Trauma and Addiction: How to Support Lasting Recovery

Trauma and addiction are often deeply interwoven.

There is a strong connection between trauma and addiction—so much so that most of the clients I treat for substance use disorders (SUDs) have at least one traumatic story to tell.
 
Take, for example, the story of a client whom I’ll call Ted. When Ted entered inpatient treatment, he underwent an in-depth psychiatric and clinical assessment that revealed he was struggling with symptoms of post-traumatic stress disorder (PTSD) that were contributing to an addiction to prescription painkillers.
 
Over the course of a few therapy sessions, Ted revealed at least one source of the trauma that played a role in his addiction: Ted had been sexually abused as a child. Growing up, his turbulent family life had caused him chronic stress. Ted’s parents divorced when he was only 10 years old, and he ended up living with his mother and her string of roommates and boyfriends, who themselves regularly used drugs and alcohol to cope with their problems.
 
Perhaps it’s not surprising that Ted, struggling to cope with these unresolved issues from childhood, would begin heavily drinking, then move on to opiates after a doctor prescribed them for a sports injury.

Recovery helps individuals with SUDs replace unhealthy behavioral patterns with healthier ones.

Stories like Ted’s are not uncommon among the clients I treat. Their experiences of trauma may vary in nature and degree of severity, but they help to explain the difficult “equation” of SUDs—namely, how a person’s life experiences can add up to a drug or alcohol addiction.
 
One or more experiences of trauma can rewire brain chemistry, making a person more vulnerable to future trauma-based addiction “triggers.” These thoughts, emotions, and behavioral patterns related to past trauma can keep resurfacing in different contexts: as flashbacks and other uncomfortable thoughts, as emotions that fuel the urge to use drugs or alcohol simply to cope.
 
One very important goal of therapy, then, is to help people struggling with SUDs healthier ways to manage and cope with these mental, emotional and behavioral triggers. In fact, much of addiction treatment involves helping people with addiction and co-occurring mental health problems replace unhealthy behavioral patterns with healthier ones.

Trauma and addiction can be positively addressed through dialectical behavior therapy.

One therapeutic intervention that has been well-studied in the treatment of trauma-based addiction is dialectical behavior therapy (DBT). DBT can help people with SUDs achieve better treatment outcomes. Here’s how DBT helped Ted better address and manage the trauma-based roots of his addiction:

• Mindfulness exercises: Ted learned to pay attention to the present moment without passing judgment on it, which helped him become more of a neutral observer in relation to his triggers (such as a memory or flashback related to the sexual abuse he suffered as a child).
• Distress tolerance skills: Tools for temporary distraction, self-relaxation, and greater acceptance helped Ted gradually develop a healthier way to cope with distressing events in daily life.
• Emotional regulation: Strategies for better identifying and handling intense emotions empowered Ted to practice greater emotional self-regulation. Initially, he’d been highly emotionally reactive, flying off the handle at what seemed like the slightest annoyance during his time in inpatient treatment—he’d even exploded in anger at a staff member. Over time, though, Ted gained greater mastery over his emotions.
• Interpersonal skills: Ted learned to navigate social encounters more successfully by developing and working towards a goal in these interactions. For instance, one goal was to assert and enact healthier interpersonal boundaries in his relationship with his mother. In their interactions, he aimed to convey love and respect but also his need for autonomy and self-differentiation.

A trauma-informed approach supports optimal outcomes when treating trauma and addiction.

DBT is not the only therapy used for treating trauma-based addiction. Other methods include eye movement desensitization and reprocessing (EMDR), trauma-based cognitive behavioral therapy and psychodrama therapy.
 
What’s key is finding a rehab center that offers a variety of these trauma-informed therapies so that you have multiple treatment options and, in turn, a greater likelihood of meeting your individualized treatment needs.
 
Do some investigative work before signing on the dotted line with any rehab program. Call and visit prospective rehab facilities and ask them:

• about the trauma-informed therapies they offer
• whether the clinicians administering these therapies are credentialed in those therapies
• how they integrate these therapies into any plan of treatment

The bottom line? Even if you’re not sure whether trauma is part of your story, finding a treatment provider that takes a trauma-informed approach is a wise way to go when dealing with a substance abuse problem.
 
ABOUT THE AUTHOR
Anna Ciulla is the Chief Clinical Officer at Beach House Center for Recovery, where she oversees the supervision and delivery of client care. Anna has written extensively about addiction recovery and has more than 20 years of experience helping individuals and families affected by addiction. You can learn more about Beach House and their treatment programs — including treatment for trauma-based addiction — on their website.