To enter Family Treatment Court, where I was the site coordinator, applicants were required to meet with me to complete a packet of questions about the nature and chronology of their substance abuse, their treatment to date, and also their family history. These questions were intended to help the treatment team learn more about each participant and to help them to find a path to recovery.
A History of Trauma
Over and over again, when I sat down with prospective clients, all of whom were parents who’d become involved in the child welfare system due to their substance use, I heard stories of trauma. One mother held back tears as she told me that during the first year of heavy drinking, she lost a parent, a sibling, and her best friend. Another mother seemed to lose all trace of emotion as she talked about severe domestic violence she had suffered at the hands of several different abusers over the course of two decades. There were numerous victims of sexual assault. Every person I met with had a history of one or more traumas that contributed to the development of their addiction.
Substance abuse and trauma are often found together. This is called comorbid or co-occurring diagnoses. That is not to say that every person who struggles with addiction has a diagnosis of Post Traumatic Stress Disorder (PTSD) or even that every person who has experienced traumatic life events will develop either substance use disorder or PTSD.
It is important to understand what trauma is and what it is not. According to the SAMHSA-HRSA Center for Integrated Health Solutions, trauma can occur when:
- A person faces adversity that they do not have the tools to handle.
- A person experiences a traumatic event, series of events, or set of circumstances, such as a natural disaster, abuse, poverty, community violence, death of a loved one, or divorce.
- A person feels physically or emotionally unsafe.
Trauma impacts mental, physical, social, emotional, and spiritual well-being. It is a unique experience for every person. What traumatizes one individual may not be considered traumatic for another. A traumatic experience can create triggers for people, things that cause them to think of or even relive their adverse experience.
Trauma has become a punchline for jokes, with the inferred assumption that people who are “triggered” by something are weak, entitled, or spoiled. This perception can make it more difficult for people who have survived trauma to get the help and support they need and deserve.
Trauma Versus PTSD
Just as there are some people who can experience an adverse event without finding it traumatic, it is also possible for people to experience something they find traumatic without developing PTSD.
Trauma that is addressed in a prompt, sensitive, safe way is less likely to have negative, long-term outcomes. Trauma that goes unaddressed, is repeated, or is particularly severe may lead to the associated disorder.
The only way for a person to be sure if they have PTSD is to be diagnosed by a qualified mental health provider. If, however, a person has experienced three of the five criteria below in the past month, it is recommended that they speak to their family doctor, a therapist, their clergy, or a trusted loved one about getting help:
- Nightmares about the event(s) or thought about the event(s) when they didn’t want to have them
- Trying to avoid thinking about the event(s) or going out of their way to avoid situations that remind them of the event
- Being constantly on guard, vigilant, or easily startled
- Feeling numb or detached from people, activities, and/or surroundings
- Experiencing feelings of guilt or blaming themselves or others for the event(s) or any problems the event(s) caused
This list was created by the Department of Veterans’ Affairs, which treats huge numbers of people who struggle with PTSD resulting from experiences during their military service.
The Connections Between PTSD and Addiction
There are actually a variety of ways that PTSD and substance use disorder can each exacerbate and perpetuate the other diagnosis:
- People who grew up with addicted parents may have experienced trauma resulting from their parents’ choices.
- Children may learn from their parents to use substances in lieu of healthier coping skills.
- A person who experienced trauma may attempt to numb difficult feelings they experience around the trauma with alcohol or other drugs.
- While under the influence of substances, a person is more vulnerable to further traumatization.
- Trauma a person experienced while under the influence may fuel feelings of guilt, worthlessness, and self-loathing, which can make it harder to attain recovery.
- Society sometimes reinforces the idea that admitting to having difficult feelings is a sign of weakness. Men, in particular, are often socialized to “have a drink” after a difficult experience, instead of crying, seeking out therapy, or talking to a trusted confidant.
At Safe Harbor Recovery Center in Portsmouth, Virginia, we treat each guest as a whole person, with a unique personal and family history, unique physical and mental health needs, and unique paths to recovery.