Estimates of the co-occurrence of trauma and addiction are quite high, and depending on how trauma is defined, one could argue that most who struggle with addiction have experienced some type of trauma in their life.
In my clinical work, most patients had histories of traumatic events that shaped their life in significant ways, even if their present symptoms did not meet criteria for PTSD. The problem with trauma is that it is the gift that keeps on giving – but often in very subtle ways.
The effects of trauma
When a person has experienced trauma, not only do physical changes in the brain take place that increase sensitivities to stress, but psychologically a person becomes vulnerable to future traumatic experiences – often experiences similar to the original trauma.
This is because trauma is like unfinished business, it desires resolution or completion – or a way to make sense of what happened.
What this looks like in everyday life is that a person will continue to repeat similar experiences: a sexually abused child will hook up with adult partners that continue the abuse, a physically abused child may find themselves in situations where they are physically abused as adults – and so on.
Although each situation may appear different, the underlying theme is that unresolved trauma plays a role in perpetuating a painful life. Because re-experiencing trauma in different forms is painful, addiction becomes a powerful antidote.
Thus the reason why one cannot expect good outcomes from addiction treatment if underlying trauma issues are not addressed.
All of your key points truly hit home, as addiction has been present in my family for quite some time. This post is especially relevant and I agree whole-heartedly with the phrase that trauma is ‘the gift that keeps on giving’. Although I would hardly call it a ‘gift’. But I understand your point…
I am fascinated by the neural imaging slides, and am curious about the exact physiological changes that occur in the brain following a trauma, and how this relates to addiction. How do the neurons fire differently in a trauma survivor when the addiction is being fed? Are these pathways able to be re-directed?
Thank you so much for your ability to share this knowledge with us in a clear, relatable manner. I am excited to keep checking back in to your site!
Jess,
Well-taken about the use of the word “gift.” For the best website on trauma related resources, including many great free downloadable articles, see: http://www.trauma-pages.com and check out my article on treatment. Thanks for the comments.
J
The title of this post – trauma is the gift that keeps on giving- hits the mark, though you may have to think a bit about the idea of “gift” in this context. Having worked in the medical field for some time now, it certainly seems that many addictions stem from a traumatic event. A lot of people fail to put the two together and that could be one reason why addiction is so difficult to prevent and treat. I have been there when someone was brought in to the Emergency Department after a terrible car accident and then seen them again 6 months later wanting to go to detox for their alcohol or drug addiction which started after the accident. It seems like so many people start to drink or do drugs to forget about or find resolution about what happened to them but in reality they just think about it more and nothing is solved. Every time they try to stop their addiction the memories of what triggered it in the first place simply get stronger. And, what’s worse, the deeper they get with the addiction the higher risk they are at to be involved in another trauma which can make the addiction spiral deeper. They tend to seek people with similar histories to associate with, which reinforces their addictive behaviors. It is like a bad cycle that is incredibly hard to break. This topic is not talked about enough and I really appreciate your site and all of its information!
Well said Jessica
J
Clever way to state that trauma is a gift that keeps on giving.
So, there’s a lot of correlation between sexually abused children with issues later in life that are associated with that trauma, same with physical abuse, but some individuals do not carry that trauma as a weight on their shoulders but use it to help others prevent or fight the trauma they experienced. Have you noticed any similarities in those individuals who are able to ‘manage’ the trauma as opposed to those who carry it in an unhealthy way their entire life?
A strong trait associated with better life outcomes for trauma victims is resiliency. This trait has been studied extensively over the past few decades, with resiliency factors generally following into one of three groups: 1) child characteristics, 2) family characteristics, and 3) community characteristics. In each of these groups researchers have identified multiple factors that can influence outcomes to trauma. For example, individual characteristics include: 1) secure attachment in infancy, positive peer relationships, effective emotional coping strategies, good intellectual problem-solving skills, and positive self view (or self-efficacy, confidence, worth). See Ch 32: Fostering the Future: Resilience Theory and the Practice of Positive Psychology and Ch 25: A Clinical Approach to Posttraumatic Growth in: Positive Psychology in Practice (2004) edited by P. Alex Linley and Stephen Joseph: John Wiley Assoc. for more information on this topic.
John
I guess it is true when they say trauma is a gift that keeps on giving. One of my best friends had a traumatic experience a few years ago that has also left her family and her friends devastated. The only thing that makes her happy is when she is gambling. I don’t think gambling really makes her happy, it just helps the time go by, and perhaps she goes there to escape her problems. Unfortunately she does not seem to think that she has a problem. In this blog, it states that traumatized people can put their lives in danger to fulfill their needs. I truly believe that anyone who has had a terrifying experience could go to the extreme to fulfill their goal (in this situation, she would rather spend her last two dollars at the casino then buy food). I sympathize with her for what she has been through but it seems that she has lost touch with reality. How do you convince a person that they have a problem and they need counseling when they can’t come to terms with their addiction?
