There is a type of treatment growing in popularity called Trauma Informed Care, or TIC. It is designed specifically for those who have endured trauma in their lives and have been affected negatively. According to the Trauma Informed Care Project, the main goal of TIC is to provide “…physical, psychological and emotional safety… and rebuild a sense of control and empowerment.” The idea is basically to get back to who you were before the trauma. If this sounds similar to addiction treatment, that’s because it is. Logic says that if the treatments are similar, then the reasons for treatment are similar. In this case, logic prevails. Evidence suggests a link between trauma and substance addiction. There’s plenty of proof, and it all seems to point toward one conclusion. The integration of TIC into addiction therapy is a good idea.
Proof of a Link
Perhaps the strongest proof of a link between trauma and addiction comes from the Journal of Alcoholism: Clinical and Experimental. Bear in mind that alcoholism is the single most prevalent substance addiction in the world. In February of last year, the journal published a study which “aimed to identify childhood trauma profiles in patients with alcohol dependence and examined relations of these trauma profiles with the patients’ current addiction-related problems.” The study used five different trauma profiles: sexual abuse, physical abuse, emotional abuse, physical neglect, and emotional neglect. A total of 347 patients were included. The study used the Childhood Trauma Questionnaire to determine which patients fit into which profiles. Individual occurrences of childhood trauma, regardless of profile, are known as adverse childhood experiences. According to the study, “a child with four or more adverse childhood experiences is five times more likely to become alcoholic… and a boy with four or more of these adverse experiences is 46 times more likely to become an injection user than others.” You read that right… 46 times more likely to inject drugs into the bloodstream. Further proof for the link between trauma and addiction comes from Time magazine. The long-trusted American news source published an article in 2012 about a study performed at the University of Texas. The study involved 32 teenagers, nineteen of whom had experienced childhood trauma, and thirteen of whom had no childhood trauma. Every six months, for three and a half years, the participants were followed up on. The researchers concluded that those who suffered childhood trauma were at least three times more likely to develop a substance addiction. Beyond that, the study found that adverse childhood experiences are also directly related to childhood obesity. Trauma definitely affects us in many more ways than simply making us sad or upset when a sore spot is rubbed. However, what qualifies as traumatic is different for everybody. Let’s discuss the meaning of ‘trauma,’ how it can cause substance addiction, and what can be done in order to prevent this unfortunate chain of events.
What Exactly is Trauma?
Trauma is anything that “causes physical or emotional harm from which you cannot remove yourself.” This definition comes from Larke Huang, Director of Behavioral Healthcare Equity at SAMHSA. She is an expert on the matter, receiving her doctorate from Yale before being recruited by the government. Huang understands that trauma is subjective – it’s not up to other people to decide whether or not you have experienced it. Trauma is in the eye of the beholder. In 1995, psychologist Joe Allen wrote a book that is essentially considered the ultimate guide for victims of trauma, Coping with Trauma: A Guide to Self-Understanding. Allen saw two sides to all types of human trauma. One side is the objective, what actually happened. The other, more important side deals with the subjective, how the victim responds over a lifetime to what actually happened. In the book, Allen “discusses the impact of trauma on emotion, memory, the self, and relationships…,” as well as how trauma can lead to depression, PTSD, self-destructive behavior, and even dissociative disorders. He believes trauma to be a physical illness. You’d be surprised at how often those with the illness of trauma self-medicate with substance abuse.
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The following information is from an article on this subject, published recently by the Huffington Post. Those who have experienced trauma from an illness, an accident, or a natural disaster are up to 33% more likely to abuse substances. Those who have experienced traumatic abuse of any kind are up to 75% more likely to do so. In addition, a diagnosis of PTSD (posttraumatic stress disorder) “increases the risk of developing alcohol abuse.”
