Trauma, Addiction and Mood: Self-Regulation For Recovery
A favourite saying in 12-Step fellowships is: “It’s a simple program for complicated people.” To be human is to be complex, but that complexity can make addiction seem like a labyrinthine problem, both for the addicted person and for others seeking to help. Trauma, too, is a complex condition. Researchers and clinicians have identified a large number of facets that can be related to trauma: “stuck” (that is, undischarged) flight/fight responses, tonic immobility (“freeze” response) and dissociation, disrupted and damaged belief systems and self-image, chronic anger and rage, debilitating anxiety, major depression, suicidality and homicidal ideation, massive breakdown of lifestyle and relationships, deep shame, guilt, and distrust of people. When addictions and trauma occur together, the complexity can become quite daunting. However, understanding how trauma and addiction interact can open the door to understanding how to recover.
Addiction Can Be a Coping Method for Trauma
Traumatic events are shockingly common. The General Social Survey in 1998 reported that two-thirds of Canadians over the age of 15 had experienced at least one traumatic event in the previous 12 months; and more than one-third of Canadians had experienced multiple traumatic events in the previous year.1
Not knowing how to manage the emotional and physiological stress that may be experienced after a traumatic event, many people turn to addictive substances and behaviours as a means to cope with their discomfort and pain. Studies done in the United States have found that more than two-thirds of people seeking treatment for substance abuse report having experienced one or more traumatic events in their lives.2 Substance users are two to three times more likely than the general population to witness serious injury or death and to experience physical assault.
Trauma Symptoms Fuel Addiction
Overwhelming emotions, along with frequent physical arousal and tension, are primary symptoms of trauma that sufferers have great difficulty regulating. The biological threat response (flight/fight/freeze) appears to become lodged in the nervous system of the survivor, with the result that their body feels as though – and gives their brain the message that – they are constantly in mortal danger. In addition, multisensory images of traumatic experiences may intrude frequently on the mind – images that are charged with intense feelings such as fear, rage, guilt or grief. A leading clinician and research psychiatrist in the field of trauma, Dr. Bessel A. van der Kolk, has said that, “The inability to modulate emotions gives rise to a range of behaviors that are best understood as attempts at self-regulation. These include aggression against others, self-destructive behavior, eating disorders, and substance abuse.”
People who suffer from concurrent trauma and addictions are often able to identify the specific symptoms that they have been seeking to regulate with their addictive behaviour. For example, both alcohol and cannabis can temporarily reduce chronic hypervigilance and thus help people sleep, function at work, and maintain relationships. These substances, as well as opiates or disordered eating, can also be used to “numb out” chronic anxiety by facilitating a dissociative state. On the other hand, self-harming behaviour (including some types of disordered eating) can counteract numbing and help the person feel more alive. Similarly, cocaine and stimulants can increase hypervigilance and associated feelings of power and control.
Activities that re-enact traumatic arousal can counteract a prevailing sense of emotional numbness, and may also be driven by the “stuck” flight/fight energy that is seeking to discharge itself. For example, addictive sexual behaviour can be a (not necessarily literal) re-enactment of sexual trauma, and high-risk behaviour as a result of alcohol or cocaine use can also be a way of re-enacting the anxious arousal of past traumatic experiences. Gambling, along with the sometimes consequent levels of debt, borrowing, and sketchy companions, can in itself be a high-risk re-enactment. Different types of physical exertion may replicate aspects of the flight (such as bicycling or running) or fight (such as weight training or martial arts) response, and as such can become a form of compulsive re-enactment. Sometimes people combine the functions of different addictive behaviours to move sequentially between, for instance, the arousal of re-enactment and sleep.
Another favourite 12-Step fellowship saying is: “The good news about recovery is that you get your feelings back; and the bad news is that you get your feelings back.” For survivors of trauma, this can be bad news indeed. The very symptoms they have been using substances and addictive behaviours to manage may now emerge in full force. For people in recovery, learning and practicing healthy means to self-regulate mood and physiological state is an urgent need.
Stabilizing Emotions for Recovery
Stabilization is a central principle of addiction relapse prevention. It involves establishing a balanced and health-promoting routine that includes appropriate nutrition, physical exercise, and rest, along with recovery-focused activities, work, family life and leisure. The first stage of recovery from trauma is often termed “safety and stabilization,” and is a vital foundation for the eventual work of processing and releasing traumatic memories. For the person recovering from both trauma and addiction, stabilization has an internal as well as an external component. Along with the balanced lifestyle, a trauma survivor must learn how to pay on-going attention to their internal state.
It can be extremely helpful for a traumatized person to become aware of the specific symptoms they were seeking to regulate through their addiction. Someone who had been drinking to get to sleep can focus on sleep hygiene to begin creating a sense of safety and stability. A person who has been on a roller coaster of anxious hyperarousal followed by depressed lethargy can prioritize the learning of methods to bring down the highs and bring up the lows. And if intrusive memories and images have been haunting or flooding the person’s mind, then she or he can focus on techniques for mindfully containing the images, without numbing or fearfully seeking to suppress them. Thankfully, there are methods available that can, with determined practice, effectively address the full range of trauma symptoms.
A fundamental practice for anyone seeking to recover from the suffering of concurrent trauma and addiction is to use tension reducing methods to regulate the nervous system. These techniques also help people to gradually become re-acquainted with, and accepting of their internal states, both positive and negative. A few of the most beneficial are gentle, mindful breathing, progressive muscle relaxation, specific types of soothing imagery, listening deeply to calming music, walking outdoors at a relaxed pace, and engaging in mutually nurturing social interaction and connectedness.
Recovery from the combination of trauma and addiction is absolutely possible. For as long as there have been mood altering substances, mood-altering behaviours, and human beings experiencing the trials of living, it is probable that the two conditions have been afflicting people; but recovery has also been occurring. Certainly, since Alcoholics Anonymous began in the mid-1930s, many addicted people with trauma have succeeded in regaining health and a satisfying way of life.
However, this does not mean that such recovery is easily achieved, nor has there has been a 100% success rate. As more effort has been devoted to understanding the interaction between trauma and addiction, we’ve come to understand how challenging the work of recovery can be. At the same time, a much wider array of approaches has emerged for responding to the challenges. The simple good news for complicated people is that anyone entering into recovery can learn techniques to manage traumatic emotions and memories – and physical arousal and tension – in a way that the addiction never could. While it takes a lot of work to recover from trauma and addiction, there is a very thorough set of tools at our disposal.
Originally published in the Fall 2012 issue of Moods Magazine, www.moodsmag.com.
- Statistics Canada, General Social Survey 1998
- O’Brien JM, Addiction and Trauma, Presented at the 3rd Annual Co-Occurring Disorders Institute, University of Maine at Augusta, 2011, citing Back et al, 2000
- O’Brien JM. Addiction and Trauma. Presented at the 3rd Annual Co-Occurring Disorders Institute, University of Maine at Augusta, 2011, citing Cottler et al, 2001, & Kessler et al, 1995. [Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry. 1995 Dec;52(12):1048-60.]
- Van der Kolk, BA, Fisler, RE. Childhood abuse and neglect and loss of self-regulation. Bulletin of the Menninger Clinic. 1994 Spring;58(2):145-68
- Janina Fisher, Addictions and Trauma Recovery, Paper presented at the International Society for the Study of Dissociation. San Antonio, Texas, November 13, 2000