Trauma and Addiction

Imagine a storm raging inside your loved one’s mind, tearing at the very fabric of who they are. That’s what trauma feels like – a powerful wind that can leave a person feeling broken and lost. When someone is hurting like that, it’s not uncommon to turn to anything that can make the pain go away, even for just a little while. That’s where substances come in.

Substances can seem like a way to escape the storm inside, numbing or shielding from hurt and pain. Unfortunately, relying on substances to cope with trauma can lead to a substance use disorder (e.g., addiction). It’s like getting caught in a trap – one might think they are finding relief, but they are getting caught up in something that’s even harder to break free from. So, trauma and substance use disorder become like two sides of the same coin, each making the other harder to deal with.

Treatment options for both trauma and substance use disorders exist, offering a pathway to recovery and healing. Counseling, medications and support groups may help in addition to family support. While the focus of this article is on helping a loved one, it’s important to recognize that you too may have experienced trauma and need help.

What is trauma?

Trauma is an emotional response to a highly distressing event (or ongoing events) that might be out of someone’s control.^[1] Examples of traumatic events include:^[2]

• Physical or mental abuse
• Child sexual abuse
• Other adverse childhood experiences (ACEs)
• Sexual assault
• Intimate partner violence
• Loss of a loved one
• Natural disasters
• Experiencing war
• Witnessing a violent event
• Serious illness
• Hate crimes and/or discrimination based on identity, such as being LGBTQ+ (known as minority stress)

When it comes to substance use, trauma may be experienced when witnessing an overdose, because of sexual acts exchanged for substances, or violence when buying or selling substances. Accidents from substance use can also leave physical and emotional scars.

Some of the main diagnoses and symptoms related to trauma include:

Post-Traumatic Stress Disorder (PTSD)

PTSD is when a person is exposed to actual or threatened death, serious injury or sexual violence. They may be impacted directly or indirectly through witnessing the event(s). Symptoms include unwanted memories, flashbacks, nightmares, avoidance of trauma-related triggers, poor mood and problems thinking. Sometimes a person may engage in risky behaviors or be angry and violent. Others will have suicidal thoughts. They may experience hyperarousal, which means being on edge, anxious and guarded a great deal of the time.

Acute Stress Disorder (ASD)

ASD is like PTSD, but is diagnosed when symptoms occur between 3 days and 1 month after a traumatic event. Symptoms include unwanted memories, feeling disconnected from one’s mind/body, avoiding situations, poor mood and arousal.

Adjustment Disorders

Adjustment disorders involve the development of emotional or behavioral symptoms in response to an identifiable stressor(s). These changes in mood or behavior occur within 3 months of the start of the stressor(s). Symptoms may include depressed mood, anxiety and/or conduct disturbances or acting out.

Trauma can deeply impact individuals, leaving lasting scars on loved one’s mental and emotional well-being. Symptoms can last for months or even years.

How are trauma and substance use disorder connected?

Just as mental health and substance use are often connected, there is a significant link between experiencing trauma and experiencing a substance use disorder. Those with a history of trauma are at higher risk of substance use and dependence, as much as two to four times as likely than those who have not experienced trauma.^[3] Studies show that 25-45% of individuals with PTSD meet the criteria for having a substance use disorder (SUD).^[4]

Children who experience trauma and have adverse childhood experiences (known as ACEs) are especially at risk of developing a substance use disorder later in life. Research suggests that people with a history of trauma, especially in childhood, may be as much as 74% more likely to develop a substance use disorder than those who do not.^[5] Having other mental health disorders and a family history of substance use disorder can also increase risk.

People experiencing trauma and/or PTSD may use substances to self-medicate. Substances may help them temporarily cope with their distress and numb the lasting emotions from the traumatic event.^[6]

However, substances are likely to only make PTSD symptoms worse. They can worsen depression and anxiety; make it even more difficult to sleep and concentrate; and increase angry, irritable behaviors and feelings of numbness^[7]. PTSD and SUD together can also heighten suicidal thoughts and behaviors.^[8]

What are effective treatments for trauma and substance use disorder?

The most effective way to treat co-occurring disorders, including substance use disorder and trauma, is through integrated treatment that addresses both at the same time. By treating the whole person, treatment outcomes are better.

Effective treatment for trauma often involves a combination of therapy, medication and use of support networks. The American Psychological Association strongly recommends trauma-focused cognitive behavioral therapy as the best treatment for PTSD. Cognitive behavioral therapy is intended to change harmful thinking and behavior patterns.^[9]

Eye Movement Desensitization and Reprocessing (EMDR) can also help loved ones process and cope with their trauma. Working with a trained therapist, loved ones are directed to move their eyes in a certain way while processing traumatic memories.

Narrative Therapy can also be useful. In the context of trauma, it offers a framework for understanding and processing traumatic events by exploring the stories loved ones tell themselves about their trauma. These stories may include negative beliefs, self-perceptions and interpretations of traumatic events. By examining these stories, loved ones can gain insight into the ways in which trauma has influenced their sense of identity, relationships and worldview.

Medications may be helpful as part of treatment

Therapy might include medications like anti-depressants and mood stabilizers. Medications to treat substance use disorder, like naltrexone, may also be offered and has been shown as a potential medication to help treat PTSD and SUD. More research is underway on medications and treatment plans that can treat these disorders simultaneously.^[10]

What about psychedelics?

The use of psychedelics in treating trauma is an area of growing interest and research. Psychedelics, such as MDMA (commonly known as ecstasy or Molly), psilocybin (the active ingredient in magic mushrooms) and LSD (lysergic acid diethylamide), have shown promise in certain therapeutic settings for their potential to facilitate healing and promote emotional processing. It is important to consult with a medical professional on whether this treatment could be right for your loved one, as studies on this topic are still ongoing.

Support groups

Additionally, support groups and peer counseling can provide valuable emotional support and validation. Some examples of trauma support groups include:

• National Center for PTSD, which offers guides and information for military personnel and their families
• After Silence, which is an online forum for survivors of rape, sexual abuse, and sexual assault
• CPTSD Community Safe Group, which is a Facebook group for people with complex PTSD
• r/PTSD, which is a Reddit community with over 100,000 members who share their experiences and support
• Psychology Today, where you can specifically search for trauma and PTSD support groups in your area

How can I help my loved one?

Families play a crucial role in supporting a loved one through trauma and substance use issues. Here are some ways to offer support:

• Educate Yourself: Learn about trauma and its effects to gain a better understanding of what your loved one is experiencing.
• Listen Without Judgment: Create a safe space for your loved one to express their feelings and experiences without fear of judgment or criticism.
• Encourage Professional Help: Encourage your loved one to seek professional help from therapists or counselors specializing in trauma and addiction.
• Be Patient and Understanding: Recognize that healing from trauma takes time and that setbacks are a normal part of the process. Offer patience, empathy and understanding.
• Practice Self-Care: Taking care of yourself is essential when supporting a loved one through trauma and substance use. Make sure to prioritize your own well-being and seek support when needed.
• Set Boundaries: While being supportive, it’s important to establish healthy boundaries to protect yourself from being emotionally drained or enabling destructive behaviors.
• Encourage Healthy Coping Mechanisms: Help your loved one explore and engage in healthy coping mechanisms such as exercise, mindfulness or creative outlets.

Suggesting treatment to your loved one and navigating the treatment system can be intimidating. If you need support, assistance with where to start or help with developing a plan, please reach out to our support services here. This can be a complicated topic, but your love, compassion and support can help your loved one get better.