Traumatic experiences overwhelm an individual’s sense of safety and capacity to cope. These may be from early life experiences or later in life. In many people who are struggling with substance abuse, there is trauma in their background and substance abuse in the present. In this article I describe what trauma and trauma-informed care are, their relationship with addiction and how to help.

What Is Trauma?

SAMHSA has developed a comprehensive definition of trauma as “Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being” [1].

Trauma can be viewed as three intersecting elements: the event, the experience of the event and the long-lasting adverse effects of the first two. The effect of traumatic events can have both short and long-lasting impact in a wide ranging number of ways. 

Therapist Jason Linder observed “many think trauma is about what happened to the person when in reality, it’s more about how the mind and body register what happened ” [2]. Often trauma is registered somatically—in the body, as physical symptoms, as well as emotionally and psychologically.

Trauma-informed care is care which is sensitive to and aware of these three elements. According to SAMHSA, a trauma-informed approach requires four “Rs”:

• Realization about trauma and how it can affect people
• Recognition of the signs of trauma
• Responds by applying the principles of a trauma-informed approach
• Resists re-traumatizing the traumatized person

Relation Between Trauma and Addiction

With all the publicity it gets these days, it’s common to view addiction as the cause when, in many cases, the root of the substance abuse problem is unresolved trauma. 

The relationship between trauma and substance abuse is not a simple one and has multiple pathways. [3] The connection between these disorders runs both ways: trauma increases the likelihood of substance abuse and substance abuse increases the likelihood of someone experiencing trauma. In summary:

• Trauma is a risk factor for substance abuse
• Substance abuse is a risk factor for trauma”

And among adolescents there is evidence that youth who are already abusing substances may be less able to cope with a traumatic event.

As The National Child Traumatic Stress Network stated, “Alcohol and/or drugs initially may seem to alleviate distress, either through the increased pleasurable sensations or through the avoidance of intense emotions that may follow stressful experiences. In the long run, however, substance use perpetuates a cycle of problem behaviors that can make it more difficult to recover after a traumatic event” [3] .

So, the negative effects and consequences of one disorder compound the problems of the other.

How Different Types of Trauma Link to Addiction

The relationship between trauma and addiction is complex, varying with different types of trauma and is not extensively researched. Levin et al in a study of 4025 respondents, concluded that substantial differences were found between specific types of trauma and risk of addiction [4]. 

They defined potentially traumatic life events as negative situations that have the potential to cause an extraordinary amount of stress to an individual, overwhelming their ability to cope and leaving them in fear of death, annihilation or insanity. 

Different kinds of trauma can have different outcomes. Researchers have described this as non-interpersonal (e.g. natural disasters) and interpersonal (e.g. physical assault). Interpersonal trauma is understood to be more distressing and related to higher rates of psychological disorder. It was also found to be associated with a higher risk of lifetime use of drugs of all types.

Levin et al found that direct and indirect exposure to trauma were found to be significantly related with risk of addiction. Direct exposure was most highly associated with addictions across several types of trauma. But for combat-related trauma, indirect exposure was most highly correlated with alcohol and pornography addiction, as summarized in the table below . 

In a study by Khoury et al. of 587 highly traumatized participants in an urban setting, high rates of lifetime dependence on various substances were found [5]:

• 39% alcohol
• 34.1% cocaine
• 6.2% heroin/opiates
• 44.8% marijuana 

They cite evidence that childhood trauma compromises neural structure and function, making an individual susceptible to later cognitive deficits and psychiatric illnesses including schizophrenia, major depression, bipolar disorder, PTSD and substance abuse.

They concluded that levels of substance use strongly correlated with levels of childhood physical, sexual and emotional abuse, as well as current PTSD symptoms. 

How to Help Someone Suffering from Trauma and Addiction

Healing from trauma and addiction is a gradual intertwined process. It varies widely depending on the individual, the nature of the trauma and the type of substance abuse.

Helping someone work on both at the same time is generally advised, given how interconnected trauma and addiction often are. The trauma work typically involves several stages, each crucial to a person’s recovery. Understanding these stages can help survivors and their caregivers.

