Trauma and Substance Abuse
What is Trauma?
January 8th, 2019
For many, trauma has an elusive definition. From different perspectives, it can take on various different meanings. “The effects of trauma can be pervasive and global, or they can be subtle and elusive” (Lavine 1997). The range on the spectrum of trauma can go from adverse childhood experiences that are relatively minor, all the way up to PTSD and dissociative disorders. Trauma can stem from abuse or neglect as well as other painful or frightening experiences…It can also result from growing up in an alcoholic or addicted home or any other environment where children are taught to bury their feelings” (Sack 2017). As Dr. Gabor Matè tells us, trauma “[is] not what happened in the past that creates our present misery, but the way we have allowed past events to define how we see ourselves in the present” (Matè 2011). Oftentimes, the behaviors trauma engenders are unconscious for the person suffering from trauma. “Many people may have the illusion that they are in control, only to find later that forces unknown to them were driving their decisions and behaviors for many, many years” (Matè 2011).
The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been used by mental health professionals for decades as a reference for consistent diagnostic criteria. Trauma in the DSM has a long and contentious history throughout the variations of the manual. Currently, Trauma and stressor related disorders contain their own section of the DSM-5. PTSD was first introduced to the DSM in version 3 of the well-known editions. Specific diagnostic features of the findings were (and still are) the subject of debate amongst mental health professionals. With the DSM-4, came the introduction of Acute Stress Disorder (ASD) which acknowledges a different level of trauma than that experienced by sufferers of PTSD. A list of diagnostic criteria for ASD can be found here should you wish to see what they are specifically. PTSD criteria can be viewed here. It is important to note that “symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria” (American Psychiatric Association 2013). The disturbance also must cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning. The disturbance must not be attributable to the physiological affects of a substance or another medical condition and is not better explained by brief psychotic disorder” (American Psychiatric Association 2013). The DSM is invaluable in helping to recognize trauma in individuals, however to be of help, the experience of trauma needs to be elaborated on in a way that allows everyone to increase their awareness of what is happening to them. “If we remain ignorant of our power to change the course of our instinctual responses in a proactive rather than reactive way, we will continue being imprisoned and in pain” (Lavine 1997).
The insidious nature of trauma makes it very hard to identify in ourselves, and creates confusion in the sufferer as to why they feel the way they do. Peter Lavine explains, “people don’t need a definition of trauma; we need an experiential sense of how it feels.” He goes on to describe the experience of a client whose child had been hit by a car when she turned away for an instant. The distraught mother describes her feelings in that moment: “My legs were as heavy as lead…my heart tightened and constricted, then expanded to fill my chest with dread…feeling panic-stricken and helpless…a numbness began to creep over me as I felt myself pulling away from the scene. I was just going through the motions now. I couldn’t feel anymore” (Lavine 1997). The psychological and physiological symptoms we experience in the face of traumatic events are predicted by the magnitude of the event, as well as the resiliency of the person involved. “Trauma is subjective, meaning what matters most are the individual’s internal beliefs and their innate sensitivity to stress, not whether a family member, therapist or other outsider deems an experience traumatic” (Sack 2017).
“Unresolved trauma can keep us excessively cautious and inhibited or lead us around in ever-tightening circles of dangerous re-enactment, victimization, and unwise exposure to danger.” (Lavine 1997). Resiliency becomes a person’s main weapon against the effects of trauma. Luckily, resiliency is a trait that can be built up in the individual. “Resiliency is not a moral characteristic. It’s a function of our brain. It’s how our brain controls for those genetics…how that resiliency comes in and how we support that” (Phillips 2018). A theme present among traumatized people is “they are unable to overcome the anxiety of their experience. They remain overwhelmed by the event, defeated and terrified” (Lavine 1997). These feelings of anxiety or being overwhelmed and defeated create a buildup of energy in our nervous systems. In order to get rid of this undischarged energy, the client must process these emotions and release that energy from their system. “The heart of the matter lies in being able to recognize that trauma represents animal instincts gone awry. When harnessed, these instincts can be used by the conscious mind to transform traumatic symptoms into a state of well-being” (Lavine 1997).
