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.

Drug use norms and expectations: Obsessions and compulsions in our society.

teensI used to always say, back in my using days, that speed (methamphetamine) was The American drug. Why? Meth makes its users sharper, more alert, and more focused, and it allowed me to spend entire nights up studying like I’d never been able to study before.

Unfortunately, like many other aspects of The American Dream, speed will also leave you spent before you know it, leaving the memories of those productive, focused, days far behind with little hope of coming back.

We live in a society that celebrates excess, be it in celebration or dedication to work, success, and achievement. Is it any wonder then that so many Americans turn whichever way they can to gain the edge that they feel they’re lacking when they compare themselves to those around them?

I read recently that many executives now keep a supply of medications like Adderall, Ritalin, and other attention deficit cures around for times when they need that extra push to stay up late and work.

We are skirting a dangerous line by putting out the message that everyone should be the best though of course, with no cheating… or at least no getting caught.

Teens are now using more and more prescription drugs while reducing, or at least not increasing, their use of many illicit, or illegal substances. How is this crisis we’re experiencing with our teens any different than the recent steroid stories exploding the mythic innocence of every American sport?

One of the things I want to inform my readers about in writing this blog is the process of addiction and the ways in which its development is often not under the control of the users, at least not the users likely to eventually develop into addicts. But, there’s also a different issue, the one having to do with what it is about our society that makes Americans so much more likely to turn to these substances in the first place???

It is estimated that more than a third (110 Million to be exact) of American have used at least one drug at some point in their lives. I don’t necessarily think that there is anything wrong per se with recreational drug use given the relatively low rates of addiction that develop from it. However, I think that drug use, even recreational use, that is meant to solve a problem or that is done as a normal part of life, is more likely to become problematic.

Some theories of addiction specifically assert that “self-medication”, as in using a drug to alleviate problems, especially psychological problems, can be a major indication of likely addiction potential. The problem is that the unsupervised use of the drug often does little to help the initial difficulties, and if anything, makes things worse as the drug user becomes more involved in the illegal drug culture. I probably don’t need to tell many of you about the social withdrawal and added psychological stress that goes along with becoming, or living with, a drug user.

My point is that we need to change the way we think about drugs in general. Drugs can be useful for many specific medical and psychological benefits, and possibly even for their recreational benefit (think Van Gough, or The Doors). But, in order to make sure that those we care about most don’t abuse and misuse drugs, we need to move away from the current attitude that seems to drive children and teens towards irresponsible, ill-informed, and dangerous drug use. By educating kids, not scaring them away from, the things that are dangerous for them.

You wouldn’t dream of teaching a child to look both ways before crossing the street by yelling at them that they better not EVER dream of setting a foot on the road without looking left first, would you?!

We teach our kids everything we think they need to know about life in order to prepare them for what’s ahead. Why is it that when it comes to drugs (and often sex), we shy away from bringing the subject up and still expect them to be well prepared when a friend says “Hey, want to pop one of these pills with me?”

There will always be those who for one reason or another are more likely to develop a problem with drugs regardless of how well prepared they are. Genetic influences on things such as low impulse control and sensation-seeking are known and are probably closely linked to some bad decision making. But even these people will benefit from being better prepared and more educated about their own choices so that when the time comes, even if a problem develops, they can hopefully acknowledge it, and deal with it, in a more capable, informed way.

We need to stop turning away from a problem and thinking it will solve itself. It’s time for us to look for answers and not rely on solutions appearing magically. They most likely won’t…

Question of the day:
Do you think that enforcement (of drug laws) or treatment (of heavy drug users)is the more effective way of dealing with the drug problem?