Dual diagnosis · Tarzana, CA

PTSD and addiction treatment, with safety first.

When drinking or drugs have become the way to get through nightmares, fear or memories, trauma, PTSD and addiction need to be understood together. In a small, private house in Tarzana, both are part of the conversation from the first call.

Call (818) 422-7772 What to expect

Trauma, PTSD and Addiction

PTSD and addiction treatment cares for post-traumatic stress and a substance use disorder at the same time. Many people with PTSD drink or use to quiet nightmares, fear or memories, which tends to make both worse. Federal health agencies say treating the two together usually works better than treating them one after the other.

Trauma, PTSD and substance use: how they connect

Trauma is the lasting emotional response to an event or circumstance a person experienced as harmful or threatening. Traumatic experiences are linked with substance use and with developing a substance use disorder. Most people recover from the shock over time. About 8% of people who live through trauma go on to develop post-traumatic stress disorder (PTSD), where the reactions last and interfere with daily life.

When PTSD is present, substance problems are common. The VA National Center for PTSD reports that about 45% of American adults with PTSD also have problems with drugs or alcohol, and that for most people who have both, the PTSD came first. People with both conditions also have more chronic physical health problems, more social problems and a higher risk of violence or suicide. That is the reason to look at them as one picture.

How often: About 45% of US adults with PTSD also have drug or alcohol problems (VA)
Usually first: The PTSD for most people who have both, research suggests
The approach: Both at once usually better than separate treatment, says NIDA
Veterans in crisis: 988, then 1 the Veterans Crisis Line, or text 838255

Using to cope

Why do people with trauma or PTSD drink or use drugs?

People with trauma or PTSD often drink or use because, for a while, it quiets what they cannot otherwise switch off. It is a form of self-medication: substances used to cope with distress or with the symptoms of PTSD.

The reasons are everyday ones. People use alcohol or drugs to relax, to feel more at ease around others, or to deal with thoughts and feelings they would rather avoid. Many use it simply to fall asleep, because almost everyone with PTSD has trouble sleeping.

The link can also run the other way. Alcohol and drugs impair judgment, and this can lead to accidents, injuries and other traumatic events, which can then lead to PTSD. Over time, severe or chronic stress affects the brain circuits involved in reward, motivation and learning, the same processes addiction affects.

Who carries the most risk

Not everyone who lives through trauma develops an addiction. Genetics, a family history of addiction and the severity of the trauma are among the risk factors, and healthy family and peer relationships among the protective ones. Some histories weigh more than others. NIDA reports that people abused physically or sexually as children have a 74% and 73% greater lifetime risk of a substance use disorder. In one survey of more than 600 people with a substance use disorder, almost half reported physical or sexual abuse, with women reporting much higher rates.

Recognizing it

What are the signs of PTSD alongside substance use?

The signs of PTSD fall into four groups, which the VA describes as reliving the event, avoiding reminders, more negative thoughts and feelings than before, and feeling on edge. When substance use is part of the picture, the two can be hard to tell apart.

Reliving the event. Nightmares, flashbacks, or strong reactions to reminders such as a news report or fireworks.
Avoiding reminders. Staying away from crowds, driving or places linked with what happened.
Negative thoughts and feelings. Feeling numb, guilty or ashamed, or forgetting parts of the event.
Feeling on edge. Trouble sleeping or concentrating, being easily startled, or taking risks.

If these symptoms last longer than a month and cause problems in someone’s life, it could be PTSD. They usually start soon after the event, though they may not appear until months or years later. Only a clinician can make the diagnosis, and heavy use or withdrawal can blur the picture, which is why the substance use and the trauma are assessed together.

Trauma also travels with other conditions. People with PTSD often have depression, anxiety or substance use as well. When low mood is the larger part of it, see when low mood and substance use come together; when worry and panic lead, see anxiety, panic and substance use understood side by side.

Early recovery

How can trauma show up in early recovery?

In early recovery, trauma often shows up as the symptoms the substance had been covering: broken sleep, nightmares, feeling on guard, and memories that are harder to push away. It helps to expect this, so it does not feel like failure.

Sleep is usually the first place it appears. People with PTSD may avoid going to bed because nightmares make it feel unsafe, may wake early or feel the need to stay alert, and may keep a television on all night. Someone who drank or used to fall asleep loses that crutch the day they stop.

