSD as the mind and body’s way of coming up with coping and protective mechanisms to deal with trauma.
Bringing drugs into the mix of trauma becomes a potent and dangerous combination. Sufferers of trauma already find themselves not feeling OK, and now that they’ve found a potential antidote to their pain, they’re really not OK, according to Rutter.
“There is just this deep physiological impetus to want to keep pursuing that so that a person can feel OK,” said Rutter. “And then as you know, as someone continues to reach for that ‘solution’ to feeling OK, the natural processes of addiction also began to take hold. And so it becomes this kind of double whammy.”
In an attempt to cope with her traumas, Jordan found herself attempting to constantly stay busy through work when she wasn’t in school.
“I would work from 7 a.m. to 2 p.m., have a 30-minute to about four-hour break then go back to work, mostly to avoid downtime. If I have time to stop and think about everything, everything catches up,” she said. “For the past few years, it’s been go, go, go, go, go.”
Jordan said it became harder and harder for her to relax when she did have downtime, affecting her overall work. At 15, she said, her brother introduced her to marijuana to help her take an actual break instead of remembering.
“While I was in high school and had to worry about getting drug-tested, it was still on the minor side of things because I was playing sports and whatnot,” Jordan said. “And then as things got worse but life got less busy, I started smoking more to be able to deal with that more.”
Despite suffering from a life filled with trauma, Emma Jordan finds herself smiling when she’s with nature. Taylor Sexton photo
As a freshman in college, Jordan said, she began abusing alcohol. It was her first time being on her own, seven-and-a-half hours away from home and coping with her recent traumas.
Jordan said she was not a social drinker and quickly found herself drinking the way an alcoholic would. The people who surrounded her that first year only worsened the situation.
“They weren’t people that actually cared. They were people that were like ‘Oh, she’s good at making drinks, let’s keep her around,’” Jordan said. “It wasn’t a good environment, and I knew it wasn’t a good environment. Which is why I was able to step out of it once I got home and worked 70 hours a week that summer. But, I mean to trade it off, drinking for working 70 hours a week, that’s not much better.”
Although Jordan managed to quit drinking, she said she still smokes marijuana in order to help her cope.
“Everyone has at least one vice, and if smoking is the worst thing I do as a whole, well then that’s fine,” she said. “Everybody needs some type of escape or fantasy.”
On top of self-medicating through marijuana, Jordan has been prescribed sleeping medication to help her actually go to sleep and stay asleep, something she’s struggled with due to her traumatic memories.
“Sometimes they’re vivid dreams, sometimes they’re just black, so it just kind of depends on the situation. Like, for a lot of the time when I was in high school and stuff I was incredibly lethargic and all I wanted to do was sleep. But that’s another ‘avoiding it’ mechanism,” Jordan said. “Like, if I’m having a high-anxiety day, the dreams will be more vivid and it kind of ramps some stuff up, but some days, most of the time it’s just kind of black.”
Jordan said the reason she avoided confronting her trauma for so long was that she didn’t want to acknowledge that she was a trauma case.
“I’ve never really been an ‘ask for help’ type of person,’ she said. “I never wanted somebody to sit down and know all of the dark and nitty-gritty.”
Jordan said it wasn’t until last year, when she was surrounded by strong people her senior year of college, that she began to acknowledge her trauma, using the knowledge she gained from her friends to sort through the memories.
“It takes so much energy to not think about everything,” Jordan said, “that if you think about it once, write it down maybe, but have it somewhere stored where if you feel the need to feel it again you can go back and look at it but not have to spend your life actively ignoring it to hide from it.”
Vaya Health, a public managed care organization that provides state funding for mental health services to 22 counties in Western North Carolina, has suffered from more than $50 million in budget cuts since 2017 and is predicted to continue its steady decline.
“I have consistently observed cuts, decreases, to mental health funding. I don’t remember ever hearing about increases,” said Jackson County Commission Chairman Brian McMahan.
Vaya Health provides mental health, substance use and intellectual and developmental disabilities funding to a number of local providers through the management of state, federal, local, Medicare and Medicaid funding.
Since the 2017-18 budget year, Vaya Health has lost $50,338,840, which comes out to be an approximate 11.4 percent decrease to its funding as of the 2019-2020 budget year.
“Every year there’s been cuts, and the cuts have been absorbed somewhat through fund balances, the savings in layman’s terms, but the cuts are now to a point where they’re jeopardizing services,” McMahan said.
