Understanding the link between trauma and addiction is critical in breaking the stigma around mental health and addiction.
Equally as important, mental health professionals must truly understand the intersection of trauma and addiction in order to adequately treat clients who are struggling from either or both of these challenges.
Recently, I was invited to share my expertise on trauma and addiction for the Recovery Dialogues and Sober Stories podcast.
As someone with experience supporting a loved one through addiction, as well as working in both inpatient addiction settings and trauma informed mental health settings, I can confidently say that so much of the current system of treating addiction is broken.
Some of the things that I’ve witnessed in Garrett’s addiction recovery, as well as what I saw when I interned at an inpatient substance-use disorder recovery center were just plain egregious…
I saw so-called ‘mental health professionals’ shame clients who relapsed, and watched others refuse adequate care to clients who became suicidal. It was disheartening and scary.
The reality is, so many clinicians and addiction specialists simply are not trauma informed, and can cause serious harm to clients through invalidation and retraumatization.
With this in mind, when I was invited to speak about this topic that I’m so passionate about, I had a lot to say!
(I could seriously talk about this topic all day.)
I was joined by two other experts in the field: John Roesch, a certified addiction counselor and partner at Suntra Recovery, and Duygu Balan, an LPCC that specializes in trauma and attachment injuries.
Here’s a recap of what the three of us had to say for the podcast episode, “Breaking the Chains: Navigating the Intersection of Trauma, Addiction, and Mental Health”.
When most people think of trauma, things like car crashes, natural disasters, and war often come to mind. These are often referred to as “Big T” trauma, and while they can have a lasting impact on a person’s well-being, they’re far from the only events that can leave someone traumatized.
There’s so much room for mental health professionals, and society to recognize other forms of trauma, commonly referred to as “little T” trauma, that may go unaddressed.
These can include experiences such as emotional abuse, racial trauma, chronic neglect, isolation, bullying, loss of a job, betrayal trauma, adverse childhood experiences, sexual abuse, ongoing conflicts, or witnessing domestic violence.
While these may seem less severe on the surface, the cumulative effect of these repeated or ongoing experiences can still have a significant impact on a person’s well-being, and can lead to Complex PTSD (C-PTSD).
“Small ‘t’ traumas tend to be overlooked by the individual who has experienced the difficulty. This is sometimes due to the tendency to rationalize the experience as common and therefore cognitively shame oneself for any reaction that could be construed as an over-reaction or being ‘dramatic’…
Perhaps surprisingly, sometimes these events are also overlooked or dismissed by a therapist. This usually does not happen due to the therapist lacking empathy, but rather it occurs due to a lack of understanding about the importance of these experiences for a person’s functioning,” explains Elyssa Barbash, PhD, in an article for Psychology Today.
Both ‘Big T’ and “little T” trauma have profound effects on a person’s mental, emotional, and relational well-being, disrupting their sense of safety, trust, and overall functioning.
Trauma often leads to a range of distressing symptoms such as difficulty regulating emotions, flashbacks, nightmares, hyperarousal, avoidance behaviors, chronic stress, difficulty maintaining stable relationships, and negative changes in mood and cognition.
Put simply, untreated trauma can serve as a catalyst for addiction, as individuals may turn to substance abuse or addictive behaviors as a coping mechanism to numb or alleviate their pain.
While not everyone who experiences trauma will turn to addiction, there’s definitely a correlation between trauma and addiction. The rates of addiction among people who have experienced trauma are substantially higher than those who haven’t.
Here are a few possible reasons why:
To sum it up, addiction is often formed as a completely understandable coping mechanism for individuals who have been through traumatic experiences.
In the absence of social support, and in the absence of other viable strategies for coping, people will turn to addictive substances or behaviors to survive the distress of what they’ve been through.
As I mentioned in the podcast episode, I would love to see a shift towards a ‘trauma-first’ approach to recovery and healing.
Unless someone is struggling with life-threatening addictive behaviors (in which case, safety and stabilization would be the priority), I truly believe clinicians should treat the addiction simply as a coping mechanism, rather than a ‘problem behavior’ that requires behavioral intervention.
