The Anatomy of Addiction

Overcoming the triggers that stand in the way of recovery.

Trauma Survivors and Addiction

Shell shock. Battle fatigue. PTSD.

As long as there have been wars, trauma has been recognized as the cause of debilitating symptoms that last long after the war is over. But active combat is hardly the only, or even the most common, form of trauma. Only recently have clinicians begun to realize the very wide range of traumas that have lingering effects.

Trauma is defined as a mental or physical injury caused by something outside the victim’s control and outside of normal experience. In addition to combat, trauma might be caused by a natural disaster, assault, rape, an accident, incest, sexual abuse, or serious illness. A person can be traumatized even by an event that did not directly affect him, such as the death of a loved one or witnessing a crime. Studies suggest that trauma is especially likely to result from deliberate behavior, such as rape or murder, than from accidents or natural disasters.

A traumatic event may be a single catastrophic incident, such as a car wreck, or an ongoing situation, such as domestic or sexual abuse. People respond to trauma in different ways. One person could suffer severe effects from, say, a major earthquake, while another could continue to function within the range of normality. The crucial factor is not what happened, but how the person responded to it. A person’s ability to cope with stressful events depends on three factors: the person’s history, the coping skills learned as a child and his or her emotion stability at the time of the event.

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The Physiology of Trauma

Trauma alters the physiological functioning of the brain. When the primitive brain stem sends out norepinephrine, part of the automatic fight or flight reflex that happens during moments of stress or danger, it affects us physically, with a pounding heart, for example. It also stimulates higher functioning parts of the brain, particularly the amygdala, a part of the limbic system that regulates emotional intensity. Continually flooding the amygdala with norepinephrine can result in an imbalance in the body’s chemistry. When the hormone is released by repeated stress, it makes nerve fibers more sensitive, causing neurons to misfire. Even when there is no immediate danger, a small amount of norepinephrine can cause extreme reactions, more appropriate to the original trauma than to the current situation.

Symptoms of Trauma

This hypersensitivity of the neurons is what causes the three primary symptoms of trauma. These symptoms include:

• Re-experiencing the trauma through dreams, hallucinations, flashbacks, or in the case of children, acting the trauma out in play

• Avoidance of intrusive memories by denial, emotional numbing, or dissociation from reality

• Heightened arousal and response, such as being easily startled or quick to anger, or experiencing sleeplessness or excessive vigilance against danger

The cumulative effect of these symptoms is to give the trauma survivor a feeling of extreme anxiety. He feels powerless to control these symptoms, as he was powerless to control the traumatic event, and may deal with that vulnerability in one of three ways. He might overcompensate by becoming excessively controlling and even paranoid in an attempt to avoid danger by extreme vigilance. He may actively seek out dangerous situations to prove to himself that he actually can control events. He may self-medicate.

Self-medication is any activity or behavior the trauma survivor may use in an attempt to alleviate pain. A trauma survivor lives in a never ending state of pain, continually re-experiencing a horrifying event or situation, frightened that it will occur again, and carrying a sense of the world as a terrifying place over which she has no control. Relief may come from a drug, from alcohol, or from “comforting” behaviors such as excessive eating, shopping, gambling or sex. Self-medication leads far too often to addiction.

“Curing” the addictions of a trauma survivor, therefore, is not just a matter of refraining from using the addictive substance or suppressing addictive behaviors. Efforts at recovery are doomed to failure unless and until the underlying cause is addressed. The triggering event must be consciously revisited and dealt with. The addict must be given appropriate tools to deal with the extreme emotions which that event unleashed and continues to unleash. The only lasting way to heal the pain is to regain a sense of personal power. 

Karen Khaleghi, Ph.D., is a co-founder of Creative Care, Malibu, a rehabilitation and recovery center.

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