In the treatment of addiction, we often see addicts and alcoholics that have experienced trauma in their lives. The statistics from the research show that the rate of PTSD (Post Traumatic Stress Disorder) in people with substance abuse use disorders is 12% to 34% vs. 8% in the general population of adults (SAMHSA, 2005.) In addition, over two-thirds of people seeking treatment for substance use disorder report one or more traumatic life events (Back, et.al 2000.) Clearly, there is a common connection.
But, what exactly is trauma? The Diagnostic and Statistical Manual defines trauma as exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways: directly experiencing the traumatic event(s), witnessing in person, the event(s) as it occurs to others, learning that the traumatic event(s) occurred to a close family member or close friend, or experiencing repeated or extreme exposure to aversive details of the traumatic event(s). Often clinicians refer to “Big T Trauma” and “Little t trauma.” “Big T trauma” is a single event of a severe magnitude, like a life-threatening incident. “Little t trauma” refers to multiple events, usually of a more common nature, such as bullying, divorce, job loss, neglect, moving, etc. that may not be thought of as traumatic, but can have a cumulative effect, especially when experienced in childhood.
Some of the symptoms of unresolved trauma and PTSD (Post Traumatic Stress Disorder) can be anxiety, depression, flashbacks (a re-experiencing of the traumatic event) nightmares, hyper-arousal (the condition of maintaining an abnormal awareness of environmental stimuli) avoidance of anything that reminds you of the trauma, increased anxiety, and emotional arousal, feeling detached from others and emotionally numb, difficulty sleeping and nightmares, somatic symptoms and difficulty concentrating.
Trauma changes the brain; specifically the connections in the white matter that affect language processing and planning and emotional processing with abstract thought.
Similar changes in the brain are seen with addiction and depression and may be predisposed by early changes in the brain from trauma. Up to 59% of young people with PTSD subsequently develop substance abuse problems and in surveys of adolescents receiving treatment for substance abuse, more than 70% of patients had a history of trauma exposure.
Treating the trauma, as well as the addiction, is important for people suffering from both. If the addiction is treated and the trauma is ignored, the unresolved trauma may result in a relapse of the addiction as a way for the person to self-medicate and cope with the symptoms caused by the unresolved trauma. Likewise, just treating the trauma and not the addiction will not be successful, as the addiction is primary and will prevent successful treatment of the trauma.
Trauma can be treated with a variety of methods including Trauma-Focused Cognitive Behavioral Therapy, Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE), Eye Movement Desensitization and Reprocessing (EMDR), and Psychopharmacology to treat symptoms. Early treatment is important, as PTSD often becomes worse without treatment. Treatment can commence when the addiction has been treated and stabilized and the person is emotionally stable enough to begin to process the traumatic events. An environment of safety and support is essential for the healing process to begin and the treatment of trauma takes time and patience. Trauma, like addiction, is treatable with professional care.