Addiction and Trauma
Trauma can have lasting and devastating consequences, including misuse of substances and eventually addiction. The correlation between traumatic experiences and substance use disorders is strong. It is very common for someone who is not coping well with trauma to turn to alcohol or drugs as way to try to self-medicate and feel better. This is not a healthy coping strategy and only causes more damage in the long-run. It is important to get professional help after trauma to avoid lasting symptoms and substance use and to get help if a substance use disorder develops.
What Is Addiction and Trauma?
Trauma is an emotional and psychological reaction to an event, situation, or series of events that are scary, stressful, or dangerous. People react differently to traumatic events, but there are many possible symptoms and consequences that can persist for years after experiencing them. Trauma leaves a person feeling insecure, unsafe, and helpless. What is traumatic for one person may not be for another, but children are particularly vulnerable.
The experience of trauma is a major risk factor for addiction and substance use disorders. Not everyone who experiences trauma will abuse drugs or alcohol, but those who do are typically looking for a way to cope with the negative memories and emotions. Substance abuse is not a healthy coping mechanism, and to overcome an addiction the underlying trauma must be addressed. Treatment that helps a person learn to face past traumas while also manage an addiction is most effective.
Facts and Statistics
Trauma does not always lead to substance use or addiction, but it is very common. Rates of substance use disorders among people of all ages who have experienced trauma are much higher than in those who have never been traumatized.
- Twenty-five percent of people experienced some type of traumatic event before the age of 16.
- Teens who were abused, physically or sexually, are three times more likely to use substances.
- More than 70 percent of teens in treatment for a substance use disorder have a history of trauma.
- Nearly 60 percent of young adults who are diagnosed with post-traumatic stress disorder (PTSD) will develop substance use disorders.
- Between 22 and 43 percent of people of any age with PTSD also have substance use disorders, and nearly 75 percent of veterans with PTSD develop substance use disorders.
- Rates of physical abuse in alcoholics are 33 percent for women and 24 percent for men, as compared to 8.4 percent in the general population.
- Studies have found strong correlations between severe stress and trauma in childhood and later addictions of all types, including behavioral addictions like compulsive eating and sexual behaviors.
- A child who has had adverse experiences is five times more likely to develop an alcohol use disorder.
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Symptoms and Diagnosis of Addiction and Trauma
A traumatic experience may be a single event, such as an assault or the death of a loved one, or it may be ongoing, such as recurring abuse, living with a terminal illness, or living in a dangerous neighborhood. Symptoms of trauma are not unusual immediately after a scary event, but most people will get better after a few days or weeks. For others, the symptoms persist and cause other issues, like substance abuse. Some symptoms of ongoing trauma include:
- Anxiety, sadness, anger, or fear
- Difficulty concentrating
- Difficulty sleeping, nightmares
- Obsessive thoughts about the traumatic event
- Avoiding places, situations, or people that remind you of the event
- Physical symptoms, like headaches, digestive issues, muscle tension, fatigue, racing heartbeat, sweating, and startling easily
- Social withdrawal and feeling disconnected
Addiction, according to the Diagnostic and Statistical Manual of Mental Disorders, is a continuum of substance use disorder from mild to severe. The severity of the disorder depends on how many of the addiction criteria a person meets and to what extent. The diagnostic symptoms of a substance use disorder include:
- Using a substance more than intended
- Trying and failing to cut back on use
- Spending an inordinate amount of time trying to use or using a substance
- Experiencing cravings
- Using a substance in spite of it interfering with family, home, work, or school
- Using a substance in spite of relationship problems
- Giving up other activities to use a substance
- Continuing to use a substance even in risky situations
- Continuing to use a substance even when it causes physical or psychological issues
- Experiencing tolerance
- Experiencing withdrawal symptoms
High-Functioning Addiction after Trauma
High-functioning substance use is dangerous because it is difficult for others to recognize but can be as harmful as any type of addiction. High functioning means that a person is engaged in problematic use of a substance but is able to complete most responsibilities and activities. It is not uncommon for someone to self-medicate after experiencing trauma, and high-functioning use of substances can mask signs that the individual is not coping well with the traumatic event.
Causes and Risk Factors
Many people experience events and situations that are traumatic, but some cope with it better than others. Not everyone will suffer from extended trauma or use substances to try to cope with it. Why some people develop these issues after trauma and others do not is not fully understood, but there are some known risk factors:
- Longer, extended, or repeated traumatic experiences
- More severe trauma
- Past experience of trauma
- Lack of social support
- Not having a nurturing, supportive family
- Unstable family relationships
- Lack of access to resources for healthy coping
Withdrawal and Detox
Both the underlying trauma and the addiction need to be treated when someone is suffering from trauma-related substance use disorders. The first step in this process is to detox, which means to stop using substances and let them naturally leave the body. Depending on the individual and the substances used, this process can trigger withdrawal symptoms that range from mild and uncomfortable to severe and dangerous, including:
- Pain and headaches
- Digestive issues, including nausea, diarrhea, and vomiting
- Shaking and tremors
- Excessive sweating
- Racing heartbeat and palpitations
- Anxiety, depression
- Difficulty concentrating
- Mood swings, anger, irritability
- Restlessness, difficulty sleeping
It is rare that detox and withdrawal is dangerous, but it is possible. The biggest risk of going through withdrawal is relapsing. It is important to go through this process while supervised, to avoid relapse and to make sure an individual is safe and can be given medical treatment if necessary. Once detox is complete, a thorough and comprehensive treatment plan can be initiated.
Other Co-Occurring Disorders
Addiction and trauma often go hand in hand, but there are other common disorders that co-occur with either or both of these. For instance, a person who has experienced trauma may develop a specific traumatic mental illness, like PTSD. Post-traumatic stress disorder causes persistent symptoms of trauma, such as nightmares, flashbacks, and severe anxiety and fear, for weeks or months after the event.
Trauma can also trigger a dissociative disorder, including dissociative amnesia, dissociative identity disorder, or depersonalization/derealization disorder. These are mental illnesses that cause the mind to unwillingly dissociate as a way of coping with trauma. They may cause a person to forget the trauma and things associated with it, to develop multiple personalities, or to feel disconnected from one’s own body or other people. Other mental illnesses may also co-occur with trauma and substance use, especially depression and anxiety disorders.
Treatment and Prognosis
Treating all mental health issues that a person is struggling with is important for positive outcomes. Because trauma and addiction are so closely linked, it is necessary to screen patients being treated for one issue, for the other. Treating only the addiction while ignoring past trauma puts a patient at risk for relapsing and for developing other mental health conditions. Treating trauma without addressing substance use will make it more difficult for a patient to recover.
Treating both issues at once means using therapeutic approaches and, if appropriate for the patient, medications. Medications may help with specific addictions, such as to alcohol or opioids. They may also help treat certain mental health symptoms, like depression or anxiety. Medications alone are not solutions, though, and therapy is necessary for recovery.
A common and useful type of therapy for all types of mental health issues is cognitive behavioral therapy (CBT). This helps patients learn to recognize and change negative patterns in thoughts and behaviors. Patients with trauma can also benefit from more specifically trauma-focused therapy, such as trauma-focused CBT, which uses CBT as a basis for trauma treatment. Also useful may be eye movement desensitization and reprocessing, which helps patient face their trauma and reframe it.
The outlook for patients struggling with both trauma and addiction is positive if they are dedicated to ongoing treatment. Unfortunately, many people with these issues don’t have access to the type of support they need, but for those who do, therapy and other treatment methods that focus on both issues can help lead to recovery and good outcomes.