So many addiction experts and clinicians who don’t understand trauma-informed care take a ‘behavior first’ approach to treatment. In the absence of immediate safety concerns or life threatening behaviors, this approach is completely backwards.
Reducing complex human beings to a set of “problem behaviors” truly misses the complexity of what the person is experiencing, and can lead to further shaming, stigmatization, and pathologizing.
I’ve found, through my own experiences with drinking, through Garrett’s experience with sex addiction, and with so many addicted clients I’ve worked with, that when the trauma and attachment injuries get treated, many of the addictive behaviors will begin to subside, as the client becomes more regulated and capable of secure connection.
Put simply, as clients begin to heal, new methods of coping with distress become more appealing and viable.
When it comes to treating trauma and addiction, safety is always a key consideration, to avoid re-traumatization. People who’ve experienced trauma can be understandably distrusting, hypervigilant, and prone to dysregulation.
Creating a sense of safety and trust between the therapist and client is paramount to trauma-informed care. This can be accomplished by:
Mental health professionals need to be better trained to understand, recognize, and treat clients who have experienced trauma.
For example, a well trained trauma-informed therapist should be able to recognize the signs of dissociation and dysregulation in a client. When the clinician notices these signs, it’s a clue that the client is becoming overwheled and that they may need help regulating.
Additionally, therapists should prioritize self-care and seek supervision or consultation to address any vicarious trauma or burnout they may experience while working with trauma survivors.
I believe that therapeutic modalities such as Internal Family Systems (IFS), Eye Movement Desensitization and Reprocessing (EMDR), and Emotion Focused Therapy (EFT) hold a ton of promise in treating both trauma and addiction.
Not only are all of them empirically supported, but more importantly they’re non-pathologizing.
Garrett and I have experienced the benefits of each of these modalities at various points in our therapy journey, and can say hands down, we would not be where we are today without them.
We’ve learned to self-regulate, co-regulate, attach to each other more securely, and show up in the world more confidently thanks to the trauma-informed therapists we’ve worked with.
While I believe there’s value in teaching clients coping skills, such as the skill sets taught through Dialectical Behavior Therapy (DBT), it’s usefulness in fully treating trauma and addiction is limited.
Garrett and I went through two rounds of DBT ourselves, and found tremendous value in the mindfulness and distress tolerance skills. But, that’s about where the benefits ended.
For starters, DBT is incredibly transactional, and clients are typically reduced to a set of ‘problem behaviors’. Not only is this incredibly shaming for the client, but people tend to heal faster when they can do it relationally.
It’s hard to create a safe and trusting container for a traumatized client to heal when you’re emotionally disconnected, un-attuned to their emotions, and reminding them constantly how their behaviors are a problem.
I would love to see a future where more therapists are combining mindfulness and emotional regulation skills alongside a less pathologizing modality such as IFS.
Not all therapeutic modalities are created equal, and not all therapists should be treating traumatized clients.
Trauma-informed therapists should be able to hold a safe space for their client, attune to their emotions, and self-regulate during potentially difficult sessions.
There’s so much power in corrective emotional experiences, and I believe that’s where the future of trauma and addiction recovery is headed.
Healing from addiction and trauma is completely possible.
The human brain’s remarkable capacity for neuroplasticity offers hope, as it allows for the rewiring and reshaping of neural pathways.Through trauma-informed and evidence-based therapeutic interventions, individuals can create new connections and patterns that promote healing, resilience, and recovery.
By addressing the underlying trauma and providing comprehensive support, individuals can embark on a transformative process, rewiring their brains to develop healthier coping mechanisms, self-regulation skills, and positive ways of relating to themselves and others.
With compassion, understanding, and a commitment to holistic care, the path to healing addiction and trauma can become an empowering and transformative journey of resilience and growth.
There is always hope.
Thanks again to Antonio Matta of the Recovery Dialogues and Sober Stories podcast for allowing me to share my expertise!
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