Don Buckner, CEO and medical director for Meridian Behavioral Health Services, a comprehensive behavioral health agency that provides behavioral health services to children, families and adults in nine WNC counties and is also funded by Vaya Health, said he has only seen decreases in funding since he started working there in 1999.
“The legislature has voted to decrease funding to Vaya for the past several years. In speaking with a state senator yesterday, there is the sense that LME-MCOs like Vaya have a lot of money in the bank that they could choose to use to offset these reductions. Vaya says that they are required to have financial reserves by the state and therefore cannot use those monies,” Buckner wrote in an email.
Vaya Health took a 5.7 percent decrease in budget from the 2017-18 to 2018-19 budget year and will expect to take another 6 percent decrease from the 2018-19 to 2019-20 budget year.
“These recent decreases will affect people who do not have insurance, folks we call state-funded, as Vaya receives money to provide behavioral health and substance use services to them and this is what is being reduced,” Buckner said. “Meridian will likely have to provide a less intense service to those affected, but we will not deny them care.”
The budget cuts, Buckner said, led to lower salaries for behavioral health providers and difficulty hiring and retaining employees. This creates an issue, because these are the people who are serving those who are covered by Medicaid or without health insurance.
“We have been forced to look for other funding sources such as foundations and private donors in order to continue providing high-quality services to these most vulnerable individuals,” Buckner said.
Meridian provides psychiatric services, therapy services and several higher-intensity outpatient services to approximately 1,300 people a week.
Haywood Pathways Center is one of many places that depend on Meridian to help those they serve. Pathways provides emergency shelter and short-term housing for those in Haywood County, with Meridian assisting those who come to Pathways with mental health or substance abuse problems.
“We ask folks when they come in and do an intake what their reason for this instance of homelessness is, and we ended up with 65 percent or so identifies themselves as because of addiction, mental health dual-diagnosis, release from incarceration or unemployment,” said Executive Director Mandy Haithcox.
Haywood Pathways Center connects individuals with resources within the community. This way, individuals will continue having a support system and continue having access to the services they may need, no matter if they continue staying with Haywood Pathways Center or not, Haithcox said.
Meridian provides transportation from Haywood Pathways to Meridian, and so long as clients attend at least one class or appointment during the day, Meridian will bring them back to Haywood Pathways later in the afternoon. This proves to be extremely helpful in aiding those in need get the proper services, she said.
“We have a Vaya kiosk in our dining hall that people can use. So if someone comes in and they want to access services, especially for those who come in for dinner who aren’t residents and don’t have a case manager, they can go over there and they can hit the touch screen, take a very simple assessment and you can call and make an appointment from the kiosk right at that time if you want to,” Haithcox said.
Vaya Health helps fund many of the mental health services facilities such as Haywood Pathways use, so a cut to Vaya’s budget would be unfortunate, Haithcox said.
“There’s probably other priorities of the folks who are in control of the money and even when we talk about addiction and things, the trauma that people have experienced that has induced the addiction is not really discussed,” Haithcox said. “Preventive care is not always valued as much as responding to a crisis, so if a crisis happens, you’ve gotta respond to it. But we could also do a whole lot of work on the preventive side to mitigate the crisis, but that’s not really where the funds are. Ever.”
Haithcox said there are more people who don’t have insurance and need the services state funding provides.
Jackson County helps residents who struggle with mental health on the basic health side, said McMahan. The Department of Public Health helps diagnose residents who seek help, offers limited services the county does have and then refers them to other agencies, such as Vaya Health and Meridian.
The county is currently working on instating a health care program in its jail, since many inmates struggle with mental health issues.
“A lot of those people who have mental health issues end up making bad decisions that caused them to be incarcerated,” McMahan said. “If they had had proper medication and proper treatment, they may not commit a crime, or might not be a problem for society if they had been treated.”
McMahan said the county relies heavily on the work Vaya Health and many of their other partners do for them, and it remains imperative they be funded.
“There is this attempt to try to separate mental health from regular health, and the brain is an organ in our body that’s no different than your heart or your stomach or any other organ,” McMahan said. “If you have a stomach ache, then you can go to the doctor and the doctor will see you through a health plan and provide you with coverage, but when we’ve talked about mental health, there’s this stigma and people don’t think that it’s a real illness.”