The Link Between Trauma and Addiction

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Trauma and Addiction

By:  Rick Fannin

Underneath most addictions, there are mental and emotional factors that drive a person to abuse substances in the first place. There is a distinct and strong link between trauma and addiction behaviors.  This trauma may have occurred in adulthood, but often it is childhood trauma that leaves the most profound emotional wounds that are self-medicated with drugs or alcohol.

A person's childhood plays a vital role in mental and emotional development. Traumatic experiences often profoundly affect underlying core beliefs and how people cope with their emotions and react to situations.

Trauma can create many long-term emotional and psychological issues that continue into adulthood. Unfortunately, these experiences may cause a person to self-medicate and abuse substances to cope.  However, trauma-informed care can help a person overcome addiction while also healing from painful, traumatic memories.  Therefore, if a person who suffers from addiction has experienced trauma, it is critical to address and treat unresolved trauma.

What is Trauma?

The American Psychological Association (APA) defines trauma as an emotional response to a terrible event, such as an accident, rape, or natural disaster.[1] Any time a person fears their safety, they are experiencing trauma. Trauma can be anything that puts a person's physical or emotional well-being at risk of harm. Whether it is trauma from domestic abuse or emotional neglect, trauma can take a severe toll on victims.

Each person is affected differently by trauma, so the effects of traumatic events vary from person to person. Immediately after traumatic events, shock, denial, and anger are common reactions. However, long term reactions as a result of trauma can include:

  • Unpredictable emotions
  • Flashbacks
  • Strained relationships
  • Headaches
  • Nausea
  • Difficulty coping
  • Some examples of traumatic experiences include:
  • Car accidents
  • Bullying
  • Violence
  • Sexual assault
  • Unstable home life
  • Natural disasters
  • Intense pain
  • Chronic disease
  • Verbal abuse
  • Parental neglect
  • Vicarious trauma by witnessing or hearing the details of a traumatic event

Types of Trauma Related Disorders

Previously, trauma- and stressor-related disorders were considered anxiety disorders. However, they are now considered distinct because many patients do not have anxiety but instead have symptoms of anhedonia, dysphoria, anger, aggression, or dissociation.  The common types of trauma related disorders include:

Acute Stress Disorder (ASD)

ASD is diagnosed when problematic symptoms related to trauma last for at least three days after the trauma.  The development of the disorder differs in every individual.  However, the symptoms can mirror many of the symptoms of PTSD. Typically, symptoms consist of anxiety that includes re-experiencing the trauma or reactivity related to the trauma.

The prevalence rate for acute stress disorder varies across the country and by a traumatic event. While accurate prevalence rates for acute stress disorder are difficult to determine, seeing as patients must seek treatment within 30-days of the traumatic event, it is estimated that anywhere between 7-30% of individuals experiencing a traumatic event will develop acute stress disorder (National Center for PTSD). While acute stress disorder is not a good predictor of developing PTSD, approximately 50% of those with acute stress disorder do eventually develop PTSD (Bryant, 2010; Bryant, Friedman, Speigel, Ursano, & Strain, 2010).

Adjustment Disorders

Adjustment disorders are emotional and behavioral symptoms in response to an identifiable stressor. Examples of stressors include, but are not limited to, experiencing the end of a romantic relationship, experiencing persistent pain with increasing disability, living in a high-crime neighborhood, or experiencing a natural disaster. The diagnosis should be reevaluated if the symptoms persist for more than six months following the termination of the stressor. Adjustment disorders represent a simple response to some life stress, which may or may not be traumatic, and they are quite common in children and adolescents.

Adjustment disorders are fairly common as they describe individuals who have difficulty adjusting to life after a significant stressor. In fact, in a psychiatric hospital, adjustment disorders account for roughly 50% of the admissions, ranking number one for the most common diagnosis (APA, 2013). As for the general public, it is estimated that anywhere from 5-20% of outpatient referrals are due to an adjustment disorder (APA, 2013).     

