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Complex Post-Traumatic Stress Disorder (C-PTSD) & Addiction

Last Updated: November 6, 2023

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Complex Post-Traumatic Stress Disorder, also known as c-PTSD or CPTSD, is a condition where a person will experience traditional PTSD symptoms along with additional symptoms. These other symptoms include problems controlling emotions and feeling angry or distrustful about the world or people around you.

When someone has C-PTSD, which goes untreated, it can lead to other complications. One such complication that can occur is substance misuse. A dual-diagnosis treatment center will provide therapy for an underlying mental health disorder like complex PTSD while also providing addiction treatment. Dual diagnosis programs are often more effective than programs that treat either addiction or mental illness on their own.  

What is Complex Post-Traumatic Stress Disorder (C-PTSD)?

Posttraumatic stress disorder is a psychiatric disorder triggered by a life-threatening or terrifying event. Someone may have experienced the traumatic event directly, or they might have witnessed it. The event triggering PTSD can be physically or emotionally harmful, and examples include rape or sexual assault, intimate partner violence, serious accidents, natural disasters and war or combat.

Complex post-traumatic stress disorder has the same symptoms as PTSD, plus additional ones. 

How Prevalent are C-PTSD and Substance Use Disorders in the U.S.?

While there’s less data on C-PTSD, PTSD is significantly linked to substance use. For example, women with a PTSD diagnosis are 2.48 times more likely to struggle with alcohol misuse, and men with PTSD are 2.06 times more likely to have problems related to alcohol misuse.

More than 46% of people with lifetime PTSD also meet the criteria of substance use disorders. In another study, nearly 52% of men with lifetime PTSD also had a co-occurring SUD, and almost 28% of women did.

PTSD Symptoms

Someone with PTSD will have symptoms lasting long after the end of the traumatic event itself. PTSD can trigger reliving the event in nightmares and flashbacks. Symptoms can include feeling estranged from other people, sadness and fear, and having strong adverse reactions to something as simple as a particular noise.

Complex PTSD has the symptoms of PTSD along with others, including:

  • Lack of emotional control
  • Feelings of hopelessness and emptiness
  • Feeling anger towards the world
  • A lack of trust in the world
  • Feeling different from other people
  • Avoiding relationships or finding them challenging to manage
  • The feeling others can’t understand you
  • Dissociative symptoms like depersonalization
  • Physical symptoms like stomach aches or headaches
  • Suicidal thoughts or feelings

How Is Complex Trauma Different From Simple Trauma?

The term complex PTSD is relatively new, but it’s been recognized for some time that certain types of trauma can compound the effects of PTSD. C-PTSD is more likely to occur in people with repeated exposure to trauma, and there may be changes in people with complex PTSD regarding how they see themselves and their stress response.

Complex PTSD is often seen in people who have experienced child abuse or exploitation, domestic violence, imprisonment during wartime, or sex trafficking. The people who develop complex PTSD have survived not only something traumatic and frightening but have often experienced it for long periods.

C-PTSD can also lead to:

  • Changes in beliefs—for example, it could lead to someone losing their faith or changing their morals.
  • Disturbing thoughts—a person with complex PTSD could want revenge or have other alarming thoughts or feelings about someone who inflicted abuse or trauma on them.
  • Changes in self-concept can mean someone with C-PTSD will feel guilty, different from others, or helpless.
  • Emotional changes—a person with complex PTSD may feel depressed, sad, suicidal, or angry.

Complex PTSD is more persistent and severe, and a higher risk of developing the mental health condition exists with traumatic exposures early in childhood.

The Brain, Trauma and Substance Use Disorder (SUD)

Traumatic exposure can affect the brain. Our bodies respond to danger by activating the amygdala, the brain’s fear center. Hormones like cortisol are produced, leading to feeling hyper-alert or vigilant when facing danger. For example, when we feel like we’re in a dangerous situation, we experience increased heart rate and breathing, elevated blood pressure and an overall sense of harm. The body ends that response when the danger passes, but if your fight-or-flight system is repeatedly engaged, it can become dysregulated.In cases of trauma, a person is in a consistently dysregulated state. 

