In a previous post, I discussed integrative treatment for addiction and PTSD. However, it didn’t address the question: what’s up with those two going together so much, anyway? Up to 59% percent of people in substance abuse treatment have current PTSD—this does not include people with a history of PTSD that has resolved, or who have experienced trauma but never received a diagnosis–only about a third of people who experience a traumatic event develop PTSD, so this could be a substantial group. In men who have been diagnosed with PTSD, over half (52%) will be diagnosed with alcohol abuse disorder and over a third (35%) will develop substance abuse disorder. While this does not mean that 87% percent of men will have an abuse problem (because there will be some overlap), it’s still clear that there is relationship between PTSD and substance use. But why?
Burn the Pantyhose!
Here’s the thing with describing relationships: it’s tricky. You have to make some assumptions, and those can be wrong. For example, what if I told you households where a member purchased pantyhose were several hundred times more likely to have someone be diagnosed with breast cancer than households that never bought any? Should we start burning pantyhose? “Hold up!” your common sense should be telling you right now; an obvious alternative is that households purchasing pantyhose are a lot more likely to have a member who is at risk than households that never did. Keeping that in mind, on to our attempt to describe the relationship between addiction and trauma.
The Trauma-Informed View
Addiction is complicated and there is a lot of research to describe its sources. Genetics are believed to play a role, as are other biological and environmental factors. The trauma-informed description of addiction adds that it is a method of coping. When symptoms or emotions are too much to handle, some people seek instant relief. When they find something that does that, and they compulsively to use it to numb or elevate their experience, it becomes an addiction.
Anything can be used. Common ones are, of course, drugs, alcohol, sex, gambling, food, shopping. But anything that is used to avoid distress to the point where someone can’t tolerate any discomfort is an addiction.
What’s the difference between healthy coping and addiction? Healthy coping skills are used to deal with the symptom, situation or feeling while staying connected to the experience. For example, let’s say you’re going through a breakup. Addiction is used to numb whatever feelings are there, and cravings are most likely when someone is feeling most intensely. However, someone coping with the breakup in a healthy way will both allow themselves to feel sadness and loss, but also plan activities where they feel competent and social and more like themselves.
How This Informs Treatment
The idea that addiction is a response to overwhelming trauma symptoms informs the approach that trauma therapists use to help clients who struggle with addiction.
I use the following principles:
1) I’m not going to ask you to give up your primary coping method without first giving you some others to use
2) I just ask that you come sober to sessions
3) We’re going to talk about the role that addiction plays in your life, and work to identify a connection between triggers to “use” and PTSD triggers—it’s not accident that those are the same word
It depends on the client but usually within a couple of months the addiction has organically declined on its own, and then folks are able to quit all the way. Research has shown that this happens a lot for people with co-occurring addiction and PTSD who are in trauma therapy. So while the trauma-informed approach is based on theory rather than certainty, it does seem to resonate with trauma survivors and inform evidence-based treatment that helps. And at the end of the day, that’s what’s important.