The Interconnection Between Trauma and Substance Dependence

Context:

Substance dependence, rather than "substance abuse," is the preferred term in the field of substance use disorders due to the stigma associated with the latter. This article employs "substance dependence" to avoid stigmatization.

Trauma and Substance Use:

Studies consistently demonstrate a correlation between trauma and an increased susceptibility to substance use disorders. Individuals who have experienced trauma frequently engage in more substance use and are at a higher risk for dependency, substance use disorders, and related complications compared to those who have not experienced trauma.

Defining Trauma:

Trauma refers to unsettling or disturbing events. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), a traumatic event involves exposure to real or threatened death, serious injury, or sexual violence. Traumatic events can occur through direct experience, witnessing an event happening to another person, learning about an event that happened to a close friend or family member, or repeated exposure to detailed information about a traumatic event.

Adverse Childhood Experiences (ACEs):

ACEs are traumatic events that occur between birth and age 17 and can have lasting impacts on a child's stress levels. According to the Centers for Disease Control and Prevention, ACEs include physical abuse, emotional abuse, sexual abuse, physical neglect, emotional neglect, a caregiver with untreated mental illness, witnessing violence against a parent or maternal figure, loss of a parent, incarceration of a household member, and substance dependence by a household member. ACEs are common, with almost two-thirds of adults reporting at least one such experience. They are associated with a range of issues, including mental health diagnoses, medical problems, poor social support, unemployment, substance dependence, and premature death.

Understanding the Link:

Trauma can lead to mental health conditions such as post-traumatic stress disorder (PTSD). Substance use is not officially recognized as a PTSD symptom, yet approximately 59% of individuals diagnosed with PTSD develop substance use problems and dependence. The risk of substance use issues increases when trauma occurs earlier in life. Additionally, the more traumatic events a person experiences, the more likely they are to develop substance use issues. Substance use can act as a form of self-medication, providing comfort and positive emotions in an attempt to regulate the distressing moods associated with trauma symptoms.

Recognizing Trauma-Related Substance Use:

Substance dependence and substance use problems can manifest differently for each individual. According to the DSM-5-TR, substance dependence may involve behaviors and symptoms such as consuming larger quantities or using substances for extended periods than intended, unsuccessful attempts to control or reduce use, spending considerable time obtaining, using, and recovering from substances, cravings or urges to use substances, functional problems due to substance use, continued use despite negative consequences, giving up social, occupational, or recreational activities due to substance use, risky or unsafe use, and increased tolerance or withdrawal symptoms. Signs of trauma-related substance use may include an increase in substance use following a traumatic event, using substances to cope with triggers or memories, or using substances more frequently after experiencing triggers.

Seeking Assistance:

If you struggle with substance use and have a history of trauma, seeking help is essential. Both trauma symptoms and substance use disorders are treatable mental health conditions, and support is available. It is advisable to seek a therapist who specializes in treating substance dependence and substance use disorders, as well as trauma and trauma-informed care. Group therapy or peer support can also be beneficial in the recovery process. The Substance Abuse and Mental Health Services Administration provides resources for clinicians, national resources, and information on supporting loved ones, seeking help in a crisis, harm reduction, and substance education.