How to Treat Both Trauma and Addiction

Single-gender sessions, and power in numbers.

Lantie Elisabeth Jorandby M.D. Reviewed by Vanessa Lancaster

Trauma is an emotional response to a terrible event. Trauma experienced during childhood may be especially harmful and long-lasting. Some people with unresolved trauma will turn to drugs or alcohol to numb themselves to it—and become addicted. Trauma-informed addiction care shifts the focus from “What’s wrong with you?” to “What happened to you?

Our understanding of trauma and its effects on people is clearer than it was just a few years ago. One key thing we’ve learned: Trauma is much more common than we once thought—as are the harmful ways it shows up in a person’s behavior and personality, often years after the traumatic event. For example, many people with unresolved trauma will turn to drugs or alcohol to numb themselves to it—and they get addicted in the process.

Fact: In the addiction treatment center where I am the chief medical officer, around 75 percent of the female patients we see report a traumatic event in their past. For our male patients, it’s around 50 percent. Those are astounding numbers.

4 Things to Know About Trauma

  1. Trauma is an emotional response to a terrible event such as an accident, natural disaster, emotional or physical abuse, extreme poverty, chronic social isolation, or war. Psychology Today notes that “traumatic events tend to be sudden and unpredictable, involve a serious threat to life—like bodily injury or death—and feel beyond a person’s control.”
  2. Not all traumatic events lead to the psychiatric disorder known as post-traumatic stress disorder, or PTSD. In fact, with time and good self-care, most people who witness or experience a terrifying event get better. But again, trauma can lead to other serious mental issues besides PTSD, including addiction.
  3. Trauma experienced during childhood may be especially harmful and long-lasting. These traumas are officially known as adverse childhood experiences (ACEs). They include being abused or neglected, frequently intimidated or humiliated by adults, witnessing violence, not having enough to eat, experiencing frequent loneliness, or growing up in a household with serious mental health or substance use issues. Research shows that the more ACEs young people experience, the greater their risk of addiction and other mental and physical health conditions.
  4. We’re living in traumatic times. Thanks to COVID, the increased number of severe (and deadly) weather events, seemingly ever-present gun violence, and political upheaval, our world can seem like a scary place these days. And yes, people sometimes turn to drugs and alcohol as a way to cope when things feel traumatizing and out of control.

How We Deal With Trauma in the Addiction Treatment Setting

Some leading treatment centers—ours included—use what’s called trauma-informed care (TIC) as a standard protocol. TIC acknowledges the need to understand a person’s life experiences to provide effective care. It also assumes that trauma is common, that it can continue to affect us in debilitating and long-term ways, and that it needs to be considered when we receive mental health care.

In effect, TIC shifts the focus from “What’s wrong with you?” to “What happened to you?” Here’s how that looks in practical terms:

  • We tackle trauma and addiction at the same time: Just 10 to 15 years ago, people with addiction and known trauma in their past were normally told they needed to work on their sobriety first, then their trauma. That was the accepted sequence. The more successful standard now is to attend to both at the same time in a fully integrated way. So as soon as the person gets through detox (if needed), both conditions are dealt with simultaneously.
  • “Seeing as you’re offering it, maybe I’ll check it out”: What we see in addiction treatment is people coming to rehab knowing they have a drug or alcohol problem. Period. Many don’t know they have past trauma, or if they do know it, they don’t think it’s linked with their addiction. They don’t realize the trauma may be driving the addiction and that they’re drinking or using drugs to cope. What sometimes happens is that when people see that we offer trauma therapy along with addiction therapy, they get interested. They think, maybe there’s something here for me. I’ll sit in on this trauma group and see how it goes. This can put them on the road to healing their trauma.
  • Single-gender sessions often work best with trauma therapy: This applies to addiction therapy as well, but maybe even more so with trauma groups, which makes sense. Many people are more likely to let their guard down and jettison the usual social/gender roles when they don’t need to “negotiate” the opposite sex.
  • There’s power in numbers: Group therapy sessions can be quite helpful for allowing people to work through their trauma issues. People hear others’ stories, and they see similarities. They realize they aren’t alone in what they experienced. They feel validated that it was wrong and that it wasn’t their fault. It can be very impactful and liberating when a therapist helps you realize all that. But hearing it from someone who has experienced the same can be even more powerful.

Some Medications and Therapies That Are Working

A class of drugs called selective serotonin reuptake inhibitors, or SSRIs, can help control certain emotional effects caused by trauma. Well-known SSRIs include Zoloft, Lexapro, and Prozac.

Prazosin, first developed to control high blood pressure, has been dubbed the “nightmare medication” for its ability to control the recurring bad dreams that often afflict people with trauma. Both SSRIs and Prazosin help calm patients down and improve sleep quality, so people are better able to respond positively to therapy.

As for that therapy, I mentioned in a past post (“How Trauma-Informed Care is Transforming Addiction Treatment”) the success people with trauma are finding with eye movement desensitization and reprocessing, or EMDR. A type of psychotherapy usually provided over six to eight sessions, EMDR can disconnect the visual memory of a traumatic event from the emotional response to that memory.

Another psychotherapy, and one we use at my place of work, is called accelerated resolution therapy, or ART. This relatively new therapy uses memory visualization techniques, horizontal eye movements, and memory reconsolidation to “unwire” or decouple the distressing emotions from the memories of past traumatic events.

These successful medications and therapies, and others like them, are helping people with trauma come to terms with their past and successfully move on from it. Long-term recovery becomes a far more likely prospect when that happens for a person who is also battling addiction.

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