One of the most common threads underpinning the development of addiction is trauma. In recent decades, the connection between one or more traumatic experiences and substance abuse has become even more evident, leading to changes in how leading addiction treatment programs approach healing. While medicine is employing new knowledge about trauma and addiction, individuals who are struggling with substance abuse or who know someone slipping into addiction might not understand the deep connection between the two issues.
We have developed this guide to help you deconstruct the causes, connections and influences of trauma on drug and alcohol addiction so you can make informed choices about care for yourself or a loved one.
Trauma is the name for the collection of symptoms produced by an event or series of circumstances that cause physical or emotional harm to an individual. The symptoms of trauma create long-lasting adverse effects on a person’s ability to function, and damage their well-being on spiritual, mental, physical and emotional levels.
Traumatic experiences are, unfortunately, common. In the U.S., 61% of men and 51% of women report having experienced one or more traumatic events within their lifetime. There is reason to believe these numbers may even be lower than the actual figure, as they rely on self-reporting, and not everyone has a complete grasp of what constitutes a traumatic event or series of events.
Trauma links closely with adverse health effects on the body and the brain. The stress triggered by trauma creates a cascade of physiological effects that essentially accelerate wear and tear on physical systems. Chronic stress increases inflammation, which has a hand in many severe illnesses like cardiovascular and autoimmune diseases. Such conditions can also contribute to chronic mental health issues such as depression and anxiety, and can lead to people self-medicating with drugs or alcohol.
The Role of PTSD in Addiction
The type of trauma most people are familiar with is post-traumatic stress disorder (PTSD). Reporting on this issue tends to link it with first responders and those who have had combat exposure, to the point where many people don’t realize that anyone from any background or profession can experience PTSD. Some of the most common causes of PTSD include:
- Military confrontations
- Terrorist attacks
- Severe accidents
- Natural disasters
- Death of a loved one
- Sexual assault or abuse
- Violent personal assault
- Crimes like robberies or muggings
- Diagnosis of life-threatening conditions
It’s essential to remember that there is a strong element of subjectivity to traumatic events. Whenever someone is in a situation that creates fear, horror, shock or causes them to feel helpless, they are at risk of developing PTSD. It’s common for people who all experienced the same event to have different reactions.
If a group of people survives a bus crash, for example, there will be a wide variety of results unique to each individual. Some of the individuals will likely develop symptoms of PTSD immediately after the event, while some may not have problems until months later. Others may be resilient enough not to develop PTSD at all. Factors like experience with trauma and underlying anxiety can exert a strong influence on a person’s experience of a traumatic event.
There are four types of PTSD symptoms. Intrusion symptoms include:
- Fearful thoughts
- Flashbacks and feeling like the event is happening all over again
Avoidance symptoms include:
- Loss of interest in previously enjoyable hobbies
- Steering clear of people, places, things or activities associated with the trauma
- Detachment from others
- Hopelessness about the future
- Self-medicating with drugs and alcohol
Arousal and reactivity symptoms include:
- Trouble sleeping
- Irritability and anger
- Feelings of tension and anxiety
- Hypersensitivity in reaction to potential danger
Symptoms that influence mood and cognition include:
- Not being able to remember specific elements of the event
- Feeling guilty or projecting blame
- Feeling detached from other people
- Feeling emotionally numb
- Reduced interest in life activities
- Difficulty with concentration
- Depression, anxiety or phobias
To receive a PTSD diagnosis, a person must have been exposed to a traumatic event and experience these for more than one month:
- One or more intrusion symptoms
- One or more avoidance symptoms
- Two or more symptoms affecting mood and thoughts
- Two ore more symptoms of arousal and reactivity
In many cases, receiving a diagnosis of PTSD is the first step in addressing the resulting substance abuse behaviors.
Trauma Experiences Often Co-Occur With Substance Abuse
Someone with a diagnosis of PTSD experiences life-altering symptom sets that make it difficult to function in daily life, and their symptoms can cause them to engage in addictive or otherwise dangerous behavior. About half of the people seeking treatment for drug and alcohol abuse also meet the criteria for PTSD — a rate five times greater than that of the general population.
The stress associated with PTSD affects a person’s impulse control, memory and ability to learn. The majority of people without experience in therapy do not have the tools to cope with these stressors and view substance abuse as the only way to temporarily dull their distress and discomfort. Drinking or using drugs is a means of shutting off painful memories and avoiding emotions, but the act of substance abuse only worsens symptoms like anxiety.
Alcohol is one of the most common substances abused by people with PTSD. Up to three-quarters of people who have survived a traumatic event or abuse report issues with drinking. Alcohol works by interfering with gamma-aminobutyric acid receptors in the brain, causing sedation and disinhibition. It is similar to the function of benzodiazepine drugs like Xanax®, which doctors prescribe for acute instances of anxiety. This mechanism temporarily relieves feelings of anxiety that often accompany PTSD, but it also makes those symptoms worse once the effects wear off. The trauma sufferer may begin a cycle of drinking that quickly leads to addiction.
