Trauma and addiction

 


What is Trauma?

Trauma is our normal human response to distressing or disturbing events which happen in our lives. An event is considered traumatic if we have been exposed to actual or threatened death, serious injury or sexual violence, or we have witnessed in person, the event occurring to others (vicarious trauma). This can be a one-off event like a car accident (type 1 trauma) or a series of events such as psychological or sexual abuse, usually occurring in childhood (type 2 trauma). 

Trauma is very personal, so what one person finds traumatic can differ to another person. You may not call some of the events or experiences you have had ‘Trauma’ and that is ok. If these events or experiences have left you feeling overwhelmed, scared, isolated or you felt that your survival, well-being and identity were threatened, it is likely you experienced trauma.  These examples above are likely to be highly distressing and upsetting and it is expected that most people will feel these difficult emotions (e.g. fear, anger, despair etc.) and the impact of trauma for days or weeks afterwards.   

It is important to know that, despite this, most people who experience trauma do not go on to develop long lasting symptoms. If we are in a position to talk to friends, family, support workers and be believed and supported, we are more likely to be able to move forward without this traumatic experience leaving a long-lasting effect. 

What is the impact of trauma?

Trauma can affect how we think, feel and behave (cope).  Below are some common symptoms that people find distressing and hard to manage:  

It is well established that the majority of people with substance use problems have histories of childhood trauma and adversity.   

No one wakes up one day and thinks "Hey, I fancy being a heroin addict".    

We all just do the best we can to get through life, finding ourselves carried by its current.  Sometimes this can feel calm, and at other times like being hurled through rapids and off waterfalls. Being exposed to trauma and adversity in childhood is never a child's fault. Ever. Trauma and adversity have a profound impact on how we grow and learn. It affects how our brains grow, what emotions we feel and when we feel them, and our relationships with ourselves, other people and the world. Substance use is an attempt to cope when it feels like nothing else helps us to soothe or regulate – but people are incredibly adaptive and find many different ways to cope with the circumstances and suffering that are inflicted upon them   

Children who grow up in homes where they experience abuse, neglect or adversity are substantially more likely to develop problems with substances than those who don't. They are also more likely to experience further trauma throughout their lives. These children learn to deal with the resources they have to hand, just to survive. It’s a little like being stranded in a desolate place and figuring out how to get by with the odd handful of water dug from the ground to quench our thirst, hunkering down under a rocky cliff for shelter, and using a sharp stick to keep ourselves safe from the things we know are coming for us in the dark. 

However, when the situation changes, the skills that kept us alive for so long might not work anymore. If we've learned to survive in that desolate place for so long, and we're suddenly teleported into an airport then the skills that kept us alive in the wilderness aren’t the skills we need to manage this new situation, and we're likely to find ourselves in a lot of trouble. When our coping strategies stop working, or they’re applied to situations we’re unhelpful they become problematic, and actually make things worse - it's a vicious cycle and it doesn't seem fair!     

In order to support people in their recovery, we really need to be curious about what has happened to them, what it was in their life that caused so much pain and suffering, and understand why they began using substances to cope.   

We need to ask:  

Why the pain? NOT why the addiction?  

What has happened to you? NOT what is wrong with you?    

Stop the stigma.

 

ACEs are traumatic events that occur before a child reaches the age of 18. ACEs include all types of abuse and neglect, such as parental substance use, incarceration, and domestic violence. ACEs can also include situations that may cause trauma for a child, such as having a parent with a mental illness or being part of a family going through a divorce. A landmark study in the 1990s found a significant relationship between the number of ACEs a person experienced and a variety of negative outcomes in adulthood, including poor physical and mental health, substance use, and risky behaviors.1 The more ACEs experienced, the greater the risk for these outcomes

Across Scotland, there is a government agenda to reduce harm and promote trauma-informed care. To achieve this the Medication Assisted Treatment (MAT) standards have been implemented with the aim of promoting recovery and ensuring clients have increased access to treatment and support. The MAT standards are evidence-based and they enable the consistent delivery of safe, accessible, high-quality drug treatment across Scotland. These are relevant to people and families accessing or in need of services, and health and social care staff responsible for the delivery of recovery-oriented systems of care.

For more information on MAT standards click here