Trauma in the Brain
The Huffington Post article also published some neuroscience facts that show how someone who suffers from a trauma could develop a drug addiction. There are three sections of the brain in particular that change significantly from a traumatic event: the amygdala, the hippocampus, and the cerebral cortex. One function of the amygdala is to assess threat and act accordingly. Trauma makes the amygdala overactive, causing someone “to become excessively fearful and anxious.” In severe cases, this could lead to a life of anxiety and paranoia. Anxiety is a rather common reason for people to abuse drugs. Oftentimes, anxious people self-medicate with substances such as alcohol or opiates. It seems rather possible for someone to experience a traumatic event, develop an overactive amygdala, become overly anxious, and abuse drugs for a return to ‘normalcy’. The hippocampus plays crucial roles in all forms of memory. A traumatic event can actually cause the hippocampus to become underactive. When this happens, the ability to process and save new memories is hindered. Memories of the traumatic event can actually take the place of new memories, “and play them on repeat, making disturbing and uncomfortable recollections.” Last we have the cerebral cortex, the essential control room of the brain. It’s responsible, at least partly, for almost every non-physical human function you can think of, including consciousness, thought, memory, awareness, language, and attention. If and when affected by a traumatic event, the cerebral cortex goes into something of an instinctive survival mode, which can “decrease your ability to inhibit or control certain behaviors.”
Trauma in the Body (From Trauma to Pain to Addiction)
In 2009, a study was performed that revealed some startling information regarding a link between trauma and chronic pain. Published originally in Psychiatry (Edgemont), the study consisted of “117 chronic noncancer pain patients” who ranged from 18 to 69 years old. “Participants were recruited during their initial clinical evaluations for chronic pain,” meaning other doctors had already diagnosed them. What happened next is quite simple, but there is beauty in simplicity. Each participant was given a questionnaire created by the research team. Essentially, it was a survey on childhood trauma, also with parts on drug allergies and personal demographics. The idea was to determine if childhood trauma played a role in the development of chronic pain and/or drug allergies. 72 of the 117 participants (over 60%) reported experiencing at least one type of trauma. Types included in the questionnaire were the same as in the Journal of Alcoholism study: sexual abuse, physical abuse, emotional abuse, physical neglect, and emotional neglect. The most common type of trauma experienced among all participants was emotional abuse (49.6%), while physical neglect was the least common (10.3%). This study does not mention a word about substance abuse. However, countless studies mention a link between chronic pain and opioid abuse. Those with chronic pain are commonly prescribed opioid medications. This is where the problem starts. According to a national survey, 99% of doctors prescribe opioid medicines for longer than the recommended three-day period, and 23% of doctors prescribe a month’s worth of them. Also, 99% of doctors have at least once seen a patient who was seeking pills for recreation or showed evidence of drug abuse, but only 38% of doctors ever refer such patients to get help. The worst part of all? Since the turn of the millennium, an overwhelming 75% of heroin addicts report having started with prescription pills. Could trauma be a sort of indirect breeding ground for drug addiction?
Louise Stanger, author of the Huffington Post article referenced above, is a clinician herself. Her argument in writing the article is to integrate Trauma Informed Care into substance addiction treatment. The evidence is stacked up high for a link between trauma and addiction. Plus, many addicts experience traumatic events as a result of their substance use – for example, a heroin overdose. Stanger says, “We must integrate substance abuse, mental health and chronic treatment in the behavioral health care field. Trauma as it exists is in the eye of the beholder and goes together with addiction, mental health, chronic pain, etc. Let us not see this as something out of the ordinary, rather, let’s make it part and parcel of our behavioral healthcare treatment protocols.”
We live in some troubling times. America has a questionable president, at best, and the entire planet seems to be on the verge of a third world war. People as a whole are on edge, and right now we are all most likely a little more vulnerable to perceiving something as traumatic. After all, trauma is in the eye of the beholder. Nobody can tell anyone else what should or should not be traumatic. Emotional overreaction is commonplace nowadays. If you don’t believe it, take one glance at any social media platform. We are edgy, anxious, confused, worried, at war, and all the while trying to maintain our personal lives. Life is traumatic, arguably. The healthiest thing you can do if affected by trauma and its aftermath is to stay sober. Drugs and alcohol will only ever cloud the truth. The best way to recover from a trauma is to rebuild your character and your personal strength. You have to become you again – the person you were before you suffered through a traumatic event. Substance abuse only leads you away from your true self. If you or a loved one is suffering from the symptoms of having experienced a traumatic event, please seek help immediately. Even if you or a loved one claims to be perfectly normal afterward, please be careful. It is all too easy to combat the symptoms of trauma with drugs or alcohol.