Over time,the brain can become hypervigilant even when the threat of danger has passed, and it can affect hormones like dopamine and serotonin.

Someone dealing with PTSD or chronic trauma exposure might turn to drugs or alcohol to try to feel calm or reduce their sense of impending danger or anxiety. Unfortunately, substance use can make things worse.

Drug and alcohol use releases dopamine. Dopamine is part of the brain’s reward system, and addictive substances flood it with the chemical. That reinforces substance use as something rewarding, making a person more likely to continue to drink or use drugs even with negative consequences.

How Trauma and SUD Are Diagnosed

Any time someone is experiencing symptoms of a substance use disorder, their initial diagnostic assessment should look for underlying trauma symptoms. Expert dual diagnosis providers will ask about someone’s childhood and life experiences to diagnose PTSD or complex PTSD along with a substance use disorder.

Once a clinician suspects PTSD, they might use more in-depth tools like the Trauma History Questionnaire to evaluate PTSD symptoms. This questionnaire includes 24 items that inquire about a person’s history of experiencing potentially traumatic events, such as natural disasters or sexual assault.  

Diagnosing trauma and an SUD requires expertise and training because it’s important to avoid triggering a stress response. Clinicians in dual diagnosis programs must be compassionate to avoid re-victimizing clients.

Treatment Options for Trauma and Addiction

Most treatments for PTSD are also helpful for the treatment of complex PTSD and addiction.

For example, cognitive-behavioral therapy can help someone deal with triggers and strengthen their relationships with loved ones when they have C-PTSD. Traditional medication for treating depression can help, but it is best when used with therapy.

Eye movement desensitization and reprocessing (EMDR) is a PTSD treatment that can help patients to integrate traumatic memories with other memories so the trauma is not as triggering. These treatments are also very often included in addiction treatment.

The Importance of Trauma-Informed Care

Trauma-informed care integrates an understanding of someone’s life experiences to deliver effective care. Trauma-informed care helps improve health outcomes, patient engagement, and treatment adherence.

A trauma-informed approach to care involves clients in the treatment process, ensures proper trauma screening, and ensures that staff is well-trained in treatment approaches specific to trauma. This care approach considers the widespread effects of trauma and recognizes the signs and symptoms. It’s also critical that clinicians are experienced and well-trained to avoid re-traumatization.

Evidence-Based Dual Diagnosis Treatment in Missouri

The Recovery Village Kansas City offers dual diagnosis treatment for co-occurring substance use disorders and C-PTSD. We utilize trauma-informed care best practices, research, and evidence to plan addiction treatment. We encourage you to contact our expert-led team to learn more about our Missouri facility’s rehab and mental health treatment programs.


U.S. Department of Veterans Affairs. “Complex PTSD.” October 6, 2022. Accessed October 25, 2023. 

National Institute of Mental Health. “Substance Use and Co-Occurring Mental Disorders.” March 2023. Accessed October 25, 2023. 

American Psychiatric Association. “What is Posttraumatic Stress Disorder (PTSD)?” November 2022. Accessed October 23, 2023.

National Center for PTSD. “Treatment of Co-Occurring PTSD and Substance Use Disorders in VA.” U.S. Department of Veterans Affairs, August 7, 2023. Accessed October 23, 2023.

Bremner, Douglas, J. MD. “Traumatic Stress: effects on the brain.” Dialogues in Clinical Neuroscience, December 2006. Accessed October 23, 2023.

Zisis Bimpisidis, Zisis; Wallén-Mackenzie, Åsa. “Neurocircuitry of Reward and Addiction: Potential Impact of Dopamine–Glutamate Co-release as Future Target in Substance Use Disorder.” Journal of Clinical Medicine, 2019. Accessed October 25, 2023. 

U.S. Department of Veterans Affairs. “Trauma History Questionnaire (THQ).” September 24, 2018. Accessed October 25, 2023. 

Menschner, Christopher and Maul, Alexandria. “Key Ingredients for Successful Trauma-Informed Care Implementation.” Substance Abuse and Mental Health Services Administration, April 2016. Accessed October 23, 2023.