Trauma comes in all forms and can have a significant impact on individuals years or even decades later. In order to forget these traumas, many people self-medicate with drugs and alcohol. These individuals need more than standard inpatient treatment and will get the best outcome from evidence-based trauma and substance abuse treatment.
What Is a Trauma?
According to the DSM 5, trauma is any event in which a person experiences intense fear or distress in response to physical and/or psychological harm, threats, loss, injury, or death. Trauma can also occur due to neglect.
Common traumatic events include physical/sexual abuse, assaults, and car accidents. Other significant life events can also be traumatic and have a serious effect on how safe and secure an individual feels.
How Common is Trauma?
According to a 2012 study, 12-34% of individuals in substance use treatment are also diagnosed with post-traumatic stress disorder (PTSD). Those numbers nearly double when looking at only the women in the study, who are more likely to experience both.
Three other studies from Najavits, Shafer, and Enoch have shown that up to 75% of individuals in substance abuse treatment have been exposed to or have experienced a traumatic event in their lives. There is a clear link between experiencing a trauma and substance abuse.
Symptoms of Trauma
Individuals who have experienced trauma often have intense flashbacks of the trauma. They may also experience extreme emotional reactions to reminders of the trauma, nightmares related to the traumatic event, and emotional numbing. Individuals who have experienced trauma may also feel helpless or powerless in situations where they are reminded of the trauma.
In order to survive in environments where traumatic events happen often (abusive relationships, prolonged sexual abuse, war), individuals often develop strategies to cope which can be unhealthy when applied in other environments.
For instance, an abused partner in a relationship may become introverted in the home to avoid harm. This may result in them also withdrawing from friends and family outside of the home who could act as supports. Some individuals may also abuse substances in order to cope with ongoing or previous traumatic events in their lives.
Self-Medicating to Deal With Trauma
People who have experienced trauma may seek out ways to avoid thinking about or re-experiencing the events. Shame and guilt associated with the trauma can cause individuals to unfairly blame themselves for the traumatic events that have happened to them.
Avoidance is often the most harmful symptom of trauma. In order to avoid recurring thoughts, flashbacks, or nightmares of a trauma, many individuals “self-medicate” with addictive drug and alcohol use.
Individuals with PTSD are more likely to abuse substances like:
- Prescription Medications
The Effect of Substance Abuse on Past Trauma
Unfortunately, drug and alcohol use often make symptoms worse. This can cause individuals to be re-traumatized or experience more significant trauma because of their addiction or substance abuse.
For example, individuals who survived childhood sexual abuse may turn to opiates to avoid re-experiencing the pain associated with their trauma. However, their use of opiates is likely to put them in dangerous situations where they are vulnerable and can be taken advantage of. This may unfortunately result in further trauma, and further desire to forget these experiences by self-medicating.
Trauma and Substance Abuse Treatment
It is essential that treatment providers understand what trauma is, and the role it has on an individual’s substance abuse. Given the large percentage of individuals with substance use disorders who have experienced trauma, it is highly likely that any given individual in a recovery treatment program has experienced at least one traumatic event.
For individuals entering a 28-day program, it can be intimidating to feel as though they need to address and treat both disorders. It can also be challenging for treatment providers to focus on both the individual’s substance abuse and their PTSD together. Oftentimes treatments offered only manage to focus on one.
Care for Trauma and Substance Abuse Recovery
Because of the large number of individuals in substance abuse treatment who have also experienced trauma, it is essential that treatment providers work to understand and address the trauma in order to holistically treat the person.
Evidence-Based Treatments for Trauma Disorders
There are several evidence-based treatments for PTSD and associated trauma disorders. Prolonged exposure therapy, trauma-focused cognitive behavioral therapy, and Seeking Safety have all been shown to decrease symptoms of trauma and substance abuse.
These approaches highlight decreasing avoidance of the trauma and associated stimuli, developing healthy coping mechanisms, and changing beliefs about self and others that may have developed from the trauma. But, treatment providers do not need to become experts in any of these therapies in order to provide services to their clients who abuse substances and have experienced trauma.
The Benefits of Trauma-Informed Care
Trauma-informed care aims to structure organizations and provide treatment in a way that understands how trauma affects people and their outlook. It also puts many unhealthy behaviors and symptoms into context and works to address all types of trauma.
Trauma-informed care also seeks to help individuals feel a sense of control over their situation and their symptoms. This can help to build a sense of empowerment and hope, which are often taken away in a trauma. All of this helps to create an environment of safety in order to help individuals begin to recover.
Key Takeaways of Trauma-Informed Care for Treatment Providers
Trauma-informed care has the best chance of success when the treatment provider is able to understand:
- The impact the trauma has had on the individual
- How the trauma has affected the way the individual behaves and sees the world
- The role that substances have played in helping to cope with trauma.
Treatment providers, peers, and safe supports in the community all need to do their part. With their help, the individual can develop healthy coping strategies in response to the trauma and learn new ways of living.
By understanding trauma and its impact on people, treatment providers can work with individuals to help to develop a sense of safety and to begin to heal. Without this sense of safety, individuals cannot begin to challenge unhelpful ways of thinking and behaving. They must feel safe in order to try new ways of coping and to find effective, healthy ways to address the trauma without substances.
Traditional inpatient treatment for addiction may help these individuals, but a plan specially designed for both trauma and substance abuse treatment is likely to have the best outcome.