Your statement is the raw truth. Trauma or chronic pain is something that keeps giving over and over. I myself cannot call it a gift but I understand the euphemism. For me the trauma has given its gift for more than 7 years now.
I am not “addicted” to anything except maybe the pain itself. There have been a few times when for no reason the pain was not there, and I thought there was something wrong. I don’t think I know how to be me anymore, without pain. The doctors have tried to help but they actually keep re-traumatizing my leg with each surgery. Every time they cut it open, it is a new trauma for my body to process. The last surgery has been the worst in terms of pain. The surgery itself may have been a success, depending on what how you term success. The pain is worse than it ever was and never goes away now. For me it wasn’t a success but for the doctor I’m sure it is because he accomplished what he had planned. He didn’t anticipate the pain that went with it.
I try to remember every day is a gift, whether it includes pain, it beats the alternative. I think……
Cynthia – sorry to hear about your surgerical outcome. Sounds like you would benefit from a multidisciplinary approach to pain management, where various types of providers collaboratively work together to ease your pain and find long-term solutions.
J
The more and more I learn about the human experience as it relates to the counseling profession, the more I realize how much trauma underlies every disorder. Whether you are returning home from the war or you are a gang member on the streets of Chicago or have lived in the foster care system or had parents who have divorced, trauma is apart of your life story. I’m always amazed to hear the “oh and by the way trauma plays a big part in xyz disorder”. At this point in time should not we as counselors know that their are two guarantees when working with clients. 1. They have experienced some kind of trauma in their lives and that is why they seek help 2. the relationship with the therapist is an important factor for therapeutic success.
The following are stats from the National Trauma Consortium
In mental health and substance abuse service settings
• As many as 80% of men and women in psychiatric hospitals have experienced physical or sexual abuse, most of them as children.
• The majority of adults diagnosed with Borderline Personality Disorder (81%)or Dissociative Identity Disorder (90%) were abused as children.
• Up to two-thirds of both men and women in substance abuse treatment report childhood abuse or neglect.
• Nearly 90% of alcoholic women were sexually abused as children or suffered severe violence at the hands of a parent.
In childhood and adolescence
• 82% of young people in inpatient and residential treatment programs have histories of trauma.
• Violence is a significant causal factor in 10-25% of all developmental disabilities.
In the criminal justice and juvenile justice systems
• 80% of women in prison and jail have been victims of sexual and physical abuse.
• In one study, 92% of incarcerated girls reported sexual, physical or severe emotional abuse.
• Boys who experience or witness violence are 1,000 times more likely to commit violence than those who do not.
At the moment classes about how to treat trauma are not a basic requirement for counseling programs. I hope in the years to come and the large amount of research around the subject will help to change how practitioners work in the future.
What I find so astounding is the overwhelming prevalence of trauma. I recently read that almost 1 in 3 girls before the age of 18 have been sexually abused. How can this be? I can attest that trauma changes us, in that we are one person before the trauma and another thereafter. I say this, as I was mugged several years ago, and have a completely heightened sense of danger than I did before the mugging. Still, years later, I get intense moments of fear when I feel even slightly threatened or vulnerable. I cannot; however, possibly fathom the emotional expense of a severe trauma. With that said, I wanted to bring up an amazing documentary a friend recently suggested called, “War Dance,” an unbelievable story of the children of war in Northern Uganda. These kids have experienced unfathomable traumas, witnessing death and torture to their parents, siblings, and friends. Many children are abducted by the rebels and forced to become murderers, some as young as five years old. Now today, many children are still living packed in overpopulated camps with highly unsuitable living conditions. What is so gorgeous about this heartbreaking story is the blatant demonstration of genuine resilience. These kids get the opportunity to compete in a prestigious national music and dance competition. In the light of our Me to We reading, this story is a beautiful example of the power of community, encouragement, support, and creativity. “War Dance” is enormously insightful, especially to aspiring counselors, or any of us in the helping professions, as it shows we can find meaning, hope, and strength in numbers and through creativity. “War Dance” proves we as human beings are enormously resilient creatures, even under the bleakest circumstances and are capable of overcoming and doing almost anything.