Stress and craving come next. Stress can increase craving and reduce a person’s ability to control how they respond to impulses, which is one reason researchers think stress raises the risk of a return to use. A plan for early recovery therefore needs a plan for the hard nights, not only for the cravings.

Medicines worth asking about

Two cautions from the VA are worth knowing early. Benzodiazepines are not recommended for PTSD, because they do not help its symptoms and can cause harm over time, especially when a substance use disorder is also present. And while short, time-limited use of benzodiazepines does ease alcohol withdrawal, the VA found no evidence that ongoing use eases the core symptoms of PTSD. The medicines the VA does recommend for PTSD are paroxetine, sertraline and venlafaxine, chosen with a prescriber. Medicines that reduce cravings or the pleasure of alcohol or drugs are another option the VA lists.

When alcohol was the way to get to sleep, our page on rehab for drinking that began as a way through the night covers what treatment involves once the drinking stops. For opioids, see residential opioid treatment and the medicines that support it.

Treating both

Do you have to be sober before treating trauma?

No. People with PTSD and a substance use disorder can tolerate and benefit from trauma-focused therapy, and federal guidance used in VA care says having one condition should not be a barrier to treatment for the other.

The addiction side agrees: when someone has a substance use disorder and another mental health disorder, it is usually better to treat them at the same time. In one NIDA-funded study, people who received prolonged exposure therapy for PTSD along with addiction treatment improved more in their PTSD symptoms than people who received addiction treatment alone. Providers are also advised to screen for past trauma whenever they treat a substance use disorder.

Two ways to treat both at once

Treating the two together is called concurrent treatment, and it takes two forms. Some people have two therapies at the same time, one for PTSD and one for substance use, usually with different therapists. Others have one integrated therapy, from one therapist, that covers both. COPE, which combines prolonged exposure with relapse prevention, is the integrated example the VA describes.

What the research says about which therapies

For PTSD, trauma-focused talk therapies are the most effective, with or without a substance use disorder, and three have the strongest evidence: cognitive processing therapy (CPT), prolonged exposure (PE) and eye movement desensitization and reprocessing (EMDR). Coping-skills therapies that do not work on the trauma itself, such as Seeking Safety, are well liked, but they reduce PTSD symptoms less than trauma-focused ones. For the substance use, the listed therapies are motivational enhancement, cognitive behavioral therapy, contingency management and relapse prevention.

The research is honest about its limits. In the VA’s summary, the benefits of combined treatment were real but modest, and many people dropped out whatever the therapy. It is worth asking any program how it helps people stay through the hard middle weeks.

At Lumora

PTSD and addiction in Los Angeles: where Lumora fits

Lumora is a house on a quiet street in Tarzana, in the San Fernando Valley, home to a small household at a time. At Lumora, co-occurring mental health conditions are assessed alongside substance use, and the first call and the assessment that follows decide whether a residential setting fits the person. Lumora is not a psychiatric hospital. When the danger is acute, a hospital comes first.

When withdrawal needs care first, it happens in the same house, and treatment carries on under the same roof without a transfer. Clinical conversations take place in private offices behind closed doors, and the wellness room, with its living green wall, is a quiet place to sit between them. More on the level of care itself is in residential treatment when trauma sits underneath the substance use, and the wider picture is on how Lumora approaches dual diagnosis as a whole.

Which therapies a person receives is set by the assessment and the treatment plan. Ask us about trauma therapy, sleep and medicines, and we will answer directly.

For families

How can a family help someone with trauma and an addiction?

A family helps most by staying steady and keeping the door open. PTSD can make people pull away, even from those closest to them, and it is hard on the whole family.

You do not need to know what happened in order to help. Practical steps for starting the conversation are in how families can help when trauma and substance use are tangled together.

Safety first

Thoughts of suicide, or a flashback that feels dangerous: call or text 988.

The VA reports that people with both PTSD and a substance use disorder have a higher risk of depression, anxiety and suicide. If someone talks about ending their life, call or text 988 to reach the Suicide and Crisis Lifeline at any hour, and stay with them. Veterans, or anyone worried about a veteran, can call 988 and press 1, or text 838255. Call 911 if someone is in immediate danger, has taken more than they meant to, or cannot be woken.

Call 911 Call or text 988

Go deeper

The detail, if you want it

What does alcohol or drug use do to PTSD symptoms over time?

Over time, alcohol and drug use tend to make PTSD symptoms worse rather than better, which is the VA’s plain conclusion. The table follows each common reason for using to what federal sources say happens next, and to what is worth raising with a care team instead.

