Trauma and Substance Abuse
The Connection between Trauma and Substance Abuse
How many of us know someone, or are ourselves, struggling with substance abuse or addiction? Have you ever wondered, “What happened to this person?” or “Why me?” Why have I gone on to develop this debilitating disease when others have seemingly no issues with it (addiction) at all? Unresolved trauma may be the root of the problem.
Before we discuss the connection between early traumatic experiences and addiction, it is important that we first discuss what is meant by “trauma.” An event is traumatic if it is extremely upsetting, at least temporarily overwhelms the individual’s internal resources, and produces lasting physiological symptoms. This is important to note as while some traumatic experiences are more prone to cause post-traumatic stress (big “T” trauma), other experiences may only cause post-traumatic stress in individuals who lack adequate coping strategies, resilience, and social support, thus overwhelming the individual’s internal resources (little “t” trauma).
Types of Traumas
While it is useful to differentiate between the different types of traumas, what matters most is the impact the traumatic experience has on the individual and how it affects their life. What is traumatic for one person may not be traumatic for another, and this depends on a multitude of factors including support systems, resiliency, coping strategies, co-occurring mental health issues, and interpretation of the event. With that said many types of experiences would most definitely result in post-traumatic stress, often classified as big “T” trauma. These types of traumatic experiences include but are not limited to, physical, sexual, psychological, or emotional abuse, witnessing violence, neglect, abandonment, loss of a loved one, war, accidents, natural disasters, bullying, and homelessness. Little “t” trauma, on the other hand, is not generally related to life-threatening events, like Big “T” trauma, but still creates significant distress for the individual. Types of little “t” trauma include a breakup, divorce of a parent, job loss, death of a pet, getting bullied, etcetera. Any event or ongoing situation that causes distress, fear, and a sense of helplessness qualifies as trauma.
What about Relational Trauma and Adverse Childhood Experiences?
Traumatic events that occur in childhood are Adverse Childhood Experiences (ACEs). These are particularly harmful because they occur at such a critical period in a person’s life. The more ACEs a person has, the more likely that individual will grow up with comorbid mental health issues, including depression, anxiety, low self-esteem, and a substance abuse disorder. This is because children’s brains are still developing, as are their core beliefs about themselves, others, and the world. If we experience a negative event or life stressor as a child, it is our caregiver’s role to buffer the negative effects of trauma and adverse experiences, by providing a safe, stable, and protective environment via a nurturing relationship. But what happens if a child’s caregivers are not safe, stable, protective, and/or unable to provide a nurturing environment or emotional connection? Before we discuss the implications of experiencing trauma at an early age, let’s first discuss the stress response system and how it is vital to our survival.
The Stress Response
The stress response is a survival mechanism that triggers hormonal and physiological changes in the body when faced with a threat or stressor. Many of you may be familiar with the phrase, “fight, flight, or freeze.” This is what is meant when we talk about the body’s stress response system. When we are met with a threat, real or perceived, we can quickly assess that threat and act accordingly to give us the best chance to survive. So, if we come into close contact with a bear, for example, what will our automatic response be? You could fight the bear, but you would likely lose that battle. You could try to run away in hopes that you are faster than the bear (or the slowest runner). Or you could freeze in hopes that the bear does not see you. This is your fight or flight response being activated. With the release of stress hormones adrenaline and cortisol, our heart rate increases, our pupils dilate, we begin to breathe rapidly, and our appetite decreases, all enabling us to act quickly. Once the threat has been resolved, our stress response deactivates and returns to baseline. But what happens if stress is experienced at an early age when our brains are still developing, and we have not yet learned how to process or regulate our emotions? Even worse, what happens if our threat is never resolved, and our stress response does not return to baseline?
Toxic Stress and Emotion Regulation
Toxic stress is a term used to describe a state of stress that occurs when the fight or flight system is activated over a prolonged period, meaning the threat is ongoing and the person’s stress response does not return to baseline. When the threat is persistent and the stress-response system is chronically activated, the result is elevated levels of the stress hormones (adrenaline and cortisol), hyperarousal, hypervigilance, and alertness. This can then lead to issues of insomnia, increased blood sugar, inflammation, cardiovascular disease, and a compromised immune system. Another significant outcome of having a dysregulated stress response system is that it makes it extremely difficult to regulate emotions, cope with stress, and self-soothe. Emotion dysregulation has many signs including experiencing intense emotions, avoidance of negative emotions, lack of emotional awareness, an inability to manage behaviours, and the length of time it takes to calm down after experiencing negative emotions. Furthermore, early stress establishes a lower “set point” for a child’s internal stress system. The child, and later as an adult, becomes stressed more easily. They will be more overactive and reactive, trigger more easily, and are more anxious and distressed.
Changing the Way You Feel
Those struggling with addiction are addicted to changing the way they feel. Individuals with dysregulated stress response systems due to early trauma may seek to regulate their heightened emotional states (hyperarousal, vigilance, fear, anxiety) by engaging in drug or alcohol abuse. Feeling tired? Take some Adderall. Want to relax? Try an opiate. Feeling anxious, lacking confidence, or wanting to wind down after a long work week? Have a drink. For every emotion, there is a substance to heighten it or numb it. The problem arises when substances become the primary means to regulate emotions. In comparing a person whose baseline arousal is normal with another whose baseline is at a higher level, both can consume alcohol, but the person who is experiencing stress more is going to have the added effect of feeling pleasure from the relief of that stress. This is a negative reinforcement; our actions remove something unpleasant. Picture two people eating dinner at a restaurant, and they order the exact same meal. One of them had lunch a few hours ago and the other hadn’t eaten in days. Which individual will experience the most relief after eating? The internal state of the individual and the heightened relief of experiencing negative emotions are significant when determining the function of substance abuse.
Self-medicating with Drugs and Alcohol
Experiencing trauma later in life may also lead to substance abuse. In both cases, the function of substance use is to alleviate negative emotions and additional symptoms associated with Post Traumatic Stress Disorder (PTSD), such as intrusive thoughts, flashbacks, trouble sleeping, nightmares, insomnia, and dissociation. Trauma can negatively impact every aspect of our lives. It is easier to escape the moment with drugs and alcohol than it is to sit with it, work through it, and move on from it. But the long-term consequences are far more disadvantageous than coping with and working through the trauma.
While we cannot change the hands we have been dealt or the family we were born into, we can learn how to cope with what happens to us and how we respond. At Incentive Counselling, we provide the tools and understanding required to help you overcome substance abuse, cope with your negative feelings, and process traumatic memories so they no longer have control over you. With compassion and without judgment we will explore early childhood experiences, past traumas, and the role substance use has played in your life. Each person’s story is unique and at Incentive Counselling we have a team of counsellors who would be honoured to hear your story and provide the help you need. Give us a call or book through our online booking system to arrange a time that best suits you.
Krista is taking both face-to-face and virtual appointments in Kelowna. You can book with Krista here.
Shonah is booking virtual appointments. You can book with Shonah here.