What Happens When Addiction Treatment Doesn’t Address Trauma?
If you or someone you love is trying to recover from addiction, it's essential to know that unresolved trauma can contribute to substance misuse and addiction disorders. It can also be a factor if you continue to relapse despite having a strong desire to stop destructive using patterns.
Trauma is often an unspoken and unacknowledged experience for many who struggle with addiction. The consequence of missing this critical connection may add to the problems for those stuck in harmful patterns of behavioural addictions or substance use.
Understandably, problematic substance use increases exposure to traumatic life events. There is a greater risk of accidents and substance-related health issues, greater exposure to violence, as well as traumatic losses that occur as the result of addiction. Even though unhealthy substance use creates additional sources of trauma, many of those with substance use disorders were exposed to significant adverse experiences long before their misuse of drugs or alcohol began.
Trauma symptoms differ significantly from person to person, but common symptoms include increased anxiety, fear, anger, and shame. Insomnia, nightmares, mood swings, agitation, or difficulty concentrating are problematic for some people. Sometimes a person remains on "high alert", or they startle easily long after the threat has passed. There also might be particular situations or places that trigger strong emotional reactions.
But it's far too easy to mistake some of these common symptoms of unresolved trauma for the negative consequences of addiction.
When we miss the connection between trauma and substance use, it increases the risk of believing all addiction issues are caused by choices and behaviours. When this happens, you are less likely to get the tools and resources needed to deal with the underlying impacts of trauma.
Suppose you struggle with problematic substance use or an addiction disorder. If you also have a history of trauma or adverse life experiences, there are seven additional challenges you may face as you seek help:
1. Too much of a focus on addiction leaves the initial issue of trauma unresolved
Trauma symptoms disrupt everyday life in a wide variety of ways. So it isn’t surprising that someone with a history of trauma seeks relief from the painful symptoms of trauma – or that substance misuse becomes a way of finding that relief. Initially, the use of mood-altering substances or behaviours may have helped medicate your painful feelings. They may have been a way of avoiding difficult memories or circumstances.
The problem with self-medicating trauma symptoms is that it leads to out-of-control patterns while still leaving the initial issue of trauma unresolved.
Although substances or behaviours may provide a temporary “fix” for your trauma symptoms, it only adds to the problem by making the symptoms worse. It also interferes with the ability to work through the traumatic experience.
Research shows that addressing trauma symptoms helps decrease substance use. But the opposite isn’t necessarily true: treating substance use alone doesn’t shift trauma symptoms in the same positive way.
2. Addiction problems are more significant for those with a trauma history
They often use a wider variety of substances, use significantly higher quantities, and have other co-occurring behavioural addictions. If you experienced childhood trauma, you are more likely to have started using substances as early as age 11 or 12. Trauma also sets you up to have more years of substance use if it was used as a coping mechanism rather than for social reasons. You may also experience more intense cravings, especially if those cravings are directly related to underlying trauma symptoms such as intrusive memories, fear, shame, anger, or other trauma triggers.
Trauma can lead you to engage in far more destructive patterns of substance use – and the consequences of that substance use are more significant.
3. Your risk of severe mental health issues increases
Those with trauma and substance use or addiction disorders struggle far more with anxiety, depression, suicidal thoughts, and other self-destructive behaviours. They are also six times more likely to have attempted suicide. In addition, research shows that those addicted to drugs or alcohol are up to 9 times more likely to have a psychiatric disorder if they experienced trauma as children than those who were not. (1)
Trauma and addiction impact your mental health in very harmful ways.
4. Addiction treatment programs can be less helpful
Trauma symptoms will likely interfere with your ability to experience the full benefit of addiction treatment. Common trauma symptoms include high levels of anxiety and panic, difficulty feeling safe in groups, feeling overwhelmed in new situations, or fears of giving up control. Going to a treatment program might activate these symptoms in some challenging ways.
Many common trauma symptoms might make it difficult for you to participate fully in a treatment program.
5. Trauma symptoms are often mistaken for an unwillingness to pursue recovery
With a past trauma history, you may find confrontation difficult – you might respond with defensiveness and anger. Or it may be too painful to look at the consequences of your behaviours, so you act as if you haven’t done anything wrong. Instead of the compassion and understanding you need, you might be shamed or judged. When we look at these behaviours through the lens of trauma, we can understand these are “normal” reactions to the loss of control you experienced in past traumatic experiences.
Some of your trauma symptoms might make it seem like you are not “ready” or not “willing” to deal with your addiction problems.
6. Relapse occurs more often for those with unresolved trauma
Even if you have a strong desire to stop destructive patterns, unresolved trauma can increase the risk of a quick relapse after a period of abstinence. The reason for this is that trauma symptoms are heightened when you stop using substances or behaviours – you're no longer numbing your trauma symptoms. This sudden increase in troubling symptoms during abstinence often triggers an overwhelming desire to mood-alter.
Abstinence may not diminish trauma symptoms but may trigger them.
7. It increases the hopelessness about the possibility of recovery
If you have experienced the effects of past trauma, a vicious cycle often gets created. Once you stop using substances or behaviours, trauma symptoms such as anxiety, emotional triggers, and upsetting memories surface again. This increase in trauma symptoms often triggers a relapse. And now you feel more shame and hopelessness, making the next attempt at recovery even more challenging.
If your underlying trauma remains unidentified or unresolved, it makes the process of addiction recovery seem an impossible task.
Trauma-Informed Care
If you have experienced some of these additional challenges in your search for help, I encourage you to find a counsellor trained in working with both trauma and addiction.
It is also more common for addiction treatment programs to be “trauma-informed”. This simply means that a program or the people offering the support follows these principles of care in their work: creating safety, being trustworthy, offering choice and collaboration, empowerment, and respect for diversity.
Trauma-informed care recognizes these principles are foundational to the process of healing and recovery for anyone experiencing a substance use disorder, especially when trauma has been a contributing factor.
In Summary
Substance use and addiction disorders are common among those who have been through traumatic experiences, especially when they continue to suffer from ongoing trauma symptoms. It is no wonder they might seek out options to help them shut down or numb out. Others use substances to counter the numbness and detachment they experience.
For those who've had trauma, addiction is, most often, a way to dampen the pain. Let's remember that substance use and other addiction disorders began as an attempt to fix a problem that trauma created.
I hope you find the support you need to heal.
Looking for more trauma-informed recovery resources?
Check out Recovery Happens - Carrie’s informative course that helps people discover pathways for healing trauma and addiction.
Reference:
(1)) Felitti, Vincent J.; Anda, Robert F.; Nordenberg, Dale; Williamson, David F.; Spitz, Alison M.; Edwards, Valerie; Koss, Mary P.; Marks, James S. "Adverse Childhood Experiences". American Journal of Preventive Medicine. 14 (4): 245–258. (1998)