Why Women With PTSD Turn to Opioids & How to Prevent It

'Women with PTSD' has been called a silent epidemic. If left untreated, it can lead to mental and physical illnesses and opioid abuse. Learn about treatments and community intervention opportunities.

About one in three women will experience a sexual assault, according to the National Center for PTSD under the U.S. Department of Veterans Affairs, which studies women's exposure to combat and sexual assault traumas.

When researchers began to study the effects of sexual assault on women, they found that the effects were similar to those expressed by male combat veterans, according to the agency. The VA also learned:

  • Women are more than twice as likely to develop post-traumatic stress disorder (PTSD) than men.
  • Women are more likely to experience sexual assault.
  • Sexual assault is more likely to cause PTSD than many other events.

After trauma, some women may feel depressed or develop PTSD and the potential for substance abuse, including opioid use disorder, rises.

The Link Between PTSD and Opioid Abuse

Along with other social, medical and pharmaceutical industry variables, women with trauma-induced PTSD have developed opioid abuse disorder.

The following highlights of research spanning at least two decades reviews the connection between PTSD and substance abuse disorder, and suggests that public health, public safety and criminal justice officials have the opportunity to apply interventions that reduce current risks for women with PTSD to develop opioid abuse disorder.

#1 Rape Victims with PTSD are 26 Times More Likely to Abuse Drugs

In 2000, the National Violence Against Women Prevention Research Center reported that 31 percent of all rape victims develop PTSD in their lifetime and are 26 times more likely to abuse drugs in their study, The Mental Health Impact of Rape.

Compared to women who had never been crime victims, rape victims with rape related PTSD were 13.4 times more likely to have two or more major alcohol problems (20.1 percent versus 1.5 percent) and 26 times more likely to have two or more major serious drug abuse problems (7.8 percent vs 0.3 percent)."

The study concluded that public health service providers and criminal justice officials need to understand the major concerns of rape victims, which includes everything from their elevated risks of developing mental health disorders to their concerns about sexually transmitted diseases, pregnancy and need for privacy and confidentiality.

#2 Women with PTSD Have Increased Risk for Opioid Abuse

In 2016, the National Institutes of Health (NIH) under the U.S. Department of Health & Human Services published a Yale University study on the non-medical opioid use and abuse and PTSD diagnosis, studying the interactions of sexual assault and symptom clusters. The Yale researchers analyzed data from the second National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of non-institutionalized adults, in part to examine the relationship between PTSD diagnosis and opioid abuse.

They suggested that PTSD is more strongly associated with substance use for women than men.

Then in 2017, a University of Toronto research team and its partners obtained data from 4,025 individuals exposed to opioid painkillers from NESARC III. Their study found that among individuals with PTSD, "arousal/reactivity cluster predicted" opioid use disorder.

Essentially, PTSD increases the risk of opioid abuse after exposure to opioid painkillers.

"Clinicians should screen for PTSD diagnosis and arousal/reactivity symptoms prior to prescribing painkillers. Integrated treatments are strongly recommended for patients with this dual diagnosis," the researchers concluded.

Early PTSD Detection

Early detection of PTSD may deliver opioid use disorder prevention and faster recovery outcomes.

From a clinical perspective, the amount of suffering and distress is substantially reduced when a person seeks treatment earlier on," wrote Elyssa Barbash, Ph.D., a licensed psychologist and mental health counselor, last year in Psychology Today.

In 2006, research by University of Alberta undegraduate student Dr. Kaitline Chivers-Wilson, now with the University of Calgary, found that "A person's cognitions have a dramatic effect on the onset, severity and progress of PTSD following sexual assault...Perceived positive regard and early social support is shown to be important to successful recovery."

Barbash said 94 percent of women that are raped experience PTSD symptoms in the two weeks following the assault -- a condition she labels as "normal."

According to Recovery Ranch, with treatment centers that address substance abuse in three states, "Almost a third of all women continue to experience their symptoms nine months after being raped. Overall, more than two-thirds of all victims of sexual assault and rape develop stress reactions that qualify as moderate or severe."

The VA indicated that PTSD can develop at any point in the course of a lifetime for five out of 10 women that experience trauma.

PTSD Triggers

Triggers can cause a person with PTSD to experience a flare-up of both mental and physical symptoms, according to Barbash and Recovery Ranch. Some examples that remind or initiate flashbacks to the source of trauma include:

  • Witnessing an event or situation
  • Seeing images
  • Visiting places
  • Hearing certain words or phrases

Barbash noted women with sexual assualt-induced PTSD may experience:

  • A compelling urge to avoid anything that could serve as a trauma trigger
  • Hypersensitivity or hyperarousal of the nervous system that causes a loss of control over the “fight-or-flight” response
  • Negative changes in everyday mood or the ability to think clearly

A woman with PTSD derived from a sexual assault might avoid having annual gynecological wellness exams, known as pelvic exams. Navy veteran and author Julie Jewels Smoot detailed her PTSD triggers and symptoms experienced during routine medical care at her VA Medical Center when she was denied "anti-anxiety medication" in a video poem, PTSD and Knocked off Balance.

Physical Health Manifestations Caused by Untreated PTSD

In 2016, Women's Health Magazine addressed the silent epidemic of PTSD among survivors of sexual assault, shedding light on the physical health manifestations that emerge with untreated PTSD, and other societal implications.

The article starts with a woman named Lucy who experienced an unexplained paralyzed vocal cord that halted her singing career and was followed by a PTSD diagnosis, stemming from what she described as a sexual assault in college. At the time, her friends had brushed it off, so she experienced self-recrimination and then reportedly went silent.

Self-recrimination can prevent survivors from seeking help and triggers can disrupt the healing process, causing chronic stress, according to psychologists and doctors interviewed for the story.

The physical manifestations that may result from untreated PTSD include:

  • Muscle cramps
  • Chronic pain
  • Intestinal diseases
  • Fibromyalgia
  • Memory problems
  • Heart disease

Read more about symptoms of PTSD and why sexual violence is a widespread public problem.

Treatment Opportunities & Recovery

The woman, Lucy, with the vocal chord damage underwent a therapy called Eye Movement Desensitization and Reprocessing (EMDR) to release physical tension caused by trauma.

Although the mental and physical symptoms of PTSD are debilitating, health professionals often do not diagnose PTSD due to a lack of training, time and resources, according to the American Psychological Association (APA).

However, Harvard School of Public Health indicated in 2015 that 70 percent of people treated for PTSD would get better.

Recovery Ranch, Barbash, Women's Health and all suggest a number of treatment interventions for women with PTSD who have survived traumas like sexual assault or rape, including:

Access more information on available PTSD treatments on the National Center for PTSD website.

Community Opportunities for PTSD Intervention

The APA advocates for increased training regarding women and trauma by the following groups:

  • Public health, medical and mental health professionals
  • Educators
  • Law enforcement
  • Community, rural and tribal agencies

VA training is available to police officers and medical professionals as well as a variety of continuing education courses related to PTSD.

Rape Victim Advocates (RPA) published Sexual Violence Myths & Facts to help friends, family, medical, social service and law enforcement personnel support sexual assault survivors. RVA also offers a series of sexual assault crisis trainings for various groups.

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