Attachment Disorders of Early Childhood

Healthy brain development depends upon forming strong attachments in infancy and early childhood to one or more caregivers. In rare cases, attachment is never established or is severely disrupted. When this happens, a child's ability to form attachments can be severely compromised.

Disinhibited social engagement disorder (DSED) and reactive attachment disorder (RAD) are attachment disorders that manifest in early childhood in situations of profound neglect. These disorders are rare and are only diagnosed in young children. RAD and DSED are sometimes seen in young children who have come into foster care after having been severely neglected, who have been hospitalized or institutionalized, or who experienced severe neglect in infancy or early childhood in an orphanage or other group care setting prior to adoption.

However, the attachment style formed in childhood typically carries into adulthood.  Research has shown that individuals with an insecure attachment style are at a significantly greater risk of developing substance use disorders.  Some researchers have proposed theories regarding addiction as a result of an Attachment Disorder.

Post-Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder, PTSD, is a trauma disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.  However, vicarious trauma can also trigger PTSD by witnessing or hearing the details of a traumatic event.

PTSD is diagnosed when problematic symptoms related to trauma last longer than four weeks following a traumatic event.  Symptoms including, but are not limited to, worrying about dying, insomnia, angry outbursts, avoiding things that are reminders of the traumatic event. The manifestation of PTSD can be different in every person.  Some experience PTSD through fear-based re-experiencing, while others have dysphoric mood states. PTSD can also manifest as arousal and reactive-externalizing symptoms.

Given the traumatic nature of the disorder, it should not be surprising that there is a high comorbidity rate between PTSD and other psychological disorders. In fact, individuals with PTSD are 80% more likely than those without PTSD to report clinically significant levels of depressive, bipolar, anxiety, or substance abuse-related symptoms (APA, 2013).

Statistics On PTSD and Drug Abuse

  • PTSD and substance abuse statistics show significant relationships between these conditions:
  • Around 33 percent of veterans seeking substance abuse treatment have comorbid PTSD.
  • About 50 percent of people in inpatient substance abuse treatment also have PTSD.
  • Nearly 80 percent of women seeking substance abuse treatment have lifetime histories of sexual or physical assault.
  • People who abuse opiates and cocaine report higher rates of exposure to trauma than users of other substances.
  • People with PTSD are at least two times more likely than the general population to have an alcohol use disorder.
  • Seventy-five percent of veterans with PTSD have a co-occurring substance use disorder.
  • Due to the strong link between PTSD and addiction, it is critical to screen for and treat PTSD and substance use disorder together.

Making the Connection Between Trauma and Substance Abuse

Without professional help, trauma, trauma related disorders, and PTSD can be devastating and have a lifelong impact on the individual and their family. After all, trauma and PTSD can make day-to-day tasks and relationships extremely difficult.

When the emotional pain becomes too much, people may turn to drugs or alcohol to hope. While the relief from substance abuse may work temporarily, this is an unhealthy way to cope with emotions. Sometimes, this substance abuse becomes compulsive and habitual. As a result, a person who abuses drugs or alcohol to cope with trauma can easily become addicted.

When addiction and trauma co-exist, an individual's lifestyle begins to deteriorate. They may start experiencing worsening anxiety, depression, and mood swings. In addition, maintaining employment and personal relationships becomes increasingly difficult.

People who suffer from addiction typically act out in destructive and risky behaviors as well, potentially putting the person at risk of experiencing further traumatization.  Individuals who abuse drugs are more likely to be involved in drug related accidence and violence. Near death experiences from an overdose or witnessing the overdose death of a friend are traumatic experiences and new PTSD originating events.

Similarities in the Brain

PTSD negatively changes the part of the brain associated with memory and emotion. PTSD interferes with the function of the brain that recognizes past experiences as rooted firmly in the past; a person with PTSD can feel as if the past event is actually occurring, with the same emotional weight and impact. The brain responds as if it is under immediate threat, and the cycle of trauma repeats. Both CBT and EMDR attempt to interrupt this faulty process and root the brain in the present moment, releasing the past.

