Trauma can be a difficult subject to understand. To put it simply, trauma is a specific psychological or emotional response to an intensely negative event or series of events. Trauma can be as upsetting as a divorce, illness, the death of someone close to you, or being the survivor of sexual assault. It can also stem from years of psychological or physical abuse from a spouse, parent, or friend. What unites trauma is the damage that these extreme experiences cause in the psyche of the afflicted individual.
Trauma victims also frequently suffer from substance use disorders. This occurs because of attempts to self-medicate and treat symptoms of trauma such as anxiety, stress, depression, and anger. Treatment providers for both trauma-related symptoms and addiction will benefit from creating integrated therapy and counseling models that address both issues concurrently. Addiction treatment that is not informed by trauma risks harm the patient in the long run by wasting their time and money on a program that does not address a significant risk factor for relapse.
According to the Diagnostic and Statistical Manual (DSM), trauma is classified according to various categories.
Sexual assault or abuse is any sexual contact or behavior that occurs without the explicit consent of the recipient. This can include the forceful infliction of sexual advances upon someone, the sharing of inappropriate media or sexually explicit comments, and the sexual exploitation of a person.
Physical assault or abuse is any actual or attempted infliction of physical pain that results in the death, serious physical or emotional harm, or exploitation of someone. This could be with or without the use of an object or weapon.
Emotional Abuse includes acts such as verbal abuse, emotional abuse, and excessive demands of expectations that could cause an individual to experience physical and cognitive disturbance. This also includes emotional neglect in the case of a minor or anything that would result in mental disorders.
Neglect is one of the more common forms of abuse that occurs among children of addicts. If any primary caregiver does not adequately care for the person they were intended to protect, this could induce traumatic associations for that person, especially if they are chronically starving or do not have a safe environment to live in. Neglect can also extend to not providing mental health or medical treatment.
Trauma often occurs from a specific event such as an accident or injury. For example, a car accident could be a traumatic event that deters someone from riding in a car again or that could conjure images and sounds of crashing vehicles. Even breaking a limb can be a traumatic event, especially if there is an open wound.
Domestic violence is defined as a pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another intimate partner. Domestic violence can be physical, sexual, emotional, economic, or psychological actions or threats of actions that influence another person. This includes any behaviors that intimidate, manipulate, humiliate, isolate, frighten, terrorize, coerce, threaten, blame, hurt, injure, or wound someone.
Bullying is classified as any behavior involving unwanted and aggressive physical and mental injuries inflicted either online or offline. Kids who are bullied may experience ongoing problems with self-esteem and anger that leads to mental health issues, substance abuse, and possibly suicide.
Trauma and Addiction
Trauma can also create lifelong impacts that trigger physical and emotional responses in those who experience them. Symptoms include denial of the event, detached emotions, extreme anger, extreme sadness, emotional outbursts, experiencing shame, sleep problems, high blood pressure, difficulty in social situations, and substance use disorders. Symptoms of trauma can easily serve as the catalyst for someone developing a substance use disorder. Research has uncovered that roughly half of people living with PTSD (46%) also meet the criteria for a substance use disorder. This shows that there is a strong correlation between individuals who have experienced trauma and those who abuse drugs and alcohol.
A significant portion of addictions can be traced to childhood trauma. The best way to understand this link between childhood trauma and addiction is to understand the way intense experiences can influence the brain’s development. The human brain has an innate ability to respond and adapt to environmental stimulation in ways that create lasting change within the synapses. As it grows and matures through childhood and adolescence, it learns to keep or discard necessary connections such as learning to walk or read, or even correlate specific events to significant emotional distress. In other words, brain development can be altered by traumatic events, causing us to think in specific patterns or associate certain things with mental states.
In one study on individuals who experienced childhood neglect or abuse, researchers discovered that being mistreated during childhood caused continuous and extremely high levels of stress that impeded normal brain development. Constant stress from childhood trauma resulted in physiological stress responses that created notable differences in neurological scans, possibly making these subjects more prone to developing a substance use disorder.
In many cases, experiences that are traumatic for children may not be as devastating for adults. However, there are several differences in brain structure and development that can account for why trauma affects children more than adults. Children are limited in their ability to process and express their feelings about an experience. They may have difficulty making sense of a traumatic experience at a young age where they have no contextual reference for right and wrong. In addition, a child may be traumatized by abuse from a relative, and therefore family support becomes unattainable. These reasons could cause a traumatic event with a lasting impact that lingers in the person’s subconscious for years.
Memory Problems and Trauma
Memories can be tricky. For example, in studies conducted by Cornell University, researchers found that children could perhaps be more reliable court witnesses because they gave more accurate recollections of what happened, whereas adults were more apt to recall the meaning of what happened. Apparently, people store two different types of memories in the brain: verbatim memories and gist traces of what happened. Gist traces recount only a person’s understanding of what happened or what the event’s meaning was, while verbatim memories are what occurred.
Memory research has shown that in times of trauma or extreme stress, the hippocampus may dysfunction, causing the details of an event to become distorted. On the other hand, the amygdala, a portion of the brain dealing with emotion, becomes overactive when stressed, giving memories of traumatic events more emotional weight when recalled later. Also called repressed memories, the brain may unconsciously repress the exact things that happened during an event and only retain the psychological association. This phenomenon is common in victims who experience a traumatic sexual abuse event at a young age.
Treating Trauma-Induced Addiction
It can be challenging to deal with the long-term effects of trauma, so self-medication is often a reality for victims of trauma. The problem is that developing a substance dependency will only prolong the problem and ultimately wind up doing more damage in the end. One conventional approach to treating trauma and addiction is through individual and group therapy and counseling. These sessions can help patients to understand and deal with the effects of trauma and develop a long-term plan to live a healthy, happier life.
Consider a scenario in which someone seeks help for addiction and repeatedly goes in and out of rehab. Then they arrive at the door of a counselor who asks questions that lead to the revelation of childhood trauma such as sexual abuse. The patient has always assumed that their problem was an addiction to drugs and alcohol, but the truth is that they have had an ongoing problem dealing with the effects of a traumatic event in their childhood that impaired their brain functions. Treatment is available at residential rehab and intensive outpatient treatment programs. These types of facilities offer a safe environment to share and discuss trauma, explore coping mechanisms, and learn from clinically trained professionals in the fields of addiction and trauma. From there, the patient can build strategies and skills to help cope with traumatic responses and associated addictive behaviors. Sufferers of both childhood trauma and addiction can find help in the form of support groups catering to addiction and child abuse and neglect.
In conclusion, treatment providers for both trauma-related symptoms and addiction can benefit from creating integrated therapy and counseling models that address both issues concurrently. An addiction treatment program that is uninformed and does not treat trauma will harm the patient in the long run by wasting their time and money on treatment that doesn’t address a key risk factor for relapse. Although many victims of trauma may resort to substance abuse as a means to cope with their affliction, it still means they are forced to live a life of substance dependency. Anyone who finds themselves physically dependent on a substance to deal with the damage of a past or current traumatic event will be able to find an effective treatment in the form of residential treatment and intensive outpatient programs.
Matthew Boyle is the Chief Operating Officer of Landmark Recovery, a drug and alcohol recovery center. He has been working in the healthcare space for 7 years with a new emphasis on recovery. Before his ventures into healthcare, Matthew graduated from Duke University in 2011 Summa Cum Laude with a Bachelor of Arts degree. After Duke Matthew went on to work for Boston Consulting Group before he realized where his true passion lied within Recovery. His vision is to save a million lives in 100 years with a unique approach to recovery that creates a supportive environment through trust, treatment, and intervention.