Post-Traumatic Stress Disorder (PTSD) and Tobacco Use: Unlocking the Mysteries

Since the days of trench warfare during World War I, returning veterans have reported disturbing symptoms that include flashbacks, irritability, nervousness, insomnia, and anger. Back in 1918 they called this shell shock. World War II-era physicians called it combat neurosis. Today, the definition of what we classify as post-traumatic stress disorder, or PTSD, dates from the 1970s, mostly as a result of problems experienced by Vietnam veterans. In 1980, the diagnosis of PTSD was formally recognized by the American Psychiatric Association, allowing patients to get the help and treatment they needed to cope with this devastating disorder. This definition describes an anxiety disorder that some people develop after seeing or living through an event that caused or threatened serious harm or death. The National Institute of Mental Health outlines the symptoms that include but are not limited to:

Flashbacks
Bad dreams
Emotional numbness
Intense guilt or worry
Angry outbursts
Feeling on edge
Avoiding thoughts or situations that remind people of the trauma

How does this relate to you? If your tour exposed you to violence or traumatic events, you might have already sought the advice of your doctor or mental health provider for medication, counseling, and treatment. An excellent source of information is the National Center for PTSD, which the United States Department of Veterans Affairs (VA) has established to "advance the clinical care and social welfare of U.S. Veterans through research, education, and training on PTSD and stress-related disorders." At the VA's AboutFace video gallery you can hear about PTSD from veterans who live with it every day and how treatment has helped them get back on track.

How Are PTSD, the Military, and Tobacco Use Related?

Unfortunately, those with PTSD are also very likely to start using smoking cigarettes, chewing tobacco or increase their current tobacco use. The research shows a link between nicotine addiction and PTSD in the general population,¹ and among military personnel in particular.² In a study among veterans of Operations Iraqi Freedom and Enduring Freedom, more than half of service members had a mental health concern, most commonly, PTSD.³

Studies also suggest that PTSD, rather than the actual trauma exposure, is a powerful risk factor for increasing the likelihood of smoking. Rates of nicotine dependence in the general public and in weterans were found to be elevated among individuals exposed to trauma to be highest among and those diagnosed with PTSD compared to persons not exposed to trauma.⁴

The link between tobacco use and PTSD is strong – but why? People with PTSD may smoke cigarettes or chew tobacco in an attempt to manage or smother their feelings and symptoms and to boost their mood. It can seem like nicotine is helping, but people who use tobacco to feel better are "self-medicating".⁵ Nicotine temporarily changes the chemistry in the brain and can lessen some of these symptoms, but it doesn’t last long so it's not a good solution.⁶

You may think the smoke or chew will make you feel better, when in truth, it’s a strike against your chance of recovery. Smoking can actually make you feel more anxious or hopeless in between cigarettes when you can’t smoke, leaving you more stressed than you would be if you weren’t addicted to nicotine.⁷ Picking a quit date and making a quit plan means that you are gaining back control of your life and that you no longer have to be a prisoner of nicotine.

Don’t use tobacco products as a crutch or a temporary Band-Aid. If you have been diagnosed or feel you may be experiencing PTSD, it’s important that you see a health care professional along with your quit attempt. There are so many different medications that are designed to help you with anxiety and depression while you embark on your quit attempt. Military personnel with PTSD smoke less as their symptoms are resolved or when symptoms are not present.⁸

You always want the best equipment for the mission, and this case is no different. Start reaching out for the help you need to take aim against tobacco and PTSD.

Sources

¹ Feldner MT, Babson KA, Zvolensky M J. (2007) Smoking, traumatic event exposure, and post-traumatic stress: A critical review of the empirical literature. Clinical Psychology Review, 27(1):14-45. Retrieved September 27, 2012 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2575106/
² Koeenen KC, Hitsman B, Lyons MJ, Niaura R, McCaffery J, Goldberg J, Eisen SA, True W, Tsuang MA.(2005) Twin registry study of the relationship between posttraumatic stress disorder and nicotine dependence in men. Archives of General Psychiatry, 62(11):1258-1265. Retrieved September 27, 2012 from http://www.ncbi.nlm.nih.gov/pubmed/16275813 (abstract only)
³ Helmer DA, Rossignol M, Blatt M, Agarwal R, Teichman R, Lange G. (2007). Health and exposure concerns of veterans deployed to Iraq and Afghanistan. Journal of Occupational and Environmental Medicine,49(5):475-480. Retrieved September 27, 2012 from http://www.ncbi.nlm.nih.gov/pubmed/17495689 (abstract only).
⁴McFall M., Cook, J. (2006). PTSD and Health Risk Behavior. PTSD Research Quarterly, 17(4). Retrieved September 27, 2012 from http://www.ptsd.va.gov/professional/newsletters/research-quarterly/V17N4.pdf.
⁵ McFall M., Cook, J. (2006). PTSD and Health Risk Behavior. PTSD Research Quarterly, 17(4). Retrieved September 27, 2012 from http://www.ptsd.va.gov/professional/newsletters/research-quarterly/V17N4.pdf.
⁶ McFall M., Cook, J. (2006). PTSD and Health Risk Behavior. PTSD Research Quarterly, 17(4). Retrieved September 27, 2012 from http://www.ptsd.va.gov/professional/newsletters/research-quarterly/V17N4.pdf.
⁶ National Institute on Drug Abuse. (2012). Tobacco Addiction. Research Reports. Retrieved September 27, 2012 from http://www.drugabuse.gov/publications/research-reports/tobacco-addiction.
⁷ Parrott, AC, Murphy, RS. (2012). Explaining the Stress-Inducing Effects of Nicotine to Cigarette Smokers. Human Psychopharmacology: Clinical and Experimental, 27: 150–155. Retrieved September 27, 2012 from http://www.scdgp.org.au/icms_docs/126783_Smoking_Cessation_26_June.pdf.
⁸ Smith TC, Wingard, DL, Ryan MAK, Kritz-Silverstein D, Slymen DJ, Sallis F. (2009). PTSD Prevalence, Associated Exposures, and Functional Health Outcomes in a Large, Population-Based Military Cohort. Public Health Reports, 124(1): 90–102. Retrieved September 27, 2012 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2602934/.