“For those with trauma, alcohol and other drug use can become a survival strategy. Obviously, it’s a strategy that doesn’t work in the long run…” ~ Johanna O’Flaherty, The Correlation Between Trauma and Addiction

The lingering shock and stress from a traumatic event can ultimately lead to substance abuse, addiction, scientists say. Although a person can experience trauma at any age and at any time, the biggest impact is felt when they are at their most vulnerable and their most impressionable – during childhood. The National Child Traumatic Stress Network reports that 1 out of 4 American children will experience at least one Adverse Childhood Event before they reach adulthood. Unresolved trauma later leads many teenagers into substance experimentation and use and, ultimately, addiction. In fact, research shows that for every ACE experienced, the risk of alcohol or drug use initiation increases 2 to 4 times. Of special relevance, a child suffering 5 or more ACEs has a risk of substance abuse that is up to 10 times higher than a child who had experienced none. What Are Some Kinds of Traumatic Events That Can Contribute to Addiction?

“No matter how the events occurred, trauma leaves scars. These scars can be short-term and healed with grief, or grief counseling. The scars can also be much deeper, to the point where they never really heal, or at least it SEEMS they’ll never heal.” ~ David W. Yeager, Be Happy with Crappy: A Journey through Trauma, Addiction, Rock-Bottom, and Recovery

Trauma is any experience that is physically or emotionally painful, dangerous, or beyond the person’s control:

• Witnessing or experiencing domestic abuse
• Physical or emotional neglect
• Parental substance abuse
• Natural disasters – tornadoes, hurricanes, floods, earthquakes, fires, etc.
• Severe illness, disease, or injury
• Rape/Sexual assault
• Death of a family member or close friend
• Surviving/witnessing a serious accident
• Divorce
• War or Combat Service

Post-Traumatic Stress Disorder (PTSD) is an emotional condition in which someone continues to experience debilitating stress or anxiety following experiencing traumatic exposure. Usually, PTSD stems from a past trauma that leaves unresolved emotional issues. For example, the victim may be overwhelmed with fearful memories that it will happen again, or they may blame themselves for what occurred. Sometimes, a person may still be suffering from lingering physical pain associated with injury or illness. They deal with that pain by abusing drugs and/or alcohol. What Are the Symptoms of PTSD?

“The basic cause of addiction is predominantly experience-dependent during childhood, and not substance-dependent.” ~ Dr. Vincent Felitti

PTSD is emotionally debilitating, and without treatment, it can totally disrupt the person’s life. PTSD can manifest at any time and with no warning – even years after the fact. Symptoms of PTSD include:

• Overwhelming anxiety, fear, or hysteria
• Excessive guilt or shame
• Constantly reliving the event mentally
• Strongly reacting to anything that reminds them of the trauma
• Overreaction to certain stimuli – loud noises
• Insomnia and nightmares
• Irritability, anger, and aggression
• Crying jags
• Angry outbursts
• Depression
• Social isolation
• Suicidal thoughts
• Substance abuse

Trauma and Addiction Statistics

“While psychological trauma is characterized by disruptions in a person’s sense of control, addiction can also be viewed as a disorder of control, or more accurately, an inability to control. The loss of control is insidious, often unrecognized by the addict until, in Alcoholics Anonymous terms, life becomes unmanageable.” ~Psychological Trauma and Addiction Treatment,  Dr. Bruce Carruth, PhD, LCSW, Editor

According to several studies, making the connection between trauma and substance abuse is tragically easy:

• Victims of physical or sexual or physical abuse/assault have a TRIPLED risk of alcohol or drug abuse.
• More than 70% of patients being treated for substance abuse have suffered traumatic exposure.
• Nearly 60% of PTSD sufferers will develop a comorbid Substance Abuse Disorder (SUD).
• Conversely, teenagers who abuse drugs or alcohol have a DOUBLED risk of PTSD after a traumatic experience than those who do not drink or use drugs.
• In up to two-thirds of cases, substance abuse started before the trauma occurred.
• Among men with PTSD, just over half will struggle with an Alcohol Use Disorder (AUD).
• 35% will abuse illicit or prescription drugs.
• Among women with PTSD, 28% will develop an AUD.
• 27% will struggle with drug addiction.
• Three-fourths of people who survive violence or abuse develop an AUD.
• One-third of survivors of traumatic illnesses, disasters, or accidents become alcoholics.
• Veterans are particularly vulnerable – over 25% of all vets diagnosed with PTSD also struggle with substance abuse.
• One-third of all vets with an SUD also suffer PTSD symptoms.

How Does Trauma Cause Substance Abuse?

“We believe the mechanism we discovered … could also be important for stress-induced drug abuse, which is a common problem in people with PTSD.” ~ Dr. Brian Baldo, Associate Professor of Psychiatry at the University of Wisconsin-Madison

When a person experiences a traumatic event – or relives that event mentally –  neurochemical changes occur within their brain. This is known as the “fight or flight” or the “fear” response. Repeated trauma, such as abuse or neglect can cause a permanent sensitivity. During a traumatic event, the brain produces massive amounts of endorphins – natural neurotransmitters that promote calmness, feelings of well-being, and pain reduction. But when the incident is over, those endorphin levels drop precipitously, and the person experiences the “crash” of endorphin withdrawal:

• Anxiety
• Emotional distress
• Depression
• Physical pain
• Cravings for drugs and alcohol

