When Trauma Leads to Addiction

Some people battle substance use disorder for years. They struggle with their relationships and livelihoods, suffer through multiple failed visits to rehab, and get slammed with too many relapses to count.

After a while, their hope fades. At a certain point, they think … sobriety just isn’t going to happen for me.

So, let me just say I understand all that, and I sympathize. I’ve witnessed this predicament many times in patients who come to the addiction treatment center in Florida where I’m the chief medical officer.

But you know what? Most of the time, even with these hard cases, people do get better, and they go on to live healthy, productive lives.

The key in many of these instances? People finally come to terms with the past traumatic events that have fueled their addiction.

The connection between trauma and addiction

The Substance Abuse and Mental Health Services Association (SAMHSA) defines trauma as events or experiences that create long-lasting adverse effects for people. Trauma can occur because of physical, emotional, or sexual abuse, war or natural disasters, and many other reasons. All types increase the risk of substance use disorder.

Trauma experienced during childhood may cause especially serious long-term effects. Officially known as Adverse Childhood Experiences (ACEs), these traumas include being abused or neglected, being frequently intimidated or humiliated by adults, witnessing violence, not having enough to eat, experiencing frequent loneliness, or growing up in a household where there are serious mental health or substance use issues.

Research also shows that the more ACEs that young people experience, the greater their risk of addiction and other mental and physical health conditions. So there’s an additive effect.

How common are ACEs? According to the CDC, a recent survey across 25 U.S. states found that 61 percent of adults experienced at least one ACE during their childhood. More than 15 percent of adults experienced 4 or more ACEs.

Finding solace in drugs and alcohol

The path that leads from trauma to addiction can be complicated, and often involves internal and external factors. The short version? At least at first, drugs and alcohol can offer a profound sense of relief to a person who was traumatized. Over time, it takes more drugs or alcohol to get the same effect. This inevitably leads to addiction, and a far worse state of affairs for the person than before the substance use started.

Alongside the temporary solace, drugs and alcohol can also offer a numbing effect. People don’t want to remember their traumatic experiences because they’re too painful, and drugs and alcohol help people forget.

Heavy use can also take away the nightmares that trauma survivors often have. Unfortunately, when people come into treatment and get sober, those nightmares sometimes return. Therapy is then required to get them under control.

Trauma can be hard to detect in patients

Past trauma doesn’t always present itself in obvious ways when people come into addiction treatment. This is no surprise because people can spend decades trying to push those memories farther and farther down into their subconscious. The last thing they want to think about, never mind talk about in therapy, is the trauma they once had to endure. That’s why even trained clinicians can miss it.

What we look for in our patients

Before details of the trauma even come out, we usually know there’s something going on by how a person looks and behaves, and their general attitude toward life.

Usually, the past trauma was sexual and/or emotional in nature, though it can be many other things. The abuse usually started in childhood and was inflicted by a parent or close relative. Because these aggressors are supposed to be the people who protect a child, the abuse is that much more psychologically damaging.

Trauma Essential Reads

Countering Cognitive Immobility

Why Child Trauma Survivors Often Blame Themselves

Later in life, when abused children become adults, they often choose bad partners, because that’s all they know. They get with a person who is supposed to care for them and look out for them, but who does the opposite. In the case of many women we see at our center, they are introduced to hard drugs by these partners, and they get addicted.

Men tend to be harder trauma cases

In therapy sessions, men tend to talk about issues like their role in the family, their jobs, their desire to be in control of their lives, and so on. As a rule, these tendencies and priorities make them less likely to address past trauma—sexual, emotional, environmental, or otherwise. Acknowledging abuse or trauma doesn’t fit with many men’s preferred self-perception of confidence, control, and competence.

As underreported and undetected as trauma likely is among men, we still see a lot of cases at our treatment center. While roughly 75 percent of the women who come to us report at least one traumatic event in their past, probably 50 percent of men do. That’s still an alarmingly high number.

I believe we in the addiction field need to do a much better job of recognizing past trauma in our male patients, and help them come to terms with it.

Full recovery from addiction and trauma is possible

I wish it was the case that when people start working through their past trauma, and ultimately come to terms with and recover from it, that their addiction automatically goes away. But that isn’t how it works.

That’s because addiction literally changes the structure and chemistry of your brain, and those changes may remain even if a person has made peace with a traumatic past.

Recovery from trauma and addiction is hard, and it takes time. Both conditions need to be dealt with in an integrated manner. Thanks in part to the many treatment centers around the country that have adopted the philosophy and protocols of trauma-informed care (TIC), recovery success rates are improving.

Bottom line: Recovery from trauma and addiction is possible, and people are accomplishing it every day.