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

Written by Heather Lomax

& Medically Reviewed by Jenni Jacobsen, LSW

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Complex trauma refers to repeated, prolonged exposure to difficult experiences. These experiences often happen during childhood and can greatly affect a person’s well-being and development. For this reason, complex PTSD (C-PTSD) may lead to a co-occurring substance use disorder. When someone has both complex PTSD and a substance use disorder, it’s called a dual diagnosis. This condition requires special treatment.

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

Complex trauma, or C-PTSD is seen in people who have been exposed to a series of traumatic events. C-PTSD symptoms typically develop in people who have experienced ongoing trauma, such as child abuse or domestic violence. Ongoing trauma, particularly inflicted by caretakers, can disrupt feelings of trust, safety and attachment. This leads to long-term consequences, emotionally, physically and psychologically. The effects of complex trauma often extend into adulthood, influencing the ability to form healthy relationships, regulate emotions and develop coping mechanisms.

Complex post-traumatic stress disorder, or complex PTSD, is similar to traditional PTSD. The primary difference is the repeated, prolonged nature of the trauma. PTSD usually occurs in response to a single traumatic event. On the other hand, complex PTSD develops in those exposed to ongoing trauma. 

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

There’s less overall data on C-PTSD compared to PTSD, likely because it’s not yet recognized as a distinct diagnosis. However, we do know that PTSD is significantly associated with substance use. 

It’s estimated that just over 46% of people with lifetime PTSD also meet the criteria for a substance use disorder. In a separate study, almost 52% of men with lifelong PTSD had a co-occurring SUD, compared to almost 28% of women. In addition, studies show that around half of people with an alcohol addiction also have PTSD. 

PTSD Symptoms

When someone has PTSD, their symptoms last well after the end of the traumatic event itself. PTSD can trigger the reliving of the event in terms of flashbacks and nightmares. Symptoms can include:

  • Feeling detached or distant from others
  • Fear and sadness
  • Strong reactions to simple things, like particular noises
  • Repeated memories that cause a person to become upset
  • Upsetting dreams
  • Avoiding people or places that may trigger memories of the event
  • Struggling to remember certain components of the event
  • Developing negative thoughts about oneself or the world as a whole
  • Losing interest in previously enjoyed activities
  • Outbursts of anger
  • Self-destructive behavior 

How Is “Complex” Trauma Different From “Simple” Trauma?

The most significant difference between complex and simple trauma is that complex trauma results from ongoing traumatic events. Complex PTSD is more likely to develop when someone has faced repeated traumatic experiences. The biggest risk factors for C-PTSD are people who have experienced: 

  • Domestic violence 
  • Wartime imprisonment
  • Sex trafficking
  • Child abuse or exploitation

Complex trauma often originates from events in childhood and early life. These can lead to profound changes in beliefs and self-concept.

Key features of complex PTSD can include:

  • Repetitive trauma over an extended period: This can include ongoing physical or emotional abuse, captivity or sexual abuse.
  • Effects on self-concept and personal identity development: Many people with C-PTSD struggle with self-worth and shame. They may also have a skewed sense of self.
  • Relationship struggles: Since complex trauma often involves interpersonal relationships, it can then lead to difficulties in forming and maintaining healthy relationships.
  • Emotional difficulties: Someone with C-PTSD may have intense, unpredictable emotional reactions. They may have mood swings or be highly sensitive to stress.
  • Negative thought patterns: A person with C-PTSD might have negative beliefs about themself and the world.

Complex PTSD shares the same symptoms of PTSD, as well as others, which can include:

  • Feeling hopeless and empty
  • Loss of trust in the world
  • Feeling anger towards the world
  • Problems controlling emotions
  • Feeling different from other people
  • Having trouble managing relationships or avoiding them altogether
  • Feeling like other people don’t understand you
  • Often feeling like things aren’t real or like you’re watching yourself from the outside (depersonalization and derealization)
  • Physical symptoms, like chronic pain or headaches
  • Suicidal feelings or thoughts

C-PTSD is not its own diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, many doctors recognize that the condition has special traits.