Addiction works in a similar way, with triggers causing the brain to intensify a craving for drugs or alcohol. The triggers of PTSD and the triggers of addiction can inflame each other, worsening symptoms of both disorders.

This is why treating PTSD in sobriety is key to staying clean. With proper treatment, support, and hard work, a person can be relieved of the worst of both the PTSD and addiction reactions, making positive changes easier to obtain, which then increases the person’s self-worth and belief that they can, after all, stay clean.

Treating Trauma and Addiction

Years of self-medicating to dull out trauma can create unique obstacles in the path to recovery. Consequently, people suffering from trauma and addiction benefit immensely from professional addiction treatment and trauma therapy.

If trauma is left untreated, a person may work endlessly to stay sober only to find themselves replacing substance abuse with other addictive, dangerous coping habits. As a result, before one can recover from addiction, he or she must begin healing from past trauma.

Both Substance Use Disorder (SUD) and PTSD are chronic, debilitating, and frequently Co-Occurring Disorders (COD), with these individuals suffering a more complicated course of treatment and poorer outcomes compared to those with either disorder alone [1].

Individuals with COD of SUD and PTSD report higher levels of cravings in response to trauma-related cues resulting in a higher frequency of SUD relapse [2].  The Substance Abuse and Mental Health Services Administration SAMHSA) National Survey of Substance Abuse Treatment Services reports that only 38% of addiction treatment centers consistently offer trauma-related counseling. Oy 50% of substance abuse treatment centers routinely conduct a comprehensive mental health assessment [3].

Despite this lack of integrated treatment, growing evidence supporting integrated treatments of comorbid PTSD and SUD is safe, well-tolerated, feasible, effective, and client preferred [3, 2].

When treating trauma and addiction, it is important that a person has a compassionate, trustworthy, and understanding therapist. Building trust with a therapist is the best way for a person to open up about the past. Many evidence-driven therapies can help a person heal from trauma and learn positive coping mechanisms.

Research studies evaluated an integrated treatment for PTSD/SUD veterans and compared it to a standard treatment approach and found the integrated model resulted in 83% of the participants no longer meeting the criteria for PTSD [4].  Other research has found that integrate treatment also results in improvements in PTSD symptoms and fewer relapses, and better addiction treatment outcomes [5] [2] [3].

 

References

[1] J. C. Flanagan, K. J. Korte, T. K. Killeen and S. Back, "Concurrent treatment of substance use and PTSD," Current Psychiatry Report, vol. 18, no. 70, pp. 69-78, 2016.
[2] I. Schäfer, L. Chuey-Ferrer, A. Hofmann, P. Lieberman, G. Mainusch and A. Lotzin, "Effectiveness of EMDR in patients with substance use disorder and comorbid PTSD: study protocol for a randomized controlled trial," BMC Psychiatry, vol. 17, no. 95, pp. 1-7, 2017.
[3] J. C. Flanagan, J. L. Jones, A. M. Jarnecke and S. E. Back, "Behavioral treatments for alcohol use disorder and post-traumatic stress disorder," Alcohol Research: Current Reviews, vol. 39, no. 2, pp. 179-191, 2018.
[4] S. E. Back, T. Killeen, C. L. Badour, J. C. Flanagan, N. P. Allan, E. Santa Ana, B. Lozano, K. J. Korte, E. B. Foa, and K. T. Brady, "Concurrent treatment of substance use disorders and PTSD using prolonged exposure: A randomized clinical trial in military veterans," Addictive Behaviors, pp. 369-377, 2019.
[5] C. A. Stappenbeck, J. A. Luterek, D. Kaysen, C. F. Rosenthal, B. Gurrad and T. L. Simpson, "A CONTROLed examination of two coping skills for daily alcohol use and PTSD symptom severity among dually diagnosed individuals," Behaviour Research and Therapy, vol. 66, pp. 8-17, 2015.

[6] APA: https://www.apa.org/topics/trauma/

[7] SAMHSA: https://www.integration.samhsa.gov/clinical-practice/trauma

[8] PTSD Alliance: http://www.ptsdalliance.org/ptsd-and-addiction/

 

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