PTSD caused by drug use?

By Dr. Marie Hartwell-Walker

About a year ago to the month, I was in the midst of a very painful break-up during my senior year of college. I had been with my ex for 2 years, it was a very serious relationship, we lived together, and the split was entirely unexpected. In retrospect, the relationship was unhealthy… I changed/compromised myself a lot to try and appease my ex, to fit into his life, and I think I convinced myself that I was happy regardless.

I began a close relationship with two friends (men) that were into drug experimentation. I was already a habitual marijuana smoker, but kicked it up to a gross level (at least 1 gram a day, every day, whether alone or in company). I then began experimenting with mushrooms, LSD, and, finally, MDMA. The first and only time I took MDMA, I believe I took a toxic dose over the course of 24 hours (.7 grams of pure, powder form, ingested). I experienced no major adverse reaction while intoxicated, but at the “crash” I lost my mind. Severe anxiety, paranoia, depression, uncontrollable crying, inability to be still, major depersonalization and hysteria. It was an enormous amount of emotion and mania all at once, immediately as soon as I woke up. A contributing factor was finding out in the midst of my “roll” that my ex had a new girlfriend (we had been broken up about 6 weeks), a fact that seemed to precipitate into a flood of emotions tied up in our break up (why doesn’t he feel as bad as I do? does he love me anymore? I miss him, I want to talk to him, etc).

My whirlwind of emotions was so acute I felt unsafe leaving my apartment for several days. By about the 6th day the hysteria had receded and had been replaced with intense depersonalization and no sense of reality. I was scouring the internet for a solution or diagnosis for my feelings when I came upon the term “depersonalization” and immediately dissolved into a serious depression once I had a name for what I was experiencing. By the 12th day since the “crash,” I began to feel normal, if not shaken.

About three weeks after this experience, I took a dose of mushrooms. The trip went badly. My experience was being caught in a feedback loop of negative feelings, that I would never feel any differently ever again, that I had no control over my own sanity. Eventually I became physically ill, and the mushrooms wore off. I had no “crash” effects.

I decided to stop taking psychedelic drugs after that, but continued to drink and smoke heavily. About 6 weeks after crashing on MDMA, I experienced the most intense anxiety attack of my life. One of my aforementioned friends and I were about to visit our third friend’s going-away party (he was moving out of state). Previous to this, I had absolutely no history or experience with anxiety, and actually did not know I was even having an anxiety attack until later. The feelings of anxiety and sporadic full-blown panic attacks lasted for 4 days. At that point, I stopped smoking and drinking completely, and began attending counseling via the student center.

While I finally addressed and acknowledged many issues with my break up and drug use during counseling, my general emotional/psychological health was shaky at best. There was a lot of fallout after my anxiety episode and the drug side effects. I barely made it through graduation without a complete meltdown, and only with the support of my father and a few close, sober friends.

Today, I have changed my life and am 100% a different, healthier person. My old relationship and my ex are not present in my life. I run, I practice yoga, I’m a vegetarian, I lost 15lbs. I drink socially, but have not smoked or taken any other drugs since. I am even suspicious of things like codine cough syrup or Sudafed due to their drug content. However, once in a while, something reminds me of my drug experiences or the aftermath, and I immediately feel frozen – taken back to those feelings and experiences in an overwhelmingly negative way – and have to fight off anxiety attacks. This especially happens when coming into contact with marijuana or viewing drug use in movies. Sometimes nothing triggers it, but suddenly I am consumed with the memory of something that happened during that time, and all the emotions associated with it.

I feel like my drug abuse will haunt me forever. Once in a great while, I have sudden urges to smoke marijuana or take MDMA, for no apparent reason. I have also begun dating after being single for more than a year, and sometimes experience borderline panic attacks out of nowhere in the middle of a date. I have spent the night with a guy or two a few times, and cannot sleep while someone is in the same bed as me. My heart pounds, I feel nervous, sweaty palms, and cannot relax.

When I took the Sanity Quiz on this site it says that I exhibit symptoms of PTSD, which led me to write this tome (sorry!) and ask about it. Am I experiencing PTSD as a result of my drug abuse? Will these flashbacks ever go away? I know I should probably be in regular therapy, but I can’t afford it.

A: Thank you for writing. It must be discouraging to find that you are still having symptoms of anxiety after working so hard to get clean and sober. PTSD is a subset of the anxiety disorders. I don’t know enough about you to determine whether you meet the criteria for that diagnosis. It certainly sounds as if you are having what are called “flashbacks” to your bad experience with drugs. Flashbacks are the involuntary reliving of a bad drug experience days, weeks or even months after a “trip.” They usually follow some auditory or visual cue that triggers a memory of the experience. Flashbacks feel very, very real.

You did the very important first chapter of your therapy. It’s to your credit that you finally realized that you were endangering your life and that you were motivated enough to do something about it by getting involved in some counseling and by reaching out for some help from your father and friends. Good for you! You followed up with major changes in your lifestyle. Also good.

Now you need to go to the next level. You need to learn some new coping skills both to handle the flashbacks and to manage the intense feelings that go with taking another risk at intimacy. All this is to say that you’re right: You do need to get back into some kind of therapy.

Before you decide you can’t afford it, talk to your doctor about whether there is a local clinic or therapists in private practice who offer a sliding fee scale. You might also be able to arrange a payment plan with someone. If you really can’t find a way to pay for some therapy, do some reading up on how to increase your sense of resiliency. Continue the healthy lifestyle you’ve established. Spend time developing your friendships and support system. If the flashbacks happen again, remind yourself that they are only memories and that they will go away. (Yoga practice should help.) And do ask your doctor if there is anything more you can do to counteract them.

Although a year may feel to you like a long time, from my point of view you’ve accomplished a great deal in a short time. You’ve done a wonderful job taking charge of your life to make it better. Please be patient with yourself. Go slow with the relationship. Honor your own feelings. And continue on the path you’ve started. You’ll get there.

I wish you well.
Dr. Marie

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Last reviewed: By John M. Grohol, Psy.D. on 22 Apr 2011

APA Reference
Hartwell-Walker, D. (2011). PTSD caused by drug use?. Psych Central. Retrieved on September 18, 2014, from http://psychcentral.com/ask-the-therapist/2011/04/22/ptsd-caused-by-drug-use/