Trauma and Addiction – The often ignored reality about addiction

In previous post, I’ve talked about some of the links between addiction concepts like cravings and trauma disorders like PTSD (see here). The reality is that there is a closer link between addiction and trauma that is often overlooked.

I spend a lot of time on this site covering some of the neuroscience that explains why the repeated use of addictive substances can lead to the kind of behavior that is so common in addiction. Still, most of that neuroscience ignores the portions of a person’s life that come before the actual drug use. The one exception would have to be all my writing on impulsivity, and some work on the relationship between early life stress (or trauma) and depression, which is known to be associated with drug abuse.

The way I see it, there are at least 3 distinct stages to addiction :

  • What happens before drug use.
  • What happens once chronic drug use begins.
  • What happens once a person stops using.

Though we often like to pretend otherwise, trauma is a common part of the first stage.

How do we define trauma?

In this context, trauma is any event that affects a person in a way that can be seen to have caused a substantial, long term, psychological disturbance. The key to this way of looking at trauma is its subjective nature.

Things like divorce, bullying, rejection, or physical injury can all be considered traumatic if the subjective experience can be thought to conform to this definition. Anything counts as long as it leaves a painful emotional mark.

While we’re all pretty adapt at covering up such trauma, the emotional pain often needs to be soothed and a good way to soothe it is with drugs that make it temporarily go away. The first drink of alcohol, or hit of some other drug, will often take care of that.

The reality of early trauma and addiction

Some call the experience of covering up the pain of trauma with drugs “self-medication” (though the term also applies to other situations), some dislike the term, but I think the fact remains that often, emotional pain can begin a search that often leads to risky behaviors and drugs.

I’m nowhere near calling self-medication the only reason for drug abuse as some others do, but I think it’s an important factor and one that can’t be ignored. As the stigma of emotional pain, or emotional responding in general, is reduced, people’s ability to deal with such pain in a healthy way should lead to a reduction in seemingly helpful, but ultimately self-destructive behaviors.

One of the most useful roles of psychotherapy for addicts is in dealing with the trauma in a healthy, constructive manner. This way the shame, guilt, and other negative emotions associated with it stop guiding the person’s behavior. While this is rarely enough to stop the need for self-medication by itself, it can be a very useful part of a comprehensive treatment plan. It’s important to remember that once someone has entered the realm of chronic drug use, there are brain and body changes that can often trump whatever the reason for beginning drug use was.

The ignored reality about addiction is that it often has an origin in behavior and unfortunately, trauma is often that starting point.

About Addiction: Smoking, Drugs, Drinking and Cancer

New links for interesting articles about addiction. Check them out!

Tobacco, nicotine, and Smoking

Medical News Today: According to a recent study in China there is a new effective strategy for treating tobacco addiction.  Researchers have developed a novel tea filter that seems to help with cigarette addiction. (Note: this link doesn’t give direct access to the article so we’re basing the summary on the article itself)

SAMHSA: According to a new nationwide study, adolescent smoking may be influenced by mothers’ smoking or depression. The study states that adolescents living with mothers who smoke are 25.6% more likely to smoke. It’s frightening to think that 1.4 million 11-17 year old kids started smoking in the past 12 months!

Science Daily: Exposure to prenatal smoking may lead to psychiatric problems. According to new research, exposure to prenatal smoking can increase the need for psychotropic medications in childhood and young adulthood.

Hard drugs

Science Daily:  A newly developed and tested modified enzyme has been shown to break down cocaine into inactive products nearly 1000 times faster than the human body. The article states further that cocaine toxicity due to drug overdose results in more than half a million emergency room visits annually. This new enzyme could help prevent OD deaths by breaking down the drug.

Fox News: The number of soldiers seeking opiate abuse treatment has been increasing, going up from 89 in 2004 to 529 last year.

Addiction Inbox: A study that uses the Stroop test (have to name the colors of words and not the words themselves) seems to be a good predictor for addiction treatment effectiveness and drop out rates. Pretty cool stuff!

Alcohol

Join Together: This is a short article summarizing research which shows that rare childhood leukemia is tied to drinking during pregnancy. According to this research, children whose mothers are drinking during pregnancy are 56 percent more likely to develop a rear form of leukemia called AML.

Addiction Tomorrow: Britain is considering raising the prices of their very low-end alcohols most likely in an attempt to damper the young adults that binge drink and of alcoholics since they are most often the ones that drink the low-end alcohol.

Helping Addicts with medications for cravings

If we could make it so drug addicts could stop craving the substances that have brought them to their knees, would relapse rates drop and addiction-treatment success rates soar? I sure hope so!