Recent research suggests there is a neurobiological link between PTSD and addiction. The study investigated the involvement of two specific dopamine receptors in the recall of a trauma-inducing experience and its relation to a preference for morphine in rats. The researchers used scent to remind rats of a traumatic shock to the foot, and observed their tendency to remain in an environment in which they had previously received a dose of morphine. The outcome suggested that trauma creates abnormal dopamine signaling that increases sensitivity to the pleasurable effects of drugs such as opioids. In other words, trauma creates a path to addiction by making drugs and alcohol more effective in the brain.
When someone is struggling with PTSD in addition to substance abuse, it can be challenging to determine which symptoms are attributable to the trauma and which symptoms result from addiction. The symptoms of a developing addiction include:
- Feeling the need to use a substance regularly
- Experiencing intense drug cravings that block other thoughts
- Needing more of the drug to obtain the same pleasurable effects
- Failing to meet obligations at work or school
- Reducing participation in social and recreational activities
- Engaging in risky behavior like driving under the influence or stealing
- Spending excessive time obtaining drugs, using them and recovering from their effects
The overlap between symptoms like loss of interest in activities can make it easier for substance abuse to continue undetected and undiagnosed. With both conditions contributing to a similar set of symptoms, it can be more complicated to discern the influence of PTSD from that of addiction. A dual diagnosis and appropriate treatment for both conditions are necessary to help the individual address and recover from the effects of each.
A New Type of Trauma: Complex PTSD
A new form of PTSD has been garnering more attention in recent years. Complex PTSD (CPTSD) does not have a separate definition under the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), but many mental health professionals consider it worthy of diagnosis, as its symptoms are distinct from those of PTSD.
People generally think of PTSD as a reaction to a single traumatic event or a short sequence of such events. However, people who have experienced prolonged or repeated distress also display PTSD symptoms in many cases. Often, CPTSD is a result of months or years of negative experiences that many would not consider acutely traumatic. Neglect during childhood or prolonged verbal abuse by figures of authority, for example, can lead to complex PTSD over time, even though those experiences may not meet the criteria for trauma.
Unique symptoms of CPTSD include:
- Emotional regulation issues, such as having uncontrollable feelings of anger or persistent sadness.
- Feelings of detachment and dissociation.
- Negative self-perception, including guilt and shame, and feeling different from other people.
- Difficulty forming trusting, stable relationships.
- Loss of meaningful systems such as religious beliefs or moral convictions.
- Distorted perception of and preoccupation with an abuser.
CPTSD shares many symptoms with and is easy to confuse with borderline personality disorder, another condition closely associated with substance abuse as self-medication. CPTSD can also occur alongside a traditional diagnosis of PTSD.
Adverse Childhood Experiences
Traumatic experiences during childhood, also called adverse childhood experiences (ACEs), are particularly influential in the development of addiction. Many don’t realize ACEs have an outsized impact that follows a person through their life, as trauma impacts the developing brain more deeply than the adult brain. ACEs include:
- Physical, emotional or sexual abuse
- Physical or emotional neglect
- Household challenges like mental illness, divorce, domestic abuse or substance misuse among parents or others in the home
The more ACEs a person experiences, the more likely they are to develop an addiction as an unhealthy coping mechanism. One study of more than 8,600 adults revealed that those who had experienced five or more ACEs were seven to 10 times likelier to use illicit drugs and struggle with addiction later on in life.
Childhood trauma can be more challenging to address than traumatic events experienced in adulthood. The passage of time often clouds these events or circumstances, making them difficult to interpret due to unique ways in which children experience and process trauma. It is common for people to “forget” or repress memories of childhood trauma while still suffering from the negative effects of the experiences.
Successful dual diagnosis treatment for trauma and addiction must address any adverse childhood experiences a person has had to facilitate lifelong healing.
How Addiction Influences Trauma
Trauma has clear causal ties to the development of addiction, but continued use of drugs or alcohol also adversely affects a person’s ability to resolve trauma. Here are three ways addiction affects a person’s struggle with the results of a traumatic event.
1. Reduced Motivation
Substance abuse is a significant drain on motivation. Addiction causes a person’s focus in life to narrow down to obtaining and using drugs or alcohol, with everything else becoming an afterthought. Becoming intoxicated allows people to ignore or avoid the symptoms of their trauma, reducing the motivation to seek treatment and to fully participate in treatment once it has begun. For the most effective healing process, the patient must commit to sobriety and complete the process of detoxification.