1. Safety and Stabilization

• Establishing safety, physically and emotionally, is key so the person feels secure. For those living with trauma, the world can feel like an unpredictable and dangerous place.
• This might involve removing immediate threats, ensuring a stable living situation and creating a consistent routine.
• Emotionally, this stage is about learning to regulate distressing emotions and developing coping strategies to manage symptoms like anxiety, hypervigilance and flashbacks

2. Remembrance and Mourning

• Processing the trauma can be the most challenging part of healing. It entails confronting and making sense of the traumatic memories. With the help of a therapist, the individual learns to recount the traumatic events and express the feelings associated with those memories
• Mourning the losses associated with the trauma is critical, such as the loss of a carefree childhood, lost opportunities, or broken relationships
• A supportive and understanding environment is key as revisiting traumatic memories can be retraumatizing

3. Reconnection and Integration

• This involves the person beginning to rebuild their life. Relationships are reestablished and a new sense of self is developed as trauma can significantly alter a person’s perception and how they relate to others.
• The focus here is on creating new meaningful connections and repairing old ones.
• It also involves integrating the traumatic experiences into one’s like story without letting them define the individual’s entire existence. This might involve finding new meaning in life or a renewed sense of purpose.

4. Consolidation and Future Orientation

• Consolidating the gains made during therapy and focusing on the future is where a person starts to employ the skills and strategies they have learned, to live a more fulfilled and balanced life.
• The person moves forward with new coping strategies and a greater sense of resilience. The trauma becomes a part of the person’s past that informs but does not control their future decisions and relationships.

5. Ongoing Support

• Ongoing support from therapists, family, friends and support groups is crucial. Healing from trauma is not a linear process. Individuals may cycle through these stages several times, and setbacks are a normal part of the journey.
• Each stage builds upon the last, and progress can fluctuate as individuals may revisit earlier stages as needed. The journey is deeply personal,  and healing can take months or even years.
• The ultimate goal is not just to survive the trauma and stop their substance abuse but to thrive and find meaningful and satisfying life post-trauma.

Treating Trauma During Addiction Recovery

Traumatic stress and PTSD are associated with unique (and challenging) symptoms that require targeted, trauma-informed treatment to optimize recovery from trauma and from substance abuse. 

There are similarities in the emotional and behavioral dysregulation of each. How someone responds to substance abuse triggers can be closely related to how they respond to loss and trauma.

Successful treatment approaches must be flexible enough to accommodate the multiple ways trauma and substance abuse are related. It can be difficult to engage with those who often use avoidant coping strategies in substance abuse treatment.

Substance abuse professionals who are trauma-informed look beyond the immediate circumstances of someone’s substance use and become aware of their trauma history. They observe its relationship to the person’s emotional difficulties and coping patterns as well as any co-occurring mental health issues and accommodate their therapeutic approaches accordingly so they can start recovering from it.  

Corner Canyon Can Help

Trauma-informed treatment is available in Utah. If you or a loved one are looking for a compassionate space  to heal from mental health issues such as Trauma or PTSD with our licensed professional counselors, reach out to our Admissions team now at Corner Canyon Health Centers. We’re in a peaceful setting bordered by the beautiful Wasatch Mountains.

Sources

[1] SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. 2014. Substance Abuse and Mental Health Services Administration.

[2] Linder J. 2023. What Most People Don’t Know About Trauma and Addiction. Psychology Today. 

[3] Making the Connection: Trauma and Substance Abuse. 2008. The National Child Traumatic Stress Network.

[4] Levin Y. et al. 2021. The association between type of trauma, level of exposure and addiction. Addictive Behaviors. Volume 118, July 2021, 106889

[5] Khoury L. et al. Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population. Depress Anxiety. 2010 Dec;27(12):1077-86.

Brickel R. 2016. Why Trauma-Informed Care Matters in Addiction Recovery.

Essentials of … Trauma-informed Care. 2012. Canadian Centre on Substance Abuse.
Giordano A. 2021. Why Trauma Can Lead to Addiction. Psychology Today.