Medications that stop cravings?

I’ve already written about a study by the renowned addiction researcher Barry Everitt showing that medications could be used in treatment to help addicts who are struggling with strong cravings and the effect of triggers (see it here). Still, in that study the researchers used a drug that blocked pretty much all memory formation and my original idea had to do with using a very common drug, one being used every day for hypertension, and more recently, in the treatment of PTSD.

Well, a study recently completed revealed that indeed, propranolol, a common beta-blocker, may be useful in greatly reducing the amount of time needed to overcome the sometimes crippling effect of triggers on behavior.

How this trigger to cravings study worked

The researchers trained rats to take cocaine, and after they were well trained, allowed them to press a lever for a light that had previously been associated with the drug. This is a common method to test the way animals react to triggers that have been associated with the drug. Even though the animals are no longer getting any cocaine when the light goes on, the fact that it had been previously associated with the drug makes the animals press the lever, like an addict triggered by something they’ve associated with their drug use.

The animals that were given propranolol immediately after every session took half as long to stop pressing for the drug-associated light. It took multiple administrations of propranolol (seven to be exact), but the effect was clear. The next step is to see if the same effect can be observed in people.

Helping addicts transition to outpatient substance abuse treatment

I’ve been claiming for the past few years that if we look in the right places, we can find many ways to help struggling addicts who are having a hard time quitting using currently available methods. I think that the notion that sticking to the “best method we have right now” is unwise given the fact that science has progressed quite a bit in the past 20-30 years. I agree, and am thankful, that the system works for some, but there’s no question that many still have trouble recovering from addictions that devastate their own lives and the lives of many close to them. I think these medications can offer some serious help.

The thing is, that if we could seriously reduce the impact of cravings on relapse rates, it’s possible that addicts would be ready to move from residential to outpatient substance abuse treatment  more quickly. Indeed, the main reason for keeping people in residential treatment is the thinking that they’re not ready to be in the world given the influence of triggers. My guess is that this is true for some addicts, but if we could provide an intervention, like propranolol, that would significantly reduce the influence of triggers, outpatient substance abuse treatment, which is a cheaper option, will be useful for many more. This would mean more people in treatment that truly works for them for less money. Sounds good to me.

Citation:

Ashley N. Fricks-Gleason & John F. Marshall (2008). Post-retrieval ß-adrenergic receptor blockade: Effects on extinction and reconsolidation of cocaine-cue memories. Memory & Learning, 15, 643-648

About Addiction: Alcohol, breast cancer & war veterans

Check out our weekly links about addiction!

Health Day: A new study shows that breast cancer survivors who smoke are at increased risk for a second cancer. The time frame to develop second cancer is fifteen years.

Cesar Fax: Drug positives increase consistently with age amongst DC juvenile arrestees. 53% of the juvenile arrestees tested positive for drugs.

Psychology Today: An article from Psychology Today (which Adi has been writing for so check them out!) and discusses the issue of war veterans and drug use as well as PTSD. It relates the discussion to soldiers in Iraq and Afghanistan.

Science Daily: There are some new insights into how alcohol affects brain function. Drinking alcohol over a long period of time does profoundly affect the brain.

Science Daily: More about alcohol! According to Science Daily, genetic differences that make you sleepy when you drink can protect against alcohol dependence.

Drug use memories and relapse: Can medication provide addiction help?

About a year ago, while sitting in a lecture on learning and memory, the idea that certain drugs can affect the emotional responses to memory long after the memory itself has been formed came up. As someone interested in addiction research, the implication for treatment immediately came up in my head:

Could we reduce the effect of triggers by giving people a pill?

In one word – Yes! But, the answer is not, in fact, that simple. Even in the studies already done in PTSD patients, the memories have to be re-triggered and the drug given at exactly the right time to be effective. In fact, in humans, some of the best work has been done in PTSD patients immediately after the traumatic event.

Addiction help through relapse prevention

Still, a recent study in animals suggests that the theory is sound. By interfering with the activity of a neurotransmitter important in the formation of memories, researchers were able to stop animals trained to self-administer cocaine from doing so. The animals, which had been trained to push a lever for cocaine when a light went on, reduced, or even stopped responding after a single dose of a substance that blocked memory formation. Essentially, the researchers prevented the animals from relapse. Again, this only worked if the drug was given while the light (as in the drug-trigger) was presented at the same time.

More recent studies, using repeated doses of the drug propranolol, have been shown to have an even more promising effect. Check out my coverage of that research here.

Given the powerful role of triggers in relapse, this avenue of research has some promising possibilities for future treatment of drug addiction.