Addiction is another concept that is hard to define and has created a lot of debate amongst mental health professionals. “It is impossible to understand addiction without asking what relief the addict finds, or hopes to find, in the drug or the addictive behavior” (Matè 2011). One definition of addiction is, “any repeated behavior, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life and the lives of others. Addiction involves: (1) compulsive engagement with the behavior, a preoccupation with it; (2) impaired control over the behavior; (3) persistence or relapse despite evidence of harm; and (4) dissatisfaction, irritability or intense craving when the object – be it a drug, activity or other goal – is not immediately available” (Matè 2011). According to the DSM-5 Substance-Related and Addictive Disorders “produce such an intense activation of the reward system [in our brains] that normal activities may be neglected. Instead of achieving reward system activation through adaptive behaviors, drugs of abuse directly activate the reward pathways” (American Psychiatric Association 2013). What is becoming clear as more research enlightens us, is that addiction is typically a symptom of another underlying problem. “Addiction is often a misguided attempt to relieve stress, but it is misguided only in the long-term. In the short-term addictive substances and behaviors do act as stress relievers” (Matè 2011).
“The drive to escape the moment is a common, nearly universal human characteristic. In the addicted brain it is magnified to the point of desperation. From an ecological perspective, the addiction process doesn’t happen accidentally; nor is it pre-programmed by heredity. It is a product of development in a certain context and continues to be maintained by factors in the environment” (Matè 2011). The external and internal environment in which we operate play a large part in shaping our habits. When we are children and bad things happen to us, we usually do not have the ability to escape or defend ourselves. As a response, our brain creates coping mechanisms to help minimize pain and distress caused by our external circumstances. “The stuff that happens to us when we were younger, a lot of times we carry with us, [but] we don’t even realize why we do the stuff we do. We just sort of do it out of inertia” (Phillips 2018). Our path to peace then, relies on our ability to identify unhealthy coping patterns created to defend ourselves and survive. “Addiction is primarily about the self, about the unconscious, insecure self that at every moment considers only its own immediate desires – and believes that it must behave that way. The process arises from the unmet needs of the helpless young child for whom this constant self-obsession appears, to begin with, as a matter of survival” (Matè 2011). Once identified, we must replace misguided coping skills with healthy coping mechanisms that allow us to operate while remaining connected to our true selves. “To see addiction as the only problem is to leave intact the context that triggered the addiction in the first place” (Matè 2011).
Sometimes, the individual may not even consciously understand the problem causing their addiction. “When people are influenced by past experience without any awareness that they are remembering…something is influencing [their] behavior, there is little we can do to understand or counteract it. The subtle, virtually undetectable nature of implicit memory is one reason it can have powerful effects on our mental lives.” (Matè 2011) Lack of awareness of our own conditions is a common thread when discussing addiction. An individual’s addiction “may be the elephant in the room, but that may not be what brings them in. They may not recognize it” (Phillips 2018) What is addiction? “It is a sign, a signal, a symptom of distress. It is a language that tells us about a plight that must be understood” (Matè 2011).
Addiction and Trauma
People who suffer from substance abuse problems show a high correlation with traumatic experiences. “Whereas the general population has physical abuse rates of 8.4 percent, the rate for alcoholics has been reported at 24 percent for men and 33 percent for women. The rate of sexual abuse in the general population hovers around 6 percent, while the rate for alcoholics has been reported at 12 percent for men and 49 percent for women. Rates of childhood emotional abuse and neglect, which are often underreported, are likely as prevalent among alcoholics as physical and sexual abuse have similar long-term consequences” (Sack 2017). Dr. Sack gives an example of students who attended school near Ground Zero. The more trauma-related factors they experienced, the more likely they were to use drugs and/or alcohol. Other research on this subject points to the same thing. The Adverse Childhood Experiences (ACE) test developed by Kaiser Permanente and the CDC also found that people who faced 4 or more adverse experiences were at higher risk for substance abuse. Specifically, that child would be “five times more likely to become an alcoholic and 60 percent more likely to become obese, and a boy with four or more of these experiences is 46 times more likely to become an injection drug user than other children. The researchers found that the effects of trauma are cumulative, and that one of the most destructive forms is chronic recurrent humiliation” (Sack 2017).