PTSD symptoms, the substance used for them, and what happens next
The symptom	What the substance is used for	What federal sources say happens	What to raise with a care team
Insomnia and nightmares	Falling asleep: the VA notes people use alcohol, cannabis or other drugs to get to sleep.	Alcohol makes sleep less restful, and over time drug and alcohol use harm sleep quality and health (VA).	CBT-I, a talk therapy the VA recommends over sleep medication, which also reduces nightmares.
Feeling on edge	Relaxing, and feeling more comfortable in social settings (VA).	Using drugs can increase irritable feelings (VA). Stress raises craving and weakens control over impulses (NIDA).	A relapse-prevention plan built around the moments of stress that lead to use.
Memories and feelings	Pushing away thoughts and feelings a person would rather avoid (VA).	Using drugs can increase avoidance of emotions (VA), and avoidance is itself one of the four groups of PTSD symptoms.	Trauma-focused therapy, which works on the memory of the trauma or its meaning.
Distress in general	Self-medication for the distress trauma leaves behind (NIDA).	Addiction makes stress symptoms worse, and stress increases vulnerability to relapse (NIDA).	Care for both conditions at the same time, which NIDA says usually works better than separate treatment.
Anxiety and panic	Benzodiazepines, sometimes prescribed short term for extreme anxiety, panic or sleep (VA).	They do not help PTSD symptoms, can be addictive over time and make talk therapy less effective (VA).	A plan to stop worked out with the prescriber, as the VA advises.

From the VA National Center for PTSD (Substance Use and PTSD; Sleep Problems and PTSD; Signs of Good PTSD Care) and NIDA (Trauma and Stress). General information, not a treatment plan for any one person.

None of this means a person chose badly. A drink before bed or a pill before a crowded room is often the only tool someone has had. Treatment is about replacing that tool with ones that hold up.

What does trauma-informed care mean in addiction treatment?

Trauma-informed care means a program realizes how widespread trauma is, recognizes its signs, builds that knowledge into how it works, and actively tries not to retraumatize people. That is SAMHSA’s definition, and it describes how a program behaves, not a single therapy.

SAMHSA sets out the principles behind it:

Safety. The people in care and the staff feel physically and psychologically safe.
Trustworthiness and transparency. Decisions are made in ways that build and keep trust.
Peer support. People with lived experience help establish safety and hope.
Collaboration and mutuality. Power differences between staff and the people in care are leveled.
Empowerment, voice and choice. The person’s own ability to heal comes first.

The useful test is what a program does. Turned into questions, these principles and the VA’s signs of good PTSD care become things anyone can ask on a first call.

What help is there for veterans with PTSD and substance use?

Veterans with PTSD and substance use have help built for them through the VA: a PTSD-SUD specialist at every VA Medical Center, counseling at Vet Centers, and the Veterans Crisis Line at 988, press 1.

The need is real. The VA reports that veterans who have had PTSD are twice as likely to have problems with alcohol and three times as likely to have problems with drugs as veterans who have not. Multiple deployments, combat exposure and combat-related injuries also raise the risk of addiction.

A PTSD-SUD specialist. Every VA Medical Center has one, trained to treat veterans with both PTSD and substance use problems. A primary care or mental health provider can also help.
Vet Centers. Community-based centers, often staffed by veterans, offering counseling for the move to civilian life or after military trauma. Families use them too.
VA residential rehabilitation. The VA runs residential programs for veterans with conditions such as PTSD, depression and substance use disorder.
Women veterans. Every VA Medical Center offers health care services for women veterans, including programs for PTSD.
Self-checks and apps. The VA offers a confidential five-question PTSD self-screen, a short substance use questionnaire and the VetChange app for drinking and PTSD symptoms.

A veteran can also choose care outside the VA. Whichever route fits, the guidance is the same: both conditions are treated, and neither has to wait.

Find the nearest center through the VA’s Vet Center directory, or read the National Center for PTSD’s page on substance use and PTSD.

What should you ask a program about trauma and PTSD care?

Each question checks a program against federal guidance from NIDA, SAMHSA and the VA. They work for any program, and we expect them to be asked of us.