The Brain, Trauma and Substance Use Disorder (SUD)

Trauma exposure affects the brain. Our bodies respond to danger by activating the brain’s fear center (amygdala). As a result, cortisol and other stress hormones are produced. This leads to feeling hyper-alert or vigilant when facing a dangerous situation. The body’s response to the danger ends as the trigger passes. However, if your fight-or-flight system is repeatedly engaged, it can make your body unable to regulate emotions (dysregulation).

The brain may become hypervigilant even once the threat of danger passes. In turn, this affects hormones like serotonin and dopamine. Someone who has PTSD or chronic trauma exposure might turn to alcohol or drugs to self-medicate or calm themselves down. Unfortunately, substance use often makes the problem worse.

Drugs and alcohol release dopamine, which is part of the brain’s reward system. Addictive substances flood the brain with dopamine, and that reinforces substance use. This can lead to addiction and dependence. Ultimately, the person will continue to use substances even when there are negative consequences.

How Trauma and SUD Are Diagnosed

If someone shows symptoms of substance misuse, their initial assessment should look for underlying signs of trauma. Expert dual diagnosis providers ask about a person’s life experiences, including childhood. This helps with diagnosing PTSD, C-PTSD and SUD. If a clinician suspects PTSD, there are more in-depth diagnostic tools they can use.

Diagnosing SUD and trauma at the same time requires a clinician with special training and experience. They have to avoid triggering a stress response or re-victimizing clients.

Treatment Options for Trauma and Addiction

Many treatments for PTSD can also be used for addiction and complex PTSD (C-PTSD). For instance, cognitive-behavioral therapy (CBT) is effective for all three conditions. It helps people with C-PTSD explore their triggers and improve relationships. Another treatment called eye movement desensitization and reprocessing (EMDR) is helpful for processing traumatic events in PTSD. Medication might be used in a treatment plan as well. However, it’s most effective when combined with therapy.

The Importance of Trauma-Informed Care

Trauma-informed care uses knowledge about life experiences to provide the best possible care. Providing trauma-informed care improves outcomes, treatment adherence and patient engagement. In simple terms, trauma-informed care recognizes the impact of trauma and is sensitive to the needs of people who have trauma histories. 

A trauma-informed approach involves the client throughout the treatment process. It makes sure proper screenings are done for underlying trauma. The staff is also trained in specific methods to treat trauma. Clinicians have to be specifically trained in trauma-informed care to avoid re-traumatizing clients.

Evidence-Based Dual Diagnosis Treatment in Indiana

The Recovery Village Indianapolis Drug and Alcohol Rehab provides dual diagnosis treatment for C-PTSD co-occurring with substance addiction. Our team utilizes trauma-informed care, research and evidence to plan each client’s individualized treatment plan. Reach out to our Recovery Advocates today to learn more about available mental health and addiction treatment programs in Indiana.


National Center for PTSD. “Complex PTSD.” October 6, 2022. Accessed December 28, 2023. 

American Psychiatric Association. “What is Post-traumatic 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.

Rickman, Sloane; Yalch, Matthew. “Co-Occurring Alcohol Use and Posttraumatic Stress Disorder: Prevalence, Dynamics, and Intervention Strategies.” Advances in Psychology Research, 2020. Accessed December 28, 2023. 

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

Solinas, Marcello. “Dopamine and addiction: what have we learned from 40 years of research.” Journal of Neural Transmission, 2019. Accessed December 28, 2023. 

Simpson, Tracy, et al. “Efficacy and acceptability of interventions for co-occurring PTSD and SUD: A meta-analysis.” Journal of Anxiety Disorders, December 2021. Accessed December 28, 2023. 

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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.

Cloitre, Marylène. “Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis.” European Journal of Psychotraumatology, 2014. Accessed December 28, 2023.


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