Far more than a quest for pleasure, chronic substance use is the addict’s attempt to escape distress. From a medical point of view, addicts are self-medicating conditions like depression, anxiety, post-traumatic stress, or even attention deficit/hyperactivity disorder (ADHD). Addictions always originate in pain, whether felt openly or hidden in the unconscious” (Matè 2011). Keeping in mind that addictions originate in pain, it becomes clearer how traumatized individuals would self-medicate in order to relieve the pent-up stress from their past in the short-term. From there, the chemical effects of the substance can take their hold on the brain and further distort thinking. “The addict’s reliance on the drug to reawaken her dulled feelings is no adolescent caprice. The dullness is itself a consequence of an emotional
malfunction not of her making: the internal shutdown of vulnerability. From the latin word vulnerare, to wound, vulnerability is our susceptibility to be wounded. This fragility is part of our nature and cannot be escaped. The best the brain can do is to shut down conscious awareness of it when pain becomes so vast or unbearable that it threatens to overwhelm our capacity to function. When we flee our vulnerability, we lose our full capacity for feeling emotion. We may even become emotional amnesiacs, not remembering ever having felt truly elated or truly sad” (Matè 2011). Indeed, research has found “you cannot selectively numb emotion. You can’t say, here’s that bad stuff. Here’s vulnerability, here’s grief, here’s shame, here's fear, here’s disappointment. I don’t want to feel these. I’m going to have a couple of beers and a banana nut muffin. You can’t numb those hard feelings without numbing the other affects, our emotions. You cannot selectively numb. So, when we numb those, we numb joy. We numb gratitude. We numb happiness. And then we are miserable, and we’re looking for purpose and meaning, and then we feel vulnerable, so then we have a couple of beers and a banana nut muffin. And it becomes this dangerous cycle” (Brene Brown).
Traumatic experiences are so powerful, that they create an intense, desperate desire to escape the memory and feelings of the encounter. Then, we numb ourselves to those emotions either consciously or unconsciously. It is when people use unhealthy coping mechanisms to escape these emotions that we run into trouble. The goal then, is to first become aware of our current coping mechanisms. From there, it is our job to analyze if that is the proper way to cope with external stimuli, or if it is a behavior we simply need to thank for its past help, then remove from our lives.
The first step of the process is to become aware of what is influencing our behavior. In order to achieve this, Hower Lodge provides access to licensed professional substance abuse counselors who have been through the recovery process themselves. Residents have daily access to their counselors for both 1-on-1’s as well as daily groupwork covering different topics. During this time, residents will collaborate with their counselors to create goals that are achievable, relevant and create the awareness necessary to work on undesirable behaviors. Residents will then take these goals with them to their weekly therapy session. When there, our Licensed Therapist will work with the resident on identifying current coping mechanisms as well as help create healthy ones when necessary.
Trauma is one of many causes with a positive correlation to addiction. At Hower Lodge, we are committed to helping regardless of cause. We have the resources and professionals necessary to identify root causes and be advocates for your recovery. As always, please feel free to reach out to us with any questions you have. We look forward to helping you reach your goals.
~ The Team at Hower Lodge.
Resources and Further Reading
American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition. Arlington, VA.: American Psychiatric Publishing.
Brown, Brene. (2010). The Gifts of Imperfection. Center City, MN.: Hazeldon Publishing
Lavine, Peter. (1997). Waking the Tiger: Healing Trauma. Berkeley, Calif.: North Atlantic Books.
Mate, Gabor. (2011). In the Realm of Hungry Ghosts: Close Encounters with Addiction. Berkeley, Calif.: North Atlantic Books.