Substance Use As a Coping Mechanism for Trauma | What Do CACs Need to Know?
September 2, 2025
By Amelia Siders, Ph.D.
While diagnoses of PTSD are prevalent in our work with adolescents who present for services at children’s advocacy centers, discussions about how to assess and address one of the most common coping mechanisms to deal with trauma, substance abuse, are not. It is important to provide support and resources for mental health staff who are treating these cases.
Prevalence and Overlap of PTSD and Substance Abuse
Post-traumatic stress disorder (PTSD) isn’t rare among teenagers. Estimates suggest that around 5% of teens aged 13–18 meet the diagnostic criteria for PTSD, with girls disproportionately affected compared to boys. This statistic will not be surprising for those of us serving children and adolescents who are receiving services at CACs.
When trauma hits, substances often become self-medication. Surveys of adolescents receiving treatment for substance abuse show that over 70% had a history of trauma exposure. In Ohio, teens who had suffered physical or sexual abuse were found to be three times more likely to report substance misuse than their non-traumatized peers.
Which Comes First: Trauma or Substance Use?
Longitudinal studies reveal that the relationship between PTSD and substance abuse is bi-directional. Trauma and PTSD can lead teens to develop substance use disorders (SUD), while teens who already abuse substances often expose themselves to risky environments, increasing likelihood of trauma and, consequently, PTSD. Indeed, SUD may impair coping capacity: adolescents with substance abuse issues were found to be twice as likely to develop PTSD after trauma compared to non-substance-using peers.
Heightened Risks Among Adolescents with PTSD
Adolescents diagnosed with PTSD face significantly elevated risks when it comes to substance use:
• Alcohol use disorder is about 4 times more likely.
• Cannabis use disorder is about 6 times more likely. These comparisons are with peers without PTSD.
Further complicating matters, trauma reminders—even seemingly innocuous stimuli—can trigger intense cravings in adolescents with co-occurring PTSD and SUD, increasing their risk of relapse.
Why Does This Dual Diagnosis Matter?
The co-occurrence of PTSD and substance abuse deepens challenges:
• Treatment outcomes worsen when trauma is part of the picture—teens with trauma histories often have poorer results, including lower post-treatment abstinence rates.
Effective Interventions and Treatment Approaches
Fortunately, research is clear that addressing PTSD and substance use simultaneously delivers better outcomes than tackling them separately:
• The National Institute on Drug Abuse (NIDA) emphasizes that integrated care—screening for trauma in substance use treatment and vice versa—is vital.
• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is considered the gold standard for treating PTSD in youth and has demonstrated efficacy in reducing trauma and emotional dysregulation.
Conclusion
Trauma increases the risk of substance misuse, while substance use in turn raises the likelihood of experiencing further trauma and developing PTSD. Yet, hope exists: with integrated, trauma-informed treatment strategies like TF-CBT, recovery paths are not just possible—they’re effective.
The key takeaway? Early, dual-focused intervention is essential. When providers recognize and address both PTSD and substance use together—rather than in isolation—adolescents stand a much stronger chance of healing, resilience, and a healthier trajectory into adulthood.
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Learn how to address trauma and substance use disorders in children and adolescents at Seamless 2025, the premier virtual conference for mental health professionals serving child victims of abuse, coming September 17-18, 2025.
Lastly, click this link to be directed to the NCA Institute for Better Mental Health Outcomes Training Calendar for our other learning opportunities.
Dr. Amelia Siders is a licensed clinical psychologist who has worked to support children and adolescents who have experienced trauma for over 25 years, and serves as the CEO and Founder of MindWise Insights.
