By David Sack, M.D.
Although often overlooked, emotional trauma lies at the heart of many types of addictions. Our recognition of trauma as a root cause of addiction isn’t new. Since the 1970s, treatment professionals have understood the role of trauma in the development of substance abuse disorders and relapse.
But in recent years, there has been a welcomed resurgence in awareness and treatment of trauma as a co-occurring disorder.
Research Links Addiction and Trauma
Last week, a study published in Alcoholism: Clinical & Experimental Research confirmed what many of us in the treatment field have long observed: A history of childhood neglect or sexual, physical or emotional abuse is common among people undergoing treatment for alcoholism and may be a factor in the development of alcohol use disorders.
Abuse was also linked to a higher risk of anxiety disorders, depression and suicide.
Whereas the general population has physical abuse rates of 8.4 percent, the rate for alcoholics has been reported at 24 percent for men and 33 percent for women. The rate of sexual abuse in the general population hovers around 6 percent, while the rate for alcoholics has been reported at 12 percent for men and 49 percent for women. Rates of childhood emotional abuse and neglect, which are often under-reported, are likely as prevalent among alcoholics as physical and sexual abuse and have similar long-term consequences, including increased rates of depression, anxiety, suicide and behavioral problems later in life.
This recent study adds to a large body of research linking addiction and trauma. A study of children who attended school near Ground Zero found that the more trauma-related factors they experienced (such as knowing someone who died or fearing for their life), the more likely they were to use drugs and alcohol. And the link wasn’t subtle: Children with three or more exposure factors were 19 times more likely to increase their use of drugs or alcohol.
Trauma has been associated not only with drug addiction but also overeating, compulsive sexual behavior and other types of addictions. The Adverse Childhood Experiences study, which is based on data from over 17,000 Kaiser Permanente patients, found correlations between severe childhood stress (e.g., abuse, neglect, loss of a parent, domestic violence, or having an addicted or mentally ill parent) and various types of addictions.
Again, the results left little need for interpretation: A child with four or more adverse childhood experiences is five times more likely to become an alcoholic and 60 percent more likely to become obese, and a boy with four or more of these experiences is 46 times more likely to become an injection drug user than other children. The researchers found that the effects of trauma are cumulative, and that one of the most destructive forms is “chronic recurrent humiliation” (i.e., emotional abuse in the form of name-calling or ridicule).
What Is Trauma?
Larke Huang, director of the Office of Behavioral Healthcare Equity at the Substance Abuse and Mental Health Services Administration, defines trauma broadly as a stress that “causes physical or emotional harm from which you cannot remove yourself.” Trauma is subjective, meaning what matters most are the individual’s internal beliefs and their innate sensitivity to stress, not whether a family member, therapist or other outsider deems an experience traumatic.
Trauma can stem from abuse or neglect as well as other painful or frightening experiences, such as a car accident, bullying, school killing, sudden life change or near-death experience, whether experienced firsthand or witnessed. It can also result from growing up in an alcoholic or addicted home or any other environment where children are taught to bury their feelings. As a result of the trauma, the individual feels intense fear or helplessness, which can lead to serious long-term struggles with depression, anxiety, and addictive or impulsive behaviors.
An Unhealthy Attempt to Meet Healthy Needs
Trauma is particularly damaging when it occurs in childhood. Young children do not have a frame of reference to put traumatic experiences in context or try to make sense of them. Their primary outlet for support is the family, which is often the source of trauma in cases of abuse or neglect. As a result, children adapt to getting their normal emotional needs met in unhealthy ways.
In some cases, addiction develops in the trauma survivor’s attempt to self-medicate. Rather than thinking about or reliving the event, the individual may use drugs, alcohol, or other substances or behaviors to numb feelings of fear, powerlessness or depression or to cope with intrusive memories.
Drug use may also serve other purposes for trauma survivors. For instance, it may allow them to disconnect from their feelings, dampen guilt or rage, increase feelings of relaxation or control, or reduce chronic anxiety or suicidal thinking. Depending on the drug of abuse, patients may seek to numb painful emotions or conversely to feel “alive.” Patients also report a feeling of camaraderie or unconditional acceptance among other drug users, in some ways replicating the family unit.
Dual Recovery for Dual Disorders
Whatever purpose drug use serves for the trauma survivor, what began as one problem (unresolved trauma) becomes complicated by a second serious problem (substance abuse or other high-risk behaviors), until the coping mechanism itself becomes so disruptive that treatment is needed.
Often, patients are unaware that they use drugs to cope with the symptoms of trauma. They may have little or no recollection of traumatic experiences and get into their 30s or 40s before they begin noticing problematic patterns in their relationships or professional lives that they can’t seem to resolve (trauma echo). Those who enter drug rehab may get stuck in a cycle of chronic relapse or stop using drugs only to self-soothe with an eating disorder, sex addiction or self-harm since the underlying problem (trauma) remains unaddressed.
To prevent further harm and guard against relapse, it is up to treatment professionals to recognize the prevalence of trauma among addiction sufferers, routinely screen for trauma symptoms, and deliver the integrated, multidisciplinary treatment that has proven effective in treating co-occurring disorders. Given the sensitivity of trauma treatment, not every clinician can or should provide trauma-based care, but there are specialized trauma programs and treatment providers skilled in healing the dual wounds of trauma and addiction.
Powerful video on the affects of Adverse Childhood Experiences (5 mins 43 seconds).