The high co-occurrences of trauma and addiction make me think about how we can identify the presence of resiliency, measure, and strengthen its amazing efficacy. Resilience can improve over time and be modifiable throughout the course of treatment. Happiness and positive emotions have been proven to increase our coping ability to stress, and therefore, proactively cultivating daily upbeat, optimistic, and constructive emotions can be an excellent medicine for trauma and addiction. Especially in terms of addiction, it may take awhile to “wake up” and reconnect to feeling our emotions, but the power of frequent positive energy is astounding. There is some evidence the some antidepressants, such as, Fluoxetine, may contribute to increased resiliency, and may be a useful tool in certain cases. Also, focusing on the now, finding joy in the present through mindfulness, and meditation exercises may also be affective.
Here is are some links for the trailer/information for, “War Dance,” I urge all to rent it, as it will give you energy!
http://www.youtube.com/watch?v=2saj4gJ4Lvw
http://www.wardancethemovie.com
Trauma is one of those things that people don’t like to talk about, but virtually all people will experience some form of trauma throughout their life, with an extremely large portion of people experiencing severe trauma. As clinicians (or clinicians to be) we need to be aware of this, as it will be an underlying factor in a vast majority of clients we will see. In terms of addictions, I would say that traumatic experiences are hidden in the dark pasts of almost all addicts. It is through their addiction that someone can numb their pain and repress their past. I feel that addiction treatment would be essentially ineffective without dealing with the underlying trauma. As somone previously pointed out, many counseling programs do not have a class requirement for how to deal with trauma. This surprises me, as dealing with trauma and it’s related issues will be at the core of what we will do. This is an example of a way that the system needs to change so that we can be better equipped as counselors and therapists to truly help our clients.
Therapeutic treatment must address issues of trauma in regards to addiction. What really hit home for me was what you said about trauma needing resolve. I have talked with people who experienced a trauma years ago, have used substance to avoid the issue for over 20 years, and by some trigger will explode at the thought around the trauma. This is evidence that trauma does not simply go away, or heal itself over time. Trauma needs resolve. It is piling up in our minds and our bodies, waiting to be addressed, and until it is, it isn’t going anywhere. This is one of the most powerful realities of being a clinician and working with people on a personal level. The importance of addressing this trauma cannot be overstated. Healing comes through working on the trauma, and when triggers come up, finding new ways of coping with these issues. Without therapeutic work around the issues, they will remain, ready to ignite at any time by sudden triggers, and it can be dangerous for many people.
The relationship between addiction and trauma can be a messy one. I have had some experiance with a family member who has been struggling with addictions for years and then his mother died in the midst of everything else. For a while this ‘trauma’ fueled him to get help and seek a better path in life but recently he has gone back to his old coping methods. I read the 5 hings to know about addiction as well and the one about healthy relationships hit home. A lot of people in our family are giving up on him and I am struggling with that decision because I understand he needs healthy relationships to get better but at this point I’m not postitive he even wants to get better.
I read your comment at wifeofsexaddict.blogspot.com, and sailed over here. I appreciate your active dedic. to the topic. I still feel trauma from the hurt of my hub’s acting out. But to a much less degree. Whereas before, I was OBSESSED with anything he did by himself, I now have a level of sanity about it. I have more of a trust, based on his openness about everything he does, our strengthened communication, and his diminished anger. I also have a particular amount of detachment from him. Is that what you would call, “resolved trauma?”
Yes and no. Good that the obsessions and anxiety have diminished, and that you are now on more solid ground. But my experience suggests that addictive behavior most often is perpetuated by unresolved, underlying trauma in all his forms. And…what is so apparent in relationships is that trauma bonds to trauma. So a person with addiction (who has a trauma history) will hook up with a partner who may not have an addiction, but usually has some trauma history as well. The result is that the root of relationship conflict very often is found in early trauma, not in resolving addiction. Don’t get me wrong, dealing with the addiction is very important, it is just not sufficient for long-term successful outcomes. The critical piece of work is the developmental catch-up which I have blogged about. And my experience, this work both partners need to do. Hope this makes sense.
J
but my experience is that couples struggle over time as a result of very subtle ways that we block the others
Im 30, I remember things from when I was three, Ive been abused practically my whole life in every way and its made me who I am. The past is the present with fresh eyes. Look at things differently, you cant control whats already happened you can control what happens next.
In working with adolescents it has been apparent that one of the most important questions to address and work through with especially adolescents but not limited to them is what was has been going on in your life prior to addiction.
This may not be the best place to ask this, but, I’d like to find a drug rehab and I don’t know where to find one… do you know much about this drug rehab? It’s based out of Los Angeles, only 15 minutes from my residence I can’t find comments or reviews on them
I don’t know that program and cannot help you without more information. In general, I would start with an outpatient private practice therapist with solid experience in addiction, trauma, and developmentally-based therapies. There is also a lot of information on my site about picking good therapists. Hope this helps.
J