The link between trauma and substance use disorder (SUD) has been established intuitively and scientifically. Treatment providers know from experience that individuals who suffer traumatic experiences are more likely to turn to substances to dull the pain than the general population.
With so much happening in today’s world relating to healthcare regulations, gun violence, and women’s rights, people are at a higher risk of being traumatized and looking to substances to cope. To quantify the risks and help providers intervene with trauma victims before they turn to substances, the CDC/Kaiser Permanente Adverse Childhood Experience Study (ACES) in the mid-1990s uncovered a shocking and disturbing trend.
Not only do nearly 65% of people experience at least one of the ACEs identified by the study, but those who do are at least ten times more likely to develop some form of substance use disorder. For those experiencing at least three adverse childhood experiences, the odds of alcoholism skyrocket from 1 in 69 to 1 in 9, while the risk of IV drug use increases dramatically from 1 in 480 to 1 in 43. For those with four or more adverse childhood experiences, the odds of alcoholism and drug use surge to 1 in 6 and 1 in 30, respectively.
Clearly, these are formative experiences ranging from obvious trauma like sexual or physical abuse and physical and emotional neglect to somewhat less obvious scenarios like maternal depression and parental divorce. When compounded by adverse community environments, such as poverty, discrimination, poor housing quality and affordability, and other social determinants of health, the odds of an individual developing a SUD become practically overwhelming.
Because so many people who suffer from a SUD have also been victims of trauma, it’s essential that the two be treated together. In fact, it’s virtually impossible to successfully treat the SUD without addressing the underlying trauma, and it’s why a trauma-informed care approach is so critical in addiction treatment and long-term recovery.
In trauma-informed care (TIC), the entire program is structured to acknowledge the widespread impact of trauma and its effects on the patient, their families, staff, and anyone involved in the system. Beyond recognizing the impact of trauma, the TIC approach responds by fully integrating appropriate practices and procedures to reduce the risk of re-traumatization.
In the TIC approach, five key factors play a crucial role in the success of SUD treatment, and now more than ever, programs need to prioritize these issues to give their patients the greatest chance at long-term recovery.
1. Recognize that every trauma is unique
At one time, there were specific guidelines around what kind of experiences were officially accepted as trauma. Combat veterans and victims of human trafficking, physical or sexual abuse, neglect, etc., all qualified as trauma victims. But we now know it’s much more complicated than that—and what one person may feel is traumatizing, another may handle with relative ease. For example, every one of us will lose a parent, or perhaps both, at some point in our lives. But that experience can be vastly different for different people depending on the circumstances, our relationships, etc. It’s impossible to set hard and fast rules around what qualifies as trauma—it must be based solely on the individual’s reaction and how it changes their interaction with the world, especially when it contributes to SUD.
2. Second-hand trauma is real and must be addressed
One doesn’t have to be the direct victim of an adverse event to be traumatized by it. For example, some of us are traumatized by the loss of a child, even if it’s not our own, and catastrophic events like 9/11 or the Uvalde school shooting can elicit a trauma response, even for those far removed from those events. Such world events can elicit survivor’s guilt (one of the most common forms of trauma), and these second-hand experiences must be recognized concerning the SUD.
3. Everyone must be on board
In a TIC approach, everyone involved must know how to treat patients in every encounter with universal precautions—from the staff who checks on the in-patient residents throughout the night to the dining and kitchen staff to the groundskeepers to the family members—to avoid re-traumatizing the individual.
4. Have a plan for addressing an escalation
Even as trauma victims are working on mastering new coping skills, they may experience escalation events where they are manic, unapproachable, or inconsolable. Everyone has individual preferences for how these situations should be addressed—some want to be held close, others need you to back away. Patients and their caregivers, friends, and families should discuss the signs of an escalation episode and the best ways to respond to avoid making the situation worse. It could be anything from a shared moment of guided breathing to handing them a stress ball or a glass of water. But having a plan before the moment comes is essential to reducing the escalation and the risk of a relapse.
5. Focus on activities that instill empowerment
Trauma victims turn to substances because they feel hopeless and powerless to overcome the negative feelings their experience has created. This is true not only for situations like abuse but also for the constant barrage of negative and disheartening news we all see in the media. Rather than dwelling on those feelings, it’s essential to redirect that energy into action. Doing so could mean finding a productive hobby like cooking, crafting, exercising, or any activity that is empowering and instills a sense of pride and confidence. Many people volunteer with trauma programs or at 12-step meetings in hospitals or prisons to help others see there’s an alternative path. In the case of overwhelmingly bad news, rather than doom scrolling or getting caught up in the echo chamber of social media, volunteer in your community, write to your government representatives, or attend a local rally in support of issues you’d like to see change.
One thing is definite: substance use has never made any trauma victim feel less traumatized. Instead, it makes them feel more vulnerable, helpless, and hopeless. With a well-designed trauma-informed approach to substance use disorder, all of us—providers and loved ones—can reduce the impact of trauma and help victims find healthier relief from the pain they carry with them every day.
Follow the author of this article on Twitter @franroutt.
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