Because substance use triggers overproduction of dopamine – the neurotransmitter associated with reward and pleasure – many PTSD sufferers use drugs and alcohol to re-create the positive feelings caused by endorphins. The problem arises when the drinker/drug user develops a tolerance for their substance of choice. This means that they need ever-increasing amounts and dosages to feel the desired effects. Tolerance is one of the criteria for a medical diagnosis of addiction. It reaches a point where the substance abuser – especially one with PTSD – simply cannot function at all unless they are under the influence of an intoxicant. This dependence is highlighted when the substance is unavailable or they try to abstain. Because they now physically need the drug/alcohol, they experience symptoms of withdrawal that are often so painfully uncomfortable that they are forced to drink and use again. Withdrawal is another criterium for a medical diagnosis of addiction. Substance Abuse Keeps Traumatic Memories Alive

“If the effects of alcohol on memories to fearful responses are similar in humans to what we observe in mice, then it seems that our work helps us better understand how traumatic memories form and how to target better therapies for people in therapy for PTSD. In fact, binge drinking or other attempts to use alcohol to self-medicate could be sabotaging any therapy efforts.” ~ Dr. Norman Haughey, PhD, Professor of Neurology

New research conducted by the Johns Hopkins School of Medicine suggests that drinking makes trauma-induced fear WORSE, instead of better. Alcohol makes fearful memories STRONGER. This is referred to as an “alcohol-related fear relapse”. Test mice were put in special cages that have electrified floors. Six separate times, special tones were played, and then the mice received in electric shock. This was intended to be “fear training”, giving the mice a frightening and traumatic memory. The next day, the test mice were divided into two groups. One group received plain water, while the other was given a solution of water mixed with 20% drinking alcohol. Both groups were put through a series of exercises allowing them to first retrieve the previous day’s fearful memory and then, sever any association the mice had between the tones and the subsequent shocks. After the disassociation exercises, the two groups were again put in the special cages, and the signaling tones were played. The mice given alcohol “froze”—a typical fear response among mice—at a considerably higher rate than the mice receiving water. Researchers theorize that the alcohol made the mice more vulnerable to fear relapse. When the mice were dissected, neurochemical differences between the brain tissues of the two groups were discovered. Researchers believe that alcohol was responsible for these differences that perpetuated the fear response. Drug and Alcohol Abuse as a Coping Mechanism

“People use addictions as an escape from emotional issues, yet ironically, drugs and alcohol can worsen such issues. The addict is then driven back to the object of his addiction, a vicious cycle develops, and drug and alcohol use spiral out of control.” ~ Morteza Khaleghi and Constance Loizos, Free from Addiction: Facing Yourself and Embracing Recovery

Trauma causes complicated and conflicted feelings that can be hard to process, so a person in emotional pain may turn to drugs or alcohol.

• To silence painful memories.
• To numb physical or emotional pain.

But substance abuse leads to dependence and addiction. And addiction leads to new trauma. How Substance Abuse Causes New Trauma

“Health care providers should be aware that women who present with alcohol-related problems or psychological distress may have histories of sexual victimization that underlie these problems.” ~ Dr. Tonda Hughes, PhD, University of Illinois at Chicago

Alcohol and drug abuse increases the risk of other traumatic events –accidents, injuries, arrest, violence, sexual assault, disease, and illness. Substance abuse can lead to engaging in other risky behaviors which can result in new trauma.

• Overdose – From 2002 to 2016, overdose deaths in the United States TRIPLED.
• Binge drinking – 16% of US adults binge-drink at least 4 times a month. On these occasions, they consumed an average of 8 alcoholic drinks.
• Drunk-driving –
  • 121 MILLION times a year, someone drove while they were impaired.
  • Every day 36 people die in alcohol-related crashes.
  • Another 700 are injured.

• Rape/Sexual Assault – Almost 75% of the perpetrators and more than 50% of the victims are under the influence of alcohol at the time of the assault.
• Violence –
  • 75% of people entering addiction treatment self-report engaging in violent behavior against others.
  • 50% of batterers have an addictive disorder.
  • Most women in drug or alcohol rehab have a personal history of violent trauma.
  • 94% of violent teens use alcohol.
  • 85% use marijuana.
  • 80% of child abuse cases involve substance abuse.

• Self-harm – A person with an SUD is at a SIXFOLD greater risk of attempting suicide.

Helping Someone with Co-Occurring Addiction and Trauma

“Trauma shocks, the brain, stuns the mind, and freezes the body. It overwhelms its unfortunate victims and hurls them adrift in a raging sea of torment, helplessness, and despair. For a therapist, to witness such desperation in one’s clients is to feel a compelling call to effectively relieve such suffering.” ~ Dr. Peter A. Levine, PhD, Trauma and Memory: Brain and Body in a Search for the Living Past

When self-medication due to PTSD progresses to a SUD, the result is a complex dual diagnosis that requires specialized treatment that addresses both disorders. But a person with comorbid disorders can’t just check in to ANY program – most drug and alcohol rehabs are not equipped to deal with the formidable challenges involved in treating PTSD. On the other hand, most mental health counselors don’t specialize in the myriad strategies used to address problematic substance abuse –

• Medical detox
• Medication-Assisted Therapy (MAT)
• Behavioral modification
• Individual psychotherapy
• 12-step peer group therapy
• Grief/Trauma processing
• Stress relief
• Yoga/exercise
• Nutritional guidance
• Family support
• Psychodrama
• Pet/Equine therapy
• Art/Poetry therapy
• Meditation
• Eye Movement Desensitization and Reprocessing (EMDR)
• Relapse prevention

Without an integrated treatment plan and a cooperative team of professionals with expertise and experience dealing with dual diagnoses, then any treatment offered is bound to be ineffective. But here’s the good news – there are addiction recovery programs that DO offer comprehensive treatment for co-occurring disorders. If you are struggling with substance use and PTSD, it IS possible to get the help and support you need. Regardless of the pain in your past, CAN safely return to a healthy life of sobriety, stability, and serenity.