Sunday, June 15, 2014

The Ties That Bind: How Trauma and Addiction Get Woven Together


When I was a new therapist, I was working at a sexual trauma treatment center in a major city. During that first year I often saw how traumas like rape and child abuse predisposed its survivors toward the soothing relief of drugs and alcohol.  At the same time, I was cautioned by other therapists that I could not treat trauma with a person who was still using. I felt trapped. How could I help people get better without paying some attention to the historical trauma that substances helped cover over?

I saw many substance abusing people (mostly women) come through our center.  Many of the folks I I saw had been through rehab centers had AA or NA experience or had been counseled by addictions specialists. Yet they weren’t getting better. Looking deeper I discovered that many of the women I met had traumatic histories. The specialists with whom they had worked had taken little account of their trauma history. In fact many had never been screened for a trauma experience.  Here were so many women who had spent years battling serious drug or alcohol abuse, but who could not break free from the demons in their mind.  Often those demons were intrusive memories of past abuse and a core feeling of worthlessness or shame. The legacy that childhood trauma left for these women included a life of addiction and lonely pain.

Without the hurt from past relational harm being addressed, many of these women were not beating back their dependence on alcohol and other drugs.  The substances helped them cope. What was needed was a therapist who understood addiction and also knew how to assess and treat trauma and PTSD. This is what I proceeded to do, against the recommendations of many in my therapeutic community. Luckily today, reputable addiction treatment assesses for trauma and past abuse and offers a chance to talk through those experiences. Unfortumnately for many though, the counselors who work with addiction are not trained in trauma and the therapists who understand PTSD may not understand the tricky terrain of addiction. 

When abuse and trauma are recognized and treated together, along with addiction treatment , years of dependence on substances can lift.   Without the trauma being considered, clients often experience treatment around the addiction that feels alienating and self blame and shame are re activated.  The deeper issues scream for attention. 

Certainly, not all folks struggling with addiction have a trauma or abusive past. And there are other childhood experiences that can be decisively harmful as well and often leave a person with a vulnerability to anything that will block the pain.  Among some of those factors are:  parents, who because of their own addiction,  did not provide their child with the attention they needed;  mentally ill caregivers whose struggles prevented attuned attachment; and  narcissistic or borderline personality disordered parents who confused, frightened and shamed their  child.  These are among the many types of experiences we can have as children that leave us hurting and looking for relief.  The warm buzz of alcohol or the deep alteration of a drug can mask our pain, for awhile.

Whether my client was sexually abused, neglected,  or pervasively shamed growing up  – treatment that helps make sense of these experiences, processes the feelings that were generated and offers new ways of understanding and coping can come to make the substance use less needed.  Of course, caution must be used so as not to overwhelm an already depleted internal  self  that has become locked in chemical abuse.

 Pacing and caution are used by skilled therapists to provide new supports that allow the difficult memories to be processed and contained.  Working with someone who is using is not the same as working with someone who is not…A more sensitive, slow paced and careful approach must be taken when dealing with a traumatic past and and addiction at the same time. But with proper understanding of the connection and the dynamics of both addiction and trauma,  healing of trauma and substance abuse recovery can  proceed together.

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