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Understanding the Connection Between PTSD and Substance Use Disorder: A Modern Perspective


June is PTSD Awareness Month, a time dedicated to raising awareness about post-traumatic stress disorder and the various ways it impacts lives. One critical aspect of PTSD that often goes under-discussed is its connection to substance use disorder (SUD). For too long, the disease model of addiction has dominated the discourse, focusing on moralistic and punitive approaches rather than addressing the root causes. This blog aims to dismantle the outdated model and explore the profound link between PTSD and SUD, drawing on the insights of leading experts in the field.

Dissecting the Old Disease Model of Addiction

The traditional disease model of addiction views substance use disorder as a chronic, relapsing brain disease characterized by compulsive drug-seeking behavior despite harmful consequences. This model has been criticized for its lack of scientific basis and its reliance on moral judgments rather than empirical evidence. It stigmatizes individuals struggling with addiction, often blaming them for their condition and failing to recognize the underlying causes.

The Root Cause: Trauma and PTSD

A growing body of research highlights the fact that trauma, particularly PTSD, is a significant driver of substance use disorders. Many individuals turn to substances as a coping mechanism to numb the psychological pain and distress caused by traumatic experiences. This perspective shifts the focus from blaming individuals for their addiction to understanding and addressing the underlying trauma that fuels their substance use.

Gabor Maté: Adverse Childhood Experiences and Addiction Gabor Maté, a renowned physician and author, has extensively studied the link between adverse childhood experiences (ACEs) and addiction. Maté argues that addiction is not a choice but a response to emotional pain and trauma. His work emphasizes that many people who develop substance use disorders have a history of trauma, often stemming from childhood. By addressing the root causes of trauma, Maté believes we can more effectively treat addiction and promote long-term recovery.

Robert Sapolsky: Trauma and Neurological Development Neuroscientist Robert Sapolsky has conducted significant research on how traumatic events impact brain development, particularly the frontal cortex, which is responsible for executive functions such as decision-making, impulse control, and emotional regulation. Sapolsky’s work shows that trauma can lead to changes in brain structure and function, making individuals more susceptible to substance use disorders. Understanding these neurological impacts is crucial for developing effective treatments that address the root causes of addiction.

Andrew Tatarsky: Harm Reduction Psychotherapy Psychologist Andrew Tatarsky has pioneered the integration of harm reduction principles with psychotherapy to treat substance use disorders. Tatarsky’s approach focuses on meeting individuals where they are and addressing the underlying trauma that drives their substance use. By providing a compassionate and non-judgmental therapeutic environment, harm reduction psychotherapy aims to reduce the harm associated with substance use while working towards healing the trauma that underlies it.

Addiction: A Normal Response to Abnormal Situations

It’s crucial to understand that addiction is not an abnormality but a predictable response to specific conditions. Epidemiological studies show that addiction rates are relatively consistent across different populations, indicating that substance use disorders are a common human experience rather than a rare or abnormal one. This prevalence suggests that addiction should be viewed and treated as a normal response to abnormal situations, such as trauma and chronic stress, rather than a moral failing or a choice.

Dispelling the Choice Argument

The argument that addiction is a choice is rooted in logical fallacies and a misunderstanding of human behavior. The choice argument fails to account for the complex interplay of genetic, environmental, and psychological factors that contribute to substance use disorders. Individuals with addiction do not choose to become addicted; rather, they often turn to substances as a means of coping with unbearable psychological pain.

Moreover, neuroscience has shown that addiction involves changes in brain circuitry, particularly in areas related to reward, motivation, and self-control. These changes can severely impair an individual’s ability to make free choices, further undermining the notion that addiction is simply a matter of willpower. Recognizing addiction as a result of trauma and neurological changes shifts the focus from blaming individuals to understanding and addressing the root causes.


Substance use disorder is a complex mental health issue that cannot be adequately addressed through outdated models that focus on morality and punishment. By recognizing the profound connection between PTSD and substance use disorder, we can shift our approach to one that prioritizes understanding, compassion, and effective treatment. Addressing the root causes of trauma, as emphasized by experts like Gabor Maté, Robert Sapolsky, and Andrew Tatarsky, offers a path towards healing and recovery. In this PTSD Awareness Month, let us reaffirm our commitment to treating substance use disorder as a mental health issue and support those on their journey to recovery.