According to SAMHSA, 21.5 million Americans struggle with a substance use disorder, many of whom also have mental health issues. As we better understand the dynamic relationships among mental health, life experiences, genetics/epigenetics, and addiction, we have become better equipped to help people overcome the challenges they face. In addition to genetic susceptibility to addiction, negative life experiences can play a significant role in the development of mood symptoms, anxiety disorders, and addiction. Trauma is an often overlooked factor in substance abuse treatment, but the resolution of past trauma can play a major role in successful addiction rehabilitation.
Surviving trauma often leads to substance abuse and addiction, but effective and comprehensive treatment is available. Trauma refers to any event or repeated experience that has caused lasting fear and distress. The presence of trauma is determined by the person’s subjective reaction- not on the nature of the event, as what is traumatizing for one person may not be traumatizing for another person. Trauma can be due to military combat exposure; experiencing or witnessing physical, emotional, or sexual abuse; the death of a loved one; assault; major injuries; or other catastrophic events. Trauma is not always immediately felt, recognized, understood, or treated, but can lead to post-traumatic stress disorder (PTSD) and other mental health conditions.
PTSD can include nightmares, mood swings, anger, low motivation, poor concentration, sleep issues, impulsivity, hopelessness, relationship problems, and negative thinking. It is sadly common for many people with PTSD to turn to alcohol or drugs to help them cope with these devastating changes in their lives. Studies have shown that up to two-thirds of people with addiction have experienced significant trauma at some point in their lives. The link between trauma and addiction is even stronger when the trauma occurs in childhood, while the brain is still developing. According to the CDC and Kaiser Permanente’s Adverse Childhood Experiences (ACE) study of over 17,000 people, the greater the number of traumatic events in childhood, the greater the likelihood of addiction. For example, the researchers found a 500% increased likelihood in developing alcoholism and 4,600% increased the likelihood of using injectable drugs if the person survived four or more adverse experiences in childhood.
Trauma can lead to many changes within the brain (including the prefrontal cortex, hypothalamic-pituitary-adrenal axis, limbic system, and striatum), resulting in a cascade of difficulties with thinking, mood, and behavior that can make the person more likely to develop an addiction. These changes are most pronounced for those who have had trauma (e.g., experiencing or witnessing abuse) in childhood or complex PTSD. Trauma and chronic stress can impact GABA, glutamate, and dopamine levels, which also make escalation of alcohol and drug use, dependence, and relapse more likely.
Alcohol and drug use begins as a temporary relief from the chronic distress of PTSD, but make the person’s symptoms and overall quality of life much worse in the long run. Substance abuse can quickly become an even more devastating force in their lives, including making it more likely that they will experience additional trauma. For those with comorbid diagnoses, both addiction and trauma must be successfully treated for a good long-term outcome, as each disorder impacts the other. Sadly, many people eager to get help are not provided with the treatment they need because many programs focus on addiction in isolation. Without addressing trauma and any other underlying causes of addiction, the person can be set up for dropping out of the program early, relapsing, or manifesting symptoms in another way. For example, someone may replace alcohol abuse with other addictive behaviors or maladaptive patterns as a way to cope if the underlying trauma is not addressed.
Fortunately, there is hope for overcoming both trauma and addiction with the proper treatment in the appropriate setting. A meta-analysis by Roberts, Roberts, Jones, and Bisson (2015) concluded that trauma-focused psychological interventions delivered with substance use treatment led to reduced PTSD severity and decreased alcohol and substance abuse. The trauma-informed therapies also led to a greater likelihood of sobriety maintenance, whereas non-trauma-focused interventions did not lead to positive outcomes.
Treatment for trauma was historically completed after sustained sobriety (if at all), but research has shown this approach to be much less effective than addressing both disorders simultaneously. However, to fully participate in and process the therapies, detox will generally be completed prior to beginning trauma work. Following detox, both disorders can be treated in an integrative and comprehensive manner. This can include individual and group therapies, mindfulness, medications, and family therapy, among other multidisciplinary approaches. Trauma-informed cognitive behavioral therapy with exposure techniques is highly effective in long-term symptom relief and improved overall well-being. Such treatment includes coping skills training, processing of trauma, relaxation exercises, psychoeducation, problem-solving, future planning, and relapse prevention skills.
Comprehensive therapies help with improving self-concept, decreasing avoidance behaviors, understanding the relationship between trauma and addiction, achieving and maintaining sobriety, and eliminating self-destructive behaviors. Making changes in one’s behavior, thought processes, relationships, and environment takes time but can lead to lifelong sobriety, stress reduction, healthier relationships, and improved quality of life. These interventions should be completed in a safe and honest setting that includes family member involvement, peer support, trust, and compassion. By following an integrative approach in a supportive setting, each person can make meaningful and lasting life changes. If you or a loved one has struggled with trauma and substance abuse, remember that help is available.
Back, S. E., Waldrop, A. E., Brady, K. T. (2009). Treatment challenges associated with comorbid substance use and posttraumatic stress disorder: Clinicians’ perspectives. American Journal of Addiction, 18(1).
Baschnagel, J.S., Coffey, S.F., Rash, C.J. (2006). The treatment of co-occurring PTSD and substance use disorders using trauma-focused exposure therapy. International Journal of Behavioral Consultation and Therapy Volume 2,(4).
Dube S. R., Felitti V. J., Dong, M., Chapman, D. P., Giles, W. H., Anda, R. F. (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics, 111(3).
Jacobsen, L. K., Southwick, S. M., Kosten, T. R. (2012). Substance use disorders in patients with posttraumatic stress disorder: A review of the literature published online. Clinical Psychology, 19 (3).
McCauley, J. L., Killeen, T. Gros, D. F., Brady, K. T., Back, S. E. (2012). Posttraumatic stress disorder and co-occurring substance use disorders: Advances in assessment and treatment. Clinical Psychology, 19(3).
Pietrzak, R. H., Goldstein, R. B., Southwick, S. M., Grant, B. F. (2011). Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: Results from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Anxiety Disorders, 25(3).
Roberts, N. P., Roberts, P.A., Jones, N., Bissona J. (2015). Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: A systematic review and meta-analysis. Clinical Psychology Review, 38.
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