Trauma & Addiction: What’s the Connection?

Below are common causes of trauma:¹

• Physical, sexual, emotional, or verbal abuse
• Natural disasters
• Spiritual or religious abuse
• Witnessing or experiencing bodily harm or death
• Domestic violence
• Significant life transitions
• Witnessing or experiencing combat/warzones

How Trauma Affects the Brain

Trauma triggers the fight-or-flight response, an automatic stress reaction that helps us detect danger and protect ourselves. The brain enacts a series of internal actions to prepare us to attack or flee from the threat. The amygdala signals the hypothalamus to initiate cortisol and adrenaline production to increase energy, alertness, heart rate, and breathing. These hormones work in sync to ensure survival.

This natural response is crucial in dangerous situations. However, prolonged activation can alter the prefrontal cortex and hippocampus. Impairments in these areas can impact the ability to learn, regulate emotions, and respond to stress.² Trauma can keep individuals in constant fight-or-flight mode, thus increasing the risk of developing this “trauma brain.” Over time, they become hypersensitive to any threat, real or perceived.

What Is the Connection Between Trauma & Addiction?

Trauma and addiction share a high comorbidity rate, as some studies suggest up to 59% of young people with PTSD subsequently develop a substance use disorder (SUD).³ Experiencing a fear response during a traumatic situation is natural and expected. However, this mechanism is faulty in trauma survivors, causing a state of constant distress. Sadly, substance abuse becomes the only way for some to cope with the recurrent nightmares, flashbacks, and psychological reminders of the traumatic event.⁴

Different Types of Trauma & Addiction

Researchers hypothesize the high rates of comorbid trauma and addiction stem from a tendency to self-medicate or numb emotions with alcohol or drugs. The likelihood of developing an addiction increases for those with early childhood trauma. Exposure to cumulative traumas can also lead to substance use for those with pre-existing PTSD.

Adverse Childhood Experiences (ACEs) & Addiction

Early trauma puts someone at a higher risk of substance misuse and addiction, as adverse childhood experiences (ACEs) can interrupt typical brain development. Additionally, abuse, neglect, or family dysfunction can affect self-esteem, physical safety, and attachment. Coping with these challenges can seem impossible for children without adequate support, leading some to engage in substance misuse later on.

Adverse childhood experiences that can contribute to addiction include:

• Physical abuse: Physical abuse can include hitting, spanking, punching, and any form of violence that results in bodily harm. Children exposed to these traumas are more likely to have low self-esteem, leading some to cope through substance use.
• Emotional and verbal abuse: As with physical abuse, constant emotional or verbal abuse from caregivers or other important figures can solidify deep-rooted identity issues and self-loathing. In turn, some children may seek solace through alcohol or drugs.
• Emotional neglect: Emotional neglect occurs when parents or caregivers fail to provide their children warmth, love, and affection. Not receiving these basic human needs can impact various aspects of identity, attachment, and safety, thus contributing to maladaptive coping mechanisms like substance use.
• Domestic violence: Domestic violence can lead to feelings of helplessness, dread, and worthlessness that develop into depression and anxiety. Substance use is a common response to these adverse experiences.
• Family loss: Divorce, abandonment, death, or separation can elicit a trauma response in children. The associated instability can cause trust issues, insecure attachment, and guilt.
• Parental substance abuse: Witnessing parental alcohol or drug use can normalize these behaviors in families, thus increasing the likelihood of similar issues in children.

PTSD & Addiction

Not everyone with PTSD will use substances to cope with their symptoms, but cumulative or chronic traumas can erode resilience, confidence, and stress management skills. Over time, accumulated trauma can become too heavy a burden for some survivors, thus leading to substance misuse and addiction.⁴

Can Addiction Lead to Trauma?

Sometimes, substance use exposes individuals to trauma, including rape, physical assault, interpersonal violence, overdose, and death.⁴ One study found a third of SUD patients experienced trauma during the process of using or procuring illicit substances.⁴

The Trauma to Addiction Cycle

Trauma and addiction cause, encourage, and reinforce one another. This comorbidity and interaction create a vicious cycle that makes recovery difficult for survivors. Unfortunately, seeking relief from pain through substances provides only temporary relief, and individuals must continue to engage in these unhealthy habits to feel stable, numb, or safe.

The stages of a trauma-addiction cycle include:

• Trauma disrupts the natural stress response
• A hyperactive stress response causes lasting damage to the brain
• Survivors use substances as a coping mechanism
• Substance abuse exposes the survivor to more traumas
• Repeated use and exposure continue the cycle

Other Factors Influencing Addiction & Trauma

Everyone reacts to trauma differently, meaning what triggers a lasting impact on one person may not influence a similar response in another. While a higher number of ACEs can increase the risk of addiction, other factors can play into development. Additional aspects that can contribute to comorbid substance use and trauma disorders include genetic predispositions, pre-existing mental health conditions, and a lack of support.

Other factors influencing trauma and addiction include:

• Experiencing recurrent traumas
• Genetic predispositions
• Personality/behavioral traits (i.e., neuroticism)
• Co-occurring mental health conditions (i.e., depression, anxiety, etc.)

Trauma & Addiction Treatment Options

Treatment for trauma and addiction typically focuses on developing new, healthier coping mechanisms for dealing with stress. Addiction is a disease that can be especially difficult to overcome, and some individuals may need 24/7 support and monitoring to achieve lasting recovery. Depending on the severity and duration of symptoms, survivors can seek traditional therapy, intensive outpatient care, or rehab.

Therapy Options

Psychotherapy offers a safe space for trauma survivors to share and process their experiences. Trauma-informed therapy focuses on establishing safety and addressing the often debilitating symptoms of PTSD, allowing clients to regain control over their lives and futures.

Two specific therapies may be beneficial when coping with comorbid trauma and addiction. TF-CBT assists individuals in addressing the effects of traumas, exploring their inner thought processes, and overcoming problematic behaviors. EMDR for PTSD utilizes bilateral stimulation to help individuals process traumas, allowing for mental integration and peaceful resolution. Because substance use is a common coping mechanism associated with trauma, these methods can also help treat co-occurring addictions.

Intensive Outpatient Treatment

An intensive outpatient program is appropriate for individuals with mild to moderate symptoms. Outpatient typically demands once-weekly treatment, whereas intensive outpatient involves multiple weekly sessions. Most outpatient and intensive outpatient facilities can accept insurance plans or offer a sliding scale for those without insurance.

Rehab

Rehab offers 24-hour care and supportive treatment. This treatment method is suitable for individuals with severe trauma and addiction symptoms, as care requires them to suspend their normal responsibilities and live on-site.