Is past trauma screened for at the assessment? Screening for past trauma is recommended in substance use care, given how often the two occur together.
Which trauma-focused therapies are available, and who provides them? CPT, PE and EMDR are named as the most effective. Ask whether each is offered on site, by referral, or not at all.
Are PTSD and substance use treated at the same time? Both conditions can be treated together; one should not have to wait for the other.
Do I decide when and how the trauma is talked about? Voice and choice is a principle of trauma-informed care, and good care is care you help decide.
How is progress measured? Tracking progress, often with a short questionnaire, is among the signs of good PTSD care.
How are sleep and nightmares handled? CBT-I is recommended over sleep medication for insomnia, and it reduces nightmares.
How are benzodiazepines and other medicines reviewed? Benzodiazepines are not recommended for PTSD, and a plan to stop is made with the prescriber.
Who continues the trauma work after discharge? Ask who continues the trauma work, and when, so that it does not simply stop at discharge.

FAQ

Questions families ask

Will I have to talk about my trauma in rehab?

A program that follows federal guidance on trauma should give you a say in when and how. SAMHSA lists voice and choice among the principles of a trauma-informed approach, and the VA describes good PTSD care as care you help decide. Trauma-focused therapy does work on the memory or its meaning, so ask how and when that work would begin.

Does drinking help with PTSD nightmares?

It can feel that way for a night, but the VA says alcohol makes sleep less restful, and that over time drug and alcohol use harm sleep quality. The VA’s first choice for insomnia is a talk therapy called CBT-I, which also reduces how many nightmares people have.

Is Xanax a good treatment for PTSD?

No. The VA says benzodiazepines such as alprazolam (Xanax), clonazepam and lorazepam do not help PTSD symptoms and can be harmful, because over time they can be addictive and make talk therapy less effective. If one has been prescribed, the VA advises making a plan to stop with the prescriber, not alone. What that plan involves is covered in coming off a benzodiazepine prescribed for nerves or sleep.

Why do my PTSD symptoms feel stronger since I stopped using?

Often because the symptoms the substance was quieting are still there, now without the cover. NIDA reports that stress raises craving and that addiction itself makes stress symptoms worse, so the early weeks can be hard. Tell the care team; it is a reason for more support, not a sign that treatment is failing.

Can someone have PTSD without ever being in the military?

Yes. The VA says anyone can develop PTSD at any age. NIDA lists assault, abuse, neglect, car crashes, natural disasters, the loss of a parent and discrimination among the experiences that can be traumatic.

Can PTSD start years after the trauma happened?

It can. The VA says symptoms usually begin soon after the event but may not appear until months or years later. MedlinePlus adds that they can come and go over many years.

How many people with PTSD also have a drug or alcohol problem?

A large share. The VA National Center for PTSD reports that over 4 in 10 adults in the United States who have PTSD, about 45%, also have problems with drug or alcohol use.

Where can a veteran with PTSD and a drinking problem get help?

The VA says every VA Medical Center has a PTSD-SUD specialist trained to treat both problems, and Vet Centers offer counseling, often from staff who are veterans themselves. In a crisis, call 988 and press 1 for the Veterans Crisis Line, or text 838255.

Can a head injury make addiction more likely?

It can. NIDA reports that a serious head injury, particularly in children and adolescents, is linked with a higher risk of addiction, and that researchers suspect a severe injury may disrupt the parts of the brain involved in making decisions and controlling impulses. Mention any past head injury at the assessment, even an old one.

Is Lumora a trauma treatment center?

No. Lumora is a residential program for substance use. Mental health conditions that occur alongside substance use are assessed with it, and the assessment decides whether a residential setting fits. Someone whose main need is PTSD without substance use is better served by a mental health or trauma program, and admissions will say so.

Other ways we help

Care at Lumora

Medical detox

Medically supervised withdrawal in the residence, leading straight into residential treatment.
Residential treatment

Living at Lumora for the length of the program, rather than going home each night.
Dual diagnosis care

Mental health conditions that occur with substance use, treated together with it.
Eating disorder support

Coordinated planning for eating disorders alongside substance use, including referral when that is safer.
Aftercare planning

A plan for life after Lumora, pointing to step-down care, sober living or therapy near home.
Tour the residence

Bedrooms, lounges, the wellness room and the garden.

Admissions, 24 hours a day

Trauma and substance use, talked through in one call.

Admissions answers day and night. You can say as much or as little about what happened as you like. We will be plain about whether Lumora fits, or where would serve the person better.

Call (818) 422-7772 See the residence

Last updated October 11, 2026

Sources

This page is for information and is not a substitute for medical, legal or insurance advice. Sources checked October 11, 2026.