By Ken Seeley, Founder of Ken Seeley Communities

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While the exact cause of addiction remains shrouded in mystery to a large extent, there are some identified risk factors that are believed to contribute to it. Among this list of factors is a history of trauma. Underlying unresolved emotional pain due to trauma or abuse can fuel the need to use a substance to help manage the lingering symptoms associated with past traumatic events. Self-medicating with drugs or alcohol is an all too common response to trauma. Continued use of the substance can lead to increased tolerance and eventually dependency or addiction.

Once someone has acquired a substance use disorder in response to unresolved trauma it is necessary to address both disorders in a comprehensive program for dual diagnosis treatment. Without the focus on healing the trauma, there is virtually no chance to recover from the addiction. This underscores the importance of treating both the substance use disorder and the trauma disorder simultaneously.

Through therapy it is possible to put the trauma in the past where it belongs and to begin the process of breaking the grip of addiction in recovery. Working with a psychotherapist trained in treating trauma disorder is the key to pushing through the devastating effects of a past trauma and allowing for healing and restored peace of mind.

What is Trauma?

Trauma is an event or situation witnessed or experienced firsthand that causes an intense stress response that stems from feelings of fear and a lack of control over the situation. Examples of traumas might include:

• Physical assault
• Sexual assault
• Serious auto accident
• Sudden unexpected death of a loved one
• Domestic violence
• Serious health event or diagnosis
• Natural disasters
• Terrorism
• Trauma experienced in combat duty

The traumatic event is often something that was unpredicted and sudden, triggering the brain’s fight or flight response. The event may cause the person to feel powerless, which adds to the severe and lasting emotional trauma symptoms. But even negative life events that evoke intense fear of the unknown can be considered traumatic. These might include a divorce, having to suddenly relocate to a distant place, a parent developing serious health issues, or the loss of a job or other major financial setbacks.

The effects of trauma settle deep within the person’s psyche, becoming a wound or scar that can cause them to carry the emotional burden with them through life.

The Different Types of Trauma

There are different ways that a traumatic event can manifest itself in dysfunctional patterns. Three types of trauma disorders include:

• Post-Traumatic Stress Disorder (PTSD)

PTSD involves a long-term, persistent response to experiencing an overwhelming traumatic event. Debilitating PTSD symptoms may linger for a month or more, and may feature recurring flashbacks, nightmares, and unwelcome memories of the event, insomnia or sleep disruptions, emotional numbness and detachment, avoidance of situations, people, or places that might trigger painful reminders and emotions, hyperarousal symptoms, withdrawal from friends and family, and feelings of guilt. There is a high occurrence of a co-existing substance abuse among individuals suffering from PTSD.

• Acute Stress Disorder (ASD)

ASD is also caused by a significant traumatic event that was experienced either directly or indirectly, and carries the same types of symptoms as PTSD, but which last less than one month.

• Adjustment Disorder

Adjustment disorder features an inability to cope with a significant life event. A single highly stressful event, or a series of stressful events, may cause so much emotional distress that it causes impairment in daily life. Symptoms of adjustment disorder may include feelings of being overwhelmed, neglecting responsibilities, excess worry, insomnia, loss of appetite, and withdrawing socially. Adjustment disorders may last up to six months in duration.

Addiction and Trauma

The Adverse Childhood Experiences (ACE) study, one of the largest studies of childhood abuse and neglect involving 17,000 participants over a 4-year period, demonstrated clear relationships between cumulative adverse events and subsequent life-threatening or life-diminishing conditions, including substance addiction or dependency. Whether a traumatic event was experienced in childhood or adulthood, there is an increased likelihood that alcohol consumption or drug use may result, especially if there were multiple traumas.

Substance abuse is a response to the anxiety and depression symptoms that develop due to an inability to overcome the emotional scars left by the trauma. According to a 2012 article published in Current Psychiatry Reports, about 50% of patients receiving treatment for a drug or alcohol addiction met diagnostic criteria for co-occurring PTSD. The substance allows the hurting individual to escape their emotional pain, at least for a little while. As tolerance increases and the level of substance use rises with it, dependency may result, adding just another layer of pain and turmoil for the individual.

Overcoming Both Trauma and Addiction

When seeking help for a dual diagnosis—co-occurring trauma and substance use disorders—the individual will engage in evidence-based therapies that are specific to the underlying emotional trauma. Mental health professionals have a variety of modalities at their disposal to help individuals overcome the harmful effects of the trauma. These might include:

• Trauma-Focused Cognitive Behavioral Therapy.  TFCBT helps individuals overcome trauma by reshaping the thoughts associated with the trauma that have led to maladaptive behaviors. By guiding the individual to safely express their feelings about the experience, the therapist will show them how those thoughts have led to withdrawal, loneliness, guilt, anxiety, and substance abuse. Through this process, the negative thoughts lose their potency.
• Psychodynamic Therapy. This is a longer-term therapy that guides the individual to delve into painful childhood experiences related to dysfunctional issues in their adult life. The insights gained during psychodynamic therapy can help the individual reframe their perspective on those childhood experiences and see them in a new light.
• Exposure Therapy. This is a short-term behavioral therapy that uses prolonged exposure techniques to help the person become somewhat desensitized to the memories of the trauma. By encouraging discussion of the event and incrementally exposing them to the triggers within a safe environment, the impact is gradually reduced over time.

Simultaneously with the trauma work, the individual will engage in a multi-modal addiction recovery program that also utilizes evidence-based therapies, including cognitive behavioral therapy and dialectical behavior therapy. Peer support is provided through group therapy sessions and 12-step recovery meetings. In addition, holistic and experiential activities that can help the individual better manage emotions and stress are introduced in a residential rehab, such as mindfulness training and yoga.

Through this dual diagnosis approach to recovery, the individual begins healing from the traumatic event while also learning addiction recovery strategies, helping them to overcome both disorders.