2. Masked Symptoms
Addiction can lead people to underestimate the severity of their trauma because their use of a substance temporarily reduces their symptoms. Someone who drinks alcohol each night to the point of passing out may be able to avoid recurring nightmares about a traumatic event, and thereby convince themselves that “it’s not that bad.” However, upon cessation of drinking, the symptoms will return even worse than before, due to the chemical adaptations the brain must make to sustain chronic alcohol use.
One of the most significant challenges in undergoing dual diagnosis treatment for addiction and trauma is facing all the symptoms of trauma at full strength while also experiencing the symptoms of withdrawal. Medical detoxification is always an essential part of the recovery process, but it becomes even more critical for people concurrently diagnosed with trauma. Medical detox can help minimize the shock of having trauma symptoms come back by easing the discomfort of withdrawal.
3. Unused Coping Mechanisms
When people use drugs and alcohol to mask symptoms of trauma, they are ignoring coping mechanisms that can help them find healthy ways to deal with their problems. Many start abusing substances because they never learned appropriate ways of handling sadness and anxiety in the first place. However, some people do have the tools to cope with their emotions but choose not to because substance abuse is the path of least resistance.
Relapse is an example of this. Even after having acquired and practiced methods for identifying and processing emotions, some people experience triggers so powerful that they feel compelled to return to drug or alcohol use. This problem highlights the importance of aftercare measures like 12-step groups and continued counseling in supporting continued recovery.
Why Trauma-Informed Care Is Critical
Those seeking to treat addiction rooted in trauma need a specific approach to produce the best outcomes. Trauma-informed care centers on examining the effects of trauma in every aspect of the individual’s life. Mental health professionals who take a trauma-informed approach are aware of how the overwhelming stress of surviving a traumatic event feeds into the development of addiction. The trauma-informed approach has three pillars.
1. A Non-Pathologizing View
It’s essential to respect the person seeking treatment. Many individuals become stuck in the feeling that their problems are the result of being a bad person, and many therapists do not do enough to dismantle that concept. Trauma-informed professionals understand the need to evaluate the person as a whole and help them realize that their pain is not a punishment.
Patients learn that they are not inherently defective — they are just people who need to overcome immense challenges.
2. Creating Awareness
A trauma-informed approach provides patients with a road map for whole healing, rather than addressing only the substance abuse behavior on its own. Patients must learn to identify the root cause of their pain and understand how it influences their impulses to use drugs and alcohol.
3. Empowering the Patient
The goal of trauma-informed care is to teach patients how to replace risky, self-harming and addictive behavior with healthy modes of self-care. This approach recognizes that a person will likely continue to experience the same triggers, and provides them with the tools to resolve these triggers without turning to substance abuse.
The Three Stages of Trauma-Informed Care
There are three main stages of recovery from addiction and trauma. There is often concurrent overlap between the phases, and some people may face setbacks that result in moving back and forth between them.
1. Safety and Stabilization
The first and longest stage is about learning to recognize and manage emotions. When someone has a painful flashback or becomes fixated on self-criticism, they must first be able to identify what they are feeling and why. Cognitive-behavioral therapy (CBT) is a common and effective form of therapy that helps individuals identify illogical and unhelpful thoughts and rectify the distortion in their thinking. Being able to recognize damaging thoughts allows people to challenge their ingrained responses and therefore their behavior.
2. Remembrance and Grieving
Once a patient has the tools to cope with painful emotions, they can face their trauma head-on and stay grounded while they work through what they experienced. Resolving trauma is essential to overcoming addiction, and grieving is a natural part of the resolution process. It’s natural and necessary for people to mourn what they have lost, whether that is a safe and happy childhood or the feelings of security they had before the traumatic event. Being able to recall the event without dissociation or avoidant behavior is a hallmark of healing.
In the final stages of trauma-informed care and healing, people are free from the influence of trauma. It no longer defines who the person is or controls how they live their life. Someone making good progress will be able to recognize the far-reaching impact of the traumatic event but also understand that it does not have to stand in the way of living a healthy, happy life.
At this stage, the patient can replace the self-harming behavior of addiction with coping mechanisms based on self-respect and self-care. They will make connections with others and form healthy relationships while dealing with the many triggers present in everyday life. With greater self-understanding and a growing sense of self-worth, they can continue the healing process and make positive decisions for the future.
Healing From Trauma and Addiction at Tranquil Shores
The pain of trauma, alongside the physical and mental toll of addiction, creates a situation that many people feel is hopeless. It’s easier than most people imagine to become trapped in a cycle of substance abuse in the process of trying to stop the hurting. Misuse of any substance only serves to cover up the symptoms of trauma and stands in the way of true healing.
If you or someone you love is struggling with trauma and addiction in Florida, Tranquil Shores can help. We are a private drug and alcohol rehabilitation facility providing evidence-based treatment for people of all backgrounds. We believe in the power of the integrated treatment model, which addresses your overall well-being, bringing the many aspects of